Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
EDECRIN vs DEMADEX
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Ethacrynic acid inhibits the Na-K-Cl cotransporter (NKCC2) in the thick ascending limb of the loop of Henle, reducing reabsorption of sodium, chloride, and potassium, leading to diuresis.
Inhibits the Na-K-2Cl symporter in the thick ascending limb of the loop of Henle, reducing reabsorption of sodium, chloride, and potassium, leading to increased urine output.
Treatment of edema associated with congestive heart failure, cirrhosis, and renal disease,Treatment of hypertension (off-label),Treatment of ascites (off-label),Management of hypercalcemia (off-label)
Edema associated with heart failure, hepatic cirrhosis, and renal disease,Hypertension (off-label)
Oral: 50-100 mg once or twice daily, maximum 400 mg/day. IV: 50 mg (0.5 mg/kg) once, may repeat once at 2-hour intervals if needed.
Oral: 5-10 mg once daily; may increase to 20 mg once daily if needed. IV: 5-10 mg once daily; may increase to 20 mg once daily if needed. Maximum dose: 40 mg/day.
Terminal elimination half-life is 2-4 hours; prolonged in renal impairment (up to 30 hours) and in heart failure.
The terminal elimination half-life is approximately 4 hours (range 2-8 hours) in patients with normal renal function. In renal impairment (creatinine clearance <30 m L/min), half-life is prolonged to 10-12 hours due to reduced renal clearance. In hepatic cirrhosis, half-life may be extended to 8-9 hours due to decreased metabolism.
Metabolized primarily in the liver, with approximately 30% excreted unchanged in urine and the remainder as metabolites, including the cysteine conjugate.
Primarily hepatic via CYP450 enzymes, with minimal renal clearance.
Approximately 60-70% excreted unchanged in urine via glomerular filtration and tubular secretion; remaining 30-40% eliminated via biliary/fecal route.
Approximately 50% of the absorbed dose is excreted unchanged in the urine via glomerular filtration and active tubular secretion. The remainder undergoes hepatic metabolism to glucuronide conjugates and minor oxidative metabolites, with biliary excretion of metabolites (about 30-40% of the dose) eliminated in feces. Renal clearance is the primary route for the parent drug.
Approximately 95-98% bound, primarily to albumin.
Torsemide (DEMADEX) is extensively bound to plasma proteins, primarily albumin, with a protein binding of >99%.
0.4-0.8 L/kg; reflects distribution primarily into extracellular fluid.
The apparent volume of distribution (Vd) is approximately 0.16 L/kg (range 0.12–0.20 L/kg), indicating distribution primarily within extracellular fluid. Vd is increased in conditions with expanded extracellular volume (e.g., heart failure, cirrhosis, nephrotic syndrome).
Oral: approximately 50-70% due to first-pass metabolism; Intravenous: 100%.
Oral bioavailability is approximately 80–90%, with minimal first-pass metabolism. Absorption is rapid and not significantly affected by food.
GFR 10-50 m L/min: 50% of normal dose. GFR <10 m L/min: not recommended or use with extreme caution.
GFR <20 m L/min/1.73 m²: Use with caution; may require dose reduction or discontinuation due to accumulation. GFR 20-50: No adjustment needed. GFR >50: No adjustment.
Child-Pugh A: no adjustment. Child-Pugh B: reduce dose by 50%. Child-Pugh C: contraindicated.
Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50% or extend interval. Child-Pugh C: Avoid use or reduce dose by 75%.
Oral: 1-3 mg/kg/day in 1-2 divided doses. IV: 1 mg/kg/dose, maximum 50 mg/dose.
Neonates and infants: 0.1-0.2 mg/kg/dose IV/IM once daily. Children: Oral: 0.5-1 mg/kg once daily; IV/IM: 0.1-0.2 mg/kg/dose once daily. Maximum: 5 mg/day.
Start at lowest dose (25-50 mg oral daily) due to increased risk of electrolyte disturbances and hypotension.
Start at lower end of dose range (2.5-5 mg orally once daily); titrate slowly due to increased sensitivity and renal impairment risk.
WARNING: EDECRIN is a potent diuretic which, if given in excessive amounts, can lead to profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose and dose schedule must be adjusted to the individual patient's needs.
None.
Ototoxicity: Risk of hearing loss, especially with rapid IV administration or in patients with renal impairment; avoid concurrent use with other ototoxic drugs.,Volume and electrolyte depletion: Profound diuresis leading to dehydration, hypokalemia, hyponatremia, hypochloremia, and metabolic alkalosis.,Hypersensitivity reactions: Rash, eosinophilia, and anaphylaxis.,Gastrointestinal disturbances: Nausea, vomiting, diarrhea, and gastrointestinal bleeding (rare).,Hyperuricemia may precipitate gout.,Use with caution in patients with hepatic cirrhosis due to risk of hepatic encephalopathy.
Hypotension and volume depletion,Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia),Ototoxicity (especially with rapid IV administration or high doses),Hyperuricemia,Sulfonamide allergy cross-reactivity
Anuria,Hypersensitivity to ethacrynic acid or any component of the formulation,Severe electrolyte depletion (e.g., hypokalemia, hyponatremia) until corrected,Concurrent use with other ototoxic agents (relative contraindication)
Anuria,Severe electrolyte depletion,Hypersensitivity to sulfonamides or bumetanide (Demadex is a sulfonamide derivative)
Avoid excessive intake of high-sodium foods as they can counteract the diuretic effect. Grapefruit juice may increase the risk of ototoxicity; consumption should be limited. Alcohol can exacerbate hypotension and dehydration. Ensure adequate potassium intake through diet (e.g., bananas, oranges) unless directed otherwise by a healthcare provider.
