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Etacrynic acid (INN) or ethacrynic acid (USAN), trade name Edecrin, is a loop diuretic used to treat high blood pressure and the swelling caused by diseases like congestive heart failure, liver failure, and kidney failure.
Ethacrynic acid is sold in 25 mg and 50 mg tablets for oral use. The sodium salt (ethacrynate sodium) can also be given intravenously. The IV solution must be prepared and maintained with a pH above 5.
As a diuretic, ethacrynic acid can cause frequent urination, but this usually resolves after taking the drug for a few weeks.
Ethacrynic acid can also cause low potassium levels, which may manifest as muscle cramps or weakness. It has also been known to cause reversible or permanent hearing loss(ototoxicity) and liver damage when administered in extremely high dosages. On oral administration, it produces diarrhea; intestinal bleeding may occur at higher doses.
Mechanism of action
Ethacrynic acid acts by inhibiting sodium-potassium-chloride cotransport in the ascending loop of Henle. Loss of potassium ions is less marked but chances of hypochloremic alkalosis are greater. The dose response curve of ethacrynic acid is steeper than that of furosemide and, in general, it is less manageable; dose range is 50-150mg.
Ethacrynic acid and its glutathione-adduct are potent inhibitors of glutathione S-transferase family members, which are enzymes involved in xenobiotic metabolism. This family of enzymes has recently been shown to have a high rate of genetic variability.
- Somberg JC, Molnar J; Molnar (January 2009). "The Pleiotropic Effects of Ethacrynic Acid". Am J Ther 16 (1): 102–4. doi:10.1097/MJT.0b013e3181961264. PMID 19142157.
- Bosher SK (1980). "The nature of the ototoxic actions of ethacrynic acid upon the mammalian endolymph system. I. Functional aspects". Acta Otolaryngol. 89 (5–6): 407–18. doi:10.3109/00016488009127156. PMID 7446061.
- Datey, KK; Deshmukh, SN; Dalvi, CP; Purandare, NM (1967). "Hepatocellular damage with ethacrynic acid". Br. Med. J. 3 (5558): 152–153. doi:10.1136/bmj.3.5558.152. PMC 1842848. PMID 6028103.
- Schultz, E. M.; Cragoe Jr, E. J.; Bicking, J. B.; Bolhofer, W. A.; Sprague, J. M. (1962). "Alpha, Beta-Unsaturated Ketone Derivatives of Aryloxyacetic Acids, A New Class of Diuretics". Journal of medicinal and pharmaceutical chemistry 91: 660–2. PMID 14056400.