EDECRIN

Clinical safety rating: caution

Comprehensive clinical and safety monograph for EDECRIN (EDECRIN).

How it works

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.

What the body does with it

Metabolism	Metabolized primarily in the liver, with approximately 30% excreted unchanged in urine and the remainder as metabolites, including the cysteine conjugate.
Excretion	Approximately 60-70% excreted unchanged in urine via glomerular filtration and tubular secretion; remaining 30-40% eliminated via biliary/fecal route.
Half-life	Terminal elimination half-life is 2-4 hours; prolonged in renal impairment (up to 30 hours) and in heart failure.
Protein binding	Approximately 95-98% bound, primarily to albumin.
Volume of Distribution	0.4-0.8 L/kg; reflects distribution primarily into extracellular fluid.
Bioavailability	Oral: approximately 50-70% due to first-pass metabolism; Intravenous: 100%.
Onset of Action	Oral: 30-60 minutes; Intravenous: 5-15 minutes.
Duration of Action	Oral: 6-8 hours; Intravenous: 2-4 hours; diuresis may persist up to 12 hours with dehydration risk.

Classification & Brands

Dosing & administration

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.

Dosage form	INJECTABLE
Renal impairment	GFR 10-50 mL/min: 50% of normal dose. GFR <10 mL/min: not recommended or use with extreme caution.
Liver impairment	Child-Pugh A: no adjustment. Child-Pugh B: reduce dose by 50%. Child-Pugh C: contraindicated.
Pediatric use	Oral: 1-3 mg/kg/day in 1-2 divided doses. IV: 1 mg/kg/dose, maximum 50 mg/dose.
Geriatric use	Start at lowest dose (25-50 mg oral daily) due to increased risk of electrolyte disturbances and hypotension.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for EDECRIN (EDECRIN).

Breastfeeding	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.
Teratogenic Risk	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.

Warnings & precautions

■ FDA Black Box Warning

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.

Side Effect Profile

Serious Effects

Absolute Contraindications

["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)"]

Clinical Precautions

Precautions

["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."]

Clinical Tips & Counseling

Drug interactions

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EDECRIN

Clinical safety rating: caution

Comprehensive clinical and safety monograph for EDECRIN (EDECRIN).

How it works

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.

What the body does with it

Metabolism	Metabolized primarily in the liver, with approximately 30% excreted unchanged in urine and the remainder as metabolites, including the cysteine conjugate.
Excretion	Approximately 60-70% excreted unchanged in urine via glomerular filtration and tubular secretion; remaining 30-40% eliminated via biliary/fecal route.
Half-life	Terminal elimination half-life is 2-4 hours; prolonged in renal impairment (up to 30 hours) and in heart failure.
Protein binding	Approximately 95-98% bound, primarily to albumin.
Volume of Distribution	0.4-0.8 L/kg; reflects distribution primarily into extracellular fluid.
Bioavailability	Oral: approximately 50-70% due to first-pass metabolism; Intravenous: 100%.
Onset of Action	Oral: 30-60 minutes; Intravenous: 5-15 minutes.
Duration of Action	Oral: 6-8 hours; Intravenous: 2-4 hours; diuresis may persist up to 12 hours with dehydration risk.

Classification & Brands

Dosing & administration

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.

Dosage form	INJECTABLE
Renal impairment	GFR 10-50 mL/min: 50% of normal dose. GFR <10 mL/min: not recommended or use with extreme caution.
Liver impairment	Child-Pugh A: no adjustment. Child-Pugh B: reduce dose by 50%. Child-Pugh C: contraindicated.
Pediatric use	Oral: 1-3 mg/kg/day in 1-2 divided doses. IV: 1 mg/kg/dose, maximum 50 mg/dose.
Geriatric use	Start at lowest dose (25-50 mg oral daily) due to increased risk of electrolyte disturbances and hypotension.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for EDECRIN (EDECRIN).

Breastfeeding	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.
Teratogenic Risk	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.