Avoid excessive licorice intake (glycyrrhizin) as it can exacerbate hypokalemia. Limit sodium-rich foods (processed foods, canned soups) to enhance diuretic effect and control edema. Increase potassium-rich foods (bananas, oranges, potatoes) unless on a potassium-sparing medication. Avoid grapefruit juice as it may affect metabolism.
EDECRIN (ethacrynic acid) is classified as FDA Pregnancy Category B. Limited human data; animal studies have not demonstrated teratogenic effects. However, diuretic use during pregnancy may reduce placental perfusion. Fetal risks include electrolyte disturbances, volume depletion, and possible growth restriction. Use only if clearly needed.
DEMADEX (torsemide) is a loop diuretic. Human data are limited. In animal studies, high doses caused fetal resorptions and maternal toxicity. First trimester: insufficient human data; avoid unless benefit outweighs risk. Second/third trimester: risk of fetal oligohydramnios, renal impairment, and hypovolemia; use only if clearly needed.
It is not known if ethacrynic acid is excreted in human milk. Due to potential adverse effects in the nursing infant, such as electrolyte imbalance, caution is advised. The manufacturer recommends discontinuing nursing or the drug, taking into account the importance of the drug to the mother. M/P ratio is unknown.
Torsemide is excreted in breast milk in small amounts; M/P ratio not reported. Due to potential for diuresis, electrolyte imbalance, and allergic reactions in the infant, caution is recommended. Alternative diuretics with more safety data are preferred.
Pregnancy may alter pharmacokinetics; however, no specific dose adjustments have been established. Use lowest effective dose and shortest duration. Monitor for hypovolemia and electrolyte imbalances, which may be more pronounced in pregnancy.
Dosing may need adjustment due to increased plasma volume and GFR in pregnancy. Start at lowest effective dose. Monitor diuretic response and electrolyte balance; dose titration may be required. Postpartum, drug elimination may return to prepregnancy kinetics.
EDECRIN (ethacrynic acid) is a potent loop diuretic that, unlike furosemide, is not a sulfonamide and can be used in patients with sulfonamide allergy. It can cause ototoxicity that is often irreversible, especially when given rapidly IV or with other ototoxic drugs like aminoglycosides. Monitor for hypokalemia, hypomagnesemia, and volume depletion. Use with caution in patients with hepatic cirrhosis due to risk of electrolyte-induced encephalopathy.
DEMADEX (torsemide) is a loop diuretic with high bioavailability (80-100%) and a longer half-life (3-4 hours) than furosemide, allowing once-daily dosing. It is primarily metabolized by CYP2C9, so caution is needed with CYP2C9 inhibitors like amiodarone. Monitor for ototoxicity at high doses or rapid infusion. Hypokalemia risk persists; consider potassium supplementation or aldosterone antagonist. Use cautiously in sulfonamide allergy due to potential cross-sensitivity.
Take this medication exactly as prescribed, usually once or twice daily.,Avoid alcohol and limit salt intake to reduce fluid retention.,Weigh yourself daily and report rapid weight gain or loss to your doctor.,Stand up slowly from sitting or lying down to prevent dizziness from low blood pressure.,Notify your doctor immediately if you experience hearing loss, ringing in the ears, or dizziness.,This drug may increase blood sugar; monitor if you have diabetes.,Avoid taking with other ototoxic medications like certain antibiotics without doctor approval.
Take DEMADEX exactly as prescribed, usually once daily in the morning to avoid nighttime urination.,Weigh yourself daily and report sudden weight gain or loss of more than 2-3 pounds in a day.,Avoid alcohol and beverages containing caffeine as they may increase dehydration.,Do not take DEMADEX with licorice (which can worsen hypokalemia) or with high-sodium antacids.,Report signs of hearing loss, ringing in the ears, dizziness, or muscle cramps immediately.,Stand up slowly to prevent dizziness from low blood pressure.,Monitor for signs of dehydration: dry mouth, thirst, infrequent urination.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about EDECRIN vs DEMADEX, answered by our medical review team.
EDECRIN is a Loop Diuretic that works by Ethacrynic acid inhibits the Na-K-Cl cotransporter (NKCC2) in the thick ascending limb of the loop of Henle, reducing reabsorption of sodium, chloride, and potassium, leading to diuresis.. DEMADEX is a Loop Diuretic that works by Inhibits the Na-K-2Cl symporter in the thick ascending limb of the loop of Henle, reducing reabsorption of sodium, chloride, and potassium, leading to increased urine output.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between EDECRIN and DEMADEX depend on the specific clinical indication. These are both Loop Diuretic agents and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of EDECRIN is: Oral: 50-100 mg once or twice daily, maximum 400 mg/day. IV: 50 mg (0.5 mg/kg) once, may repeat once at 2-hour intervals if needed.. The standard adult dose of DEMADEX is: Oral: 5-10 mg once daily; may increase to 20 mg once daily if needed. IV: 5-10 mg once daily; may increase to 20 mg once daily if needed. Maximum dose: 40 mg/day.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between EDECRIN and DEMADEX in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. EDECRIN is classified as Category C. EDECRIN (ethacrynic acid) is classified as FDA Pregnancy Category B. Limited human data; animal studies have not demonstrated teratogenic effects. However, diuretic use during preg. DEMADEX is classified as Category C. DEMADEX (torsemide) is a loop diuretic. Human data are limited. In animal studies, high doses caused fetal resorptions and maternal toxicity. First trimester: insufficient human da. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.