Ethacrynic acid. Use in ambulatory patients with resistant edema

Ethacrynic acid, an unusually potent and entirely new class of diuretic unrelated to thiazides and their derivatives, was administered to 40 patients. Twenty-five patients with marked edema secondary to congestive heart failure, cirrhosis and the nephrotic syndrome were resistant or refractory to thiazides or mercurials, or both, and received the new diuretic daily on an ambulatory basis for 3 to 19 months (average: 6 mo.). Most showed moderate to marked improvement. The average weight loss in these resistant patients was 12 lb. in five days, with one third to one half of this occurring in the first 24 to 48 hours. In a number of instances, weight losses of 9 to 11 lb. in 24 hours, and 15 to 20 lb. in 48 to 72 resulted, usually with submaximal doses. Six patients with congestive failure were reasonably compensated on ethacrynic acid alone without digitalis. Diuresis was not significantly impaired by either hypochloremia or hyponatremia. In patients once responsive to ethacrynic acid resistance did not develop.Hematologic abnormalities were not noted. Hypochloremia and hypokalemia were seen on occasion when higher dosages were used or when low doses were administered for long periods of time and were corrected with supplementary potassium chloride. Side effects rarely necessitated discontinuing the drug.The marked potency of ethacrynic acid, its ability to cause diuresis in patients poorly responsive or refractory to conventional diuretics, its effectiveness in spite of hyponatremia and hypochloremia, and its extremely rapid onset of action will provide a significant therapeutic advance in all types of edema. Finally, its ability to allow the temporary omission of digitalis, if this observation can be confirmed, will lessen the dilemma deciding whether a patient is under- or overdigitalized.