Etakrinovaya acid - instructions for use, dose, side effects, contraindications

Clinical and pharmacological group: & nbsp

Diuretics

Included in the formulation

Uregit®

pills inwards

EGIS ZAO Pharmaceutical Plant Hungary

АТХ:

C.03.C.C.01 Ethcarinic acid

Pharmacodynamics:

"Loopback" diuretic, a derivative of dichlorophenoxyacetic acid. Has a pronounced diuretic effect, increases urinary excretion of sodium, chlorine, potassium, magnesium and calcium ions. The mechanism of action is associated with inhibition of reabsorption of ions and water in the thick segment of the ascending section of the Henle loop, as well as in the proximal convoluted tubule. Does not affect the activity of carbonic anhydrase, does not increase the secretion of bicarbonates. Reduces systemic blood pressure. After a single oral intake diuretic effect begins in 20-40 minutes, reaches a maximum after 1-2 hours and lasts 6-9 hours.

Pharmacokinetics:

After oral administration ethacrynic acid quickly absorbed from the digestive tract. The binding with plasma proteins is high. Metabolised in the liver. Half-lifeis 30-60 minutes. It is excreted in the urine and through the intestine in unchanged form and in the form of metabolites.

Indications:

Ocular syndrome of various genesis: chronic heart failure of IIB-III degree, cirrhosis (portal hypertension syndrome), nephrotic syndrome; edema of the lungs, cerebral edema; arterial hypertension (as part of combination therapy).

ICD-10

IX.I10-I15.I15.0 Renovascular hypertension

IX.I10-I15.I15 Secondary Hypertension

IX.I10-I15.I10 Essential [primary] hypertension

XVIII.R50-R69.R60 Edema, not elsewhere classified

X.J80-J84.J81 Pulmonary edema

VI.G90-G99.G93.6 Edema of the brain

IX.I30-I52.I50.0 Congestive heart failure

XI.K70-K77.K74 Fibrosis and cirrhosis of the liver

XIV.N00-N08.N04 Nephrotic syndrome

Contraindications:

Hypersensitivity, acute glomerulonephritis, pre- and comatose states against a background of severe renal and / or hepatic insufficiency, anuria, severe water-electrolyte and acid-base balance disorders (hypokalemia, alkalosis), hyperuricemia, hearing impairment in the background of auditory nerve neuritis, acute myocardial infarction myocardium, diabetes mellitus, pregnancy, breast-feeding, early childhood (up to 2 years).

Carefully:

Therapy with digitalis preparations, severe diarrhea, terminal stage of chronic heart failure, nephropathy with hypokalemia, hyperaldosteronism with normal kidney function, systemic lupus erythematosus, ventricular arrhythmia, gout and acute pancreatitis in the anamnesis.

Be wary of cirrhosis of the liver.

Older patients sometimes require lower doses.

Pregnancy and lactation:

The use of ethacrynic acid is contraindicated in pregnancy and during breastfeeding.

Dosing and Administration:

When administered orally for adults, the initial dose is 50 mg, the frequency of admission - 1-2 times a day. The scheme of maintenance therapy is established individually. The maximum daily dose is 200 mg.

For children, the initial dose is 25 mg. It is not recommended to administer intravenously to children.

With intravenous administration for adults, a single dose is 0.5-1 mg / kg.

Side effects:

From the side digestive system: anorexia, nausea, vomiting, abdominal pain, diarrhea; rarely acute pancreatitis.

From the side water-electrolyte balance: hypochloremia, hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, dehydration, metabolic alkalosis.

From the side of cardio-vascular system: in some cases - orthostatic hypotension, tachycardia, heart rhythm disturbances.

Other: ototoxic effect, dizziness, headache, muscle weakness.

Overdose:

Symptoms: pronounced disturbances of water-electrolyte metabolism (hypokalemia, hypochloraemia, hypovolemia), metabolic alkalosis, arterial hypotension, arrhythmia.

Treatment: gastric lavage, administration of drugs,Correcting acid-base balance (potassium preparations); if necessary, resuscitation measures to restore respiratory function and cardiovascular system.

Interaction:

When the group of aminoglycosides (including gentamycin, kanamycin, streptomycin, neomycin) is used together with antibiotics, it is possible to enhance the ototoxic effect as a result of the additive effect (especially in patients with renal insufficiency), an increased risk of developing nephrotoxic action.

With simultaneous application with beta-agonists (including with fenoterol, terbutaline, salbutamol), hypokalemia may be increased.

With simultaneous application with beta-blockers, hydralazine, verapamil, nifedipine, captopril, clonidine, methyldopa, octadine, prazosin, reserpine, the antihypertensive effect is enhanced.

With simultaneous use with ganglioblokatorami orthostatic hypotension is possible.

With simultaneous application with potassium-sparing diuretics, the diuretic effect increases, hypokalemia and hypomagnesemia decrease.

When used simultaneously with glucocorticosteroids, hypokalemia is increased, and the antihypertensive effect of ethacrynic acid decreases.

When used simultaneously with non-steroidal anti-inflammatory agents, it is possible to reduce the effects of ethacrynic acid.

With the simultaneous use of drugs, intensely binding to blood plasma proteins (warfarin, clofibrate) may increase diuretic effect and hypokalemia, because as a result of competition for binding to plasma proteins, the concentration of free (active) ethacrynic acid increases.

With simultaneous use with laxatives, pronounced dehydration is possible, a decrease in the content of sodium, potassium and magnesium in the body.

When used simultaneously with drugs that cause urine acidification, it is possible to enhance the effects of ethacrynic acid.

With the simultaneous use of astemizole, the risk of arrhythmia increases.

With the simultaneous use of vancomycin, oto- and nephrotoxicity may be enhanced.

With simultaneous application with cephalosporins, an increased risk of developing nephrotoxic effects of cephalosporins is possible.

With simultaneous use with tetracyclines, the concentration of urea in the blood increases, which is especially dangerous in renal failure.

With simultaneous application with cisapride, hypokalemia may be increased.

Special instructions:

During the period of treatment, it is necessary to conduct regular monitoring of the electrolyte content in blood plasma, to eat foods rich in potassium, if necessary, to prescribe potassium preparations.

With the development of diarrhea or symptoms of dehydration treatment should be discontinued.

It is not recommended to administer intravenously to children.

In the initial, individually defined period of treatment, driving vehicles and other potentially dangerous activities that require fast psychomotor reactions are contraindicated. Further, the degree of restriction depends on the patient's tolerance to ethacrynic acid.

Instructions

Ethcarinic acid (Acidum aethacrynicum)