Loop diuretics etacrynic acid

The loop diuretics increase the renal excretion of lithium after single-dose intravenous administration in both animals (711) and man (712). Furosemide has been used to treat lithium intoxication (713). The effect of etacrynic acid is larger than those of furosemide and bumetanide (712). However, long-term treatment with furosemide and bumetanide can cause lithium intoxication in some patients (714,715), perhaps by causing sodium depletion and a secondary increase in lithium reabsorption. An adverse interaction of lithium during long-term therapy with etacrynic acid is therefore theoretically likely. 

Etacrynic acid, especially in combination with spironolactone and xipamide, markedly enhances natriuresis and diuresis. The dosage is increased as required (e.g. 1 X 25 mg or 50 mg to 2 x 50 mg per day). With a low-dose application in the form of a combined diuretic therapy, there is usually no risk of hepatic encephalopathy developing. The effect of etacrynic acid sets in at the ascending branch of the loop of Henle (active chloride transport). Renovascular resistance is lowered due to enzymatic activity, presumably as a result of a rise in the release of prostaglandin. 

Among the agents that promote the nephrotoxic effects of the aminoglycosides, the loop diuretics furosemide and etacrynic acid are often mentioned. However, this... 

Nausea, abdominal pain (22), and diarrhea are relatively common with etacrynic acid (23,24), more so than with other loop diuretics. Data from the Boston Drug Surveillance Program showed that intravenous etacrynic acid was associated with an increased incidence of gastrointestinal bleeding (25,26). Overall 20% of the patients treated with etacrynic acid bled, compared with 5% of those who received furosemide. With intravenous etacrynic acid the risk of gastrointestinal hemorrhage was 26%, compared with 10% after oral administration. However, 12 of 28 patients who bled did so before etacrynic acid had been given (27), and it is not clear whether there is a true difference in risk with the different routes of administration. 

The loop diuretics increase the renal excretion of lithium after single-dose intravenous administration in both animals (40) and man (41). Furosemide has been used to treat lithium intoxication (42). The effect of etacrynic acid... 

Aminoglycosides or etacrynic acid alone can damage the ear and cause deafness, the site of action of the aminoglycosides being the hair cell and that of etacrynic acid the stria vascularis. Other loop diuretics can similarly damage hearing. 

The loop diuretics, bumetanide, furosemide and torasemide, the potassium-sparing diuretic spironolactone, and the thiazides chlortalidone and chlorothiazide, have all been shown either not to interact or to cause only a small reduction in the effects of the coumarin anticoagulants of minimal or no clinical importance. The lack of reports of clinically relevant interactions su ests that, in general, diuretics do not interact with anticoagulants. The possible exception is etacrynic acid, which on rare occasions has caused a marked increase in the effects of warfarin. 

Loop diuretics Bumetanide, Etacrynic acid, Furosemide, Rretanide, Torasemide... 

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