Names and pronunciation
(eth-uh-KRIH′nayt) Edecrin
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Drug reference
(eth-uh-KRIH′nayt) Edecrin
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Func. class.: Diuretic
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Chem. class.: Loop diuretic ACTIONS: Primarily acts to inhibit the reabsorption of sodium and chloride in the ascending limb of the loop of Henle
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USES: Treatment of peripheral edema (idio- pathic edema, lymphedema, or edema secondary to ascites, heart failure, or nephrotic syndrome)
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CONTRAINDICATIONS Hypersensitivity, acute myocardial infarc- tion, anuria, breastfeeding, heart failure, E pregnancy, renal failure Precautions: Acid/base imbalance, breastfeeding, children, dehydration, dia- betes mellitus, diarrhea, electrolyte imbal- ance, geriatric, gout, hearing impairment, hepatic disease, hepatic encephalopathy, hyperaldosteronism, hyperglycemia, hyperglycemia, hyperuricemia, hypocalce- mia, hypochloremia, hypokalemia, hypo- magnesemia, hypotension, hypovolemia, infants, metabolic alkalosis, orthostatic hypotension, pancreatitis, pregnancy, renal disease, renal failure, sympathec- tomy, syncope, systemic lupus erythemato- sus (SLE), ventricular arrhythmias
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SIDE EFFECTS CNS: Headache, confusion, fatigue, anxi- ety, vertigo, syncope GI: Anorexia, GI bleeding, diarrhea, jaundice, nausea, pancreatitis, vomiting, increased LFTs HEMA: Agranulocytosis, thrombocytope- nia, neutropenia GU: Azotemia, hematuria, polyuria, oliguria EENT: Blurred vision, hearing loss CV: Orthostatic hypotension, hypovole- mia, tinnitus META: Hyperglycemia, hyperuricemia, hypocalcemia, hypochloremia, hypo- kalemia, hypomagnesemia, hyponatre- mia MISC: Fever, chills, injection site reac- tion, muscle cramps, rash
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INTERACTIONS Increase: ototoxic effect—aminoglyco- sides, antibiotics, CISplatin Increase: hypotension—antihypertensives Increase: digoxin toxicity—cardiac glycosides, monitor drug level of di- goxin Increase: diuresis—thiazides Increase: toxicity—lithium Decrease: hypoglycemic effects—antidi- abetics Decrease: diuresis—NSAIDs Drug/Herb Increase: effect—hawthorn, horse chestnut Decrease: effect of bumetanide—gin- seng, ephedra Drug/Lab Increase: glucose Decrease: chloride, potassium, sodium, calcium, phosphorus NURSING CONSIDERATIONS
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Black Box Warning: Dehydration: weight, I&O daily to determine fluid loss; if urinary output decreases or azotemia occurs, prod- uct should be discontinued; safest dosage schedule is alternate days • B/P lying, standing; postural hypoten- sion may occur Black Box Warning: Fluid and electrolyte depletion: potassium, sodium, calcium; in- clude BUN, blood glucose, CBC, serum cre- atinine, blood pH, ABGs, uric acid, calcium, magnesium; severe electrolyte depletion should be corrected prior to starting treat- ment • Blood glucose if patient is diabetic; blood uric acid levels in those with gout • Improvement in edema of feet, legs, sacral area daily if medication is being used for HF • Signs of metabolic alkalosis: drowsi- ness, restlessness • Hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness • Rashes, temperature elevation daily • Confusion, especially in geriatric pa- tients; take safety precautions if needed • Digoxin toxicity in patients taking di- goxin products: anorexia, nausea, vom- iting, confusion, paresthesia, muscle cramps; lithium toxicity in those taking lithium • Beers: use cautiously in older adults; may cause or exacerbate syndrome of inap- propriate antidiuretic hormone secretion
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DOSAGE AND ROUTES • Adults: PO initially, 50 to 100 mg/day divided once or twice daily. May increase by 25 to 50 mg/day, max dosage is 200 mg bid; IV initially, 50 mg or 0.5 to 1 mg/ kg, usually 1 dose is sufficient • Children and adolescents: PO initially, 1 mg/kg daily, may increase up to 3 mg/ kg/day, adjust dosage at intervals of 2 to 3 days • Children and adolescents (unla- beled): IV initially, 1 mg/kg daily
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Available forms: Tablets 25 mg; injec- tion 50 mg/vial Administer PO route • Administer after meals IV route • Do not administer SUBCUT or IM be- cause of local pain and irritation • Reconstitute vial containing etha crynate sodium equivalent to 50 mg of ethacrynic acid by adding 50 mL of 5% dextrose injection or 0.9% sodium chloride injection. The resulting IV so- lution contains the equivalent of 1 mg/ mL of ethacrynic acid. If 5% dextrose injection with a pH ≤5 is used, a hazy or opalescent solution may develop and should not be used • Infuse slowly IV over 20-30 min through freely running IV infusion or in- ject directly over several min
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Assess: • For tinnitus, hearing loss, ear pain; obtain audiometric testing for long-term IV treatment
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Evaluate: • Therapeutic response: decreased edema, B/P
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Patient and caregiver information: • To increase fluid intake to 2-3 L/day unless contraindicated; to take potas- sium supplement; to rise slowly from ly- ing or sitting position • To recognize adverse reactions: mus- cle cramps, weakness, nausea, dizziness, edema, weight gain • To take with food, milk for GI symp- toms; to avoid alcohol • To take early in day to prevent noctu- ria; if another dose is needed, take after noon, not to double or miss dose • To take B/P, pulse, weight weekly • That orthostatic hypotension may oc- cur, to avoid rising rapidly • To continue other medical regimens • Pregnancy/breastfeeding: to report if pregnancy is planned or suspected or if breastfeeding • That continuing exams and blood work will be needed • To notify other health care profession- als of condition being treated, medica- tions taken TREATMENT OF OVERDOSE: Lavage if taken orally; monitor electro- lytes; administer dextrose in saline; mon- itor hydration, CV, renal status
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PHARMACOKINETICS PO: Onset 30 min, peak 2 hr, duration 6-8 hr IV: Onset rapid, peak 15-30 min, dura- tion 2 hr Half-life: 2-4 hr
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• Adults: PO initially, 50 to 100 mg/day divided once or twice daily. May increase by 25 to 50 mg/day, max dosage is 200 mg bid; IV initially, 50 mg or 0.5 to 1 mg/ kg, usually 1 dose is sufficient
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• Children and adolescents: PO initially, 1 mg/kg daily, may increase up to 3 mg/ kg/day, adjust dosage at intervals of 2 to 3 days
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• Children and adolescents (unla- beled): IV initially, 1 mg/kg daily
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