ETHACRYNIC ACID

Fetal Risk Summary

Ethacrynic acid is a potent diuretic. It has been used for toxemia, pulmonary edema, and diabetes insipidus during pregnancy (1,2,3,4,5,6,7,8,9 and 10).

Reproduction studies in mice and rabbits at doses up to 50 times the human dose showed no evidence of external malformations (11). Doses of 10 or 2.5 times the human dose in rats and dogs, respectively, did not impair fertility or growth and development of pups (11). Intrauterine growth retardation was observed in the offspring of rats at a dose 50 times the human dose, but there was no effect on survival or postnatal development (11).

Although limited 1st trimester human experience has not shown an increased incidence of malformations, ethacrynic acid is not recommended for use in pregnant women (12). Diuretics do not prevent or alter the course of toxemia, but they may decrease placental perfusion (see also Chlorothiazide) (13,14 and 15). In general, diuretics are not recommended for the treatment of pregnancy-induced hypertension because of the maternal hypovolemia characteristic of this disease.

Ototoxicity has been observed in a mother and her newborn following the use of ethacrynic acid and kanamycin during the 3rd trimester (see also Kanamycin) (16).

[*Risk Factor D if used in pregnancy-induced hypertension.]

Breast Feeding Summary

No reports describing the use of ethacrynic acid during lactation have been located (see also Chlorothiazide). The manufacturer recommends that ethacrynic acid not be used in nursing mothers (11).

References

1. Delgado Urdapilleta J, Dominguez Robles H, Villalobos Roman M, Perez Diaz A. Ethacrynic acid in the treatment of toxemia of pregnancy. Ginecol Obstet Mex 1968;23:271–80.
2. Felman D, Theoleyre J, Dupoizat H. Investigation of ethacrynic acid in the treatment of excessive gain in weight and pregnancy arterial hypertension. Lyon Med 1967;217:1421–8.
3. Sands RX, Vita F. Ethacrynic acid (a new diuretic), pregnancy, and excessive fluid retention. Am J Obstet Gynecol 1968;101:603–9.
4. Kittaka S, Aizawa M, Tokue I, Shimizu M. Clinical results in Edecril tablet in the treatment of toxemia of late pregnancy. Obstet Gynecol (Jpn) 1968;36:934–7.
5. Mahon R, Dubecq JP, Baudet E, Coqueran J. Use of Edecrin in obstetrics. Bull Fed Soc Gynecol Obstet Lang Fr 1968;20:440–2.
6. Imaizumi S, Suzuoki Y, Torri M, et al. Clinical trial of ethacrynic acid (Edecril) for toxemia of pregnancy. Jpn J Med Consult New Remedies 1969;6:2364–8.
7. Young BK, Haft JI. Treatment of pulmonary edema with ethacrynic acid during labor. Am J Obstet Gynecol 1970;107:330–1.
8. Harrison KA, Ajabor LN, Lawson JB. Ethacrynic acid and packed-blood-cell transfusion in treatment of severe anaemia in pregnancy. Lancet 1971;1:11–4.
9. Fort AT, Morrison JC, Fisk SA. Iatrogenic hypokalemia of pregnancy by furosemide and ethacrynic acid: two case reports. J Reprod Med 1971;6:21–2.
10. Pico I, Greenblatt RB. Endocrinopathies and infertility. IV. Diabetes insipidus and pregnancy. Fertil Steril 1969;20:384–92.
11. Product information. Edecrin. Merck, 2000.
12. Wilson AL, Matzke GR. The treatment of hypertension in pregnancy. Drug Intell Clin Pharm 1981;15:21–6.
13. Pitkin RM, Kaminetzky HA, Newton M, Pritchard JA. Maternal nutrition: a selective review of clinical topics. Obstet Gynecol 1972;40:773–85.
14. Lindheimer MD, Katz AI. Sodium and diuretics in pregnancy. N Engl J Med 1973;288:891–4.
15. Christianson R, Page EW. Diuretic drugs and pregnancy. Obstet Gynecol 1976;48:647–52.
16. Jones HC. Intrauterine ototoxicity: a case report and review of literature. J Natl Med Assoc 1973;65:201–3.