Loop diuretics are a mainstay of therapy for many patients with various disorders associated with fluid overload.1 These agents are inexpensive, effective, and well tolerated in the vast majority of patients. The 4 loop diuretics currently on the US market are furosemide, bumetanide, torsemide, and ethacrynic acid.2 Though few comparative studies have been performed, US physicians use the first 3 drugs almost exclusively, reserving ethacrynic acid (due to its ototoxic potential) for patients who have had serious hypersensitivity reactions to
"sulfas" or the other loop diuretics.1,3,4 Ethacrynic acid is the only loop diuretic on the US market that does not contain a sulfonamide substituent. Unfortunately, the sole US producer of ethacrynic acid (Edecrin; Merck & Co, West Point, Pa) is currently unable to provide this drug; in fact, it has stopped production of the oral form indefinitely.5 This can present a dilemma to the clinician who has a patient requiring a loop diuretic who has a history of a serious reaction to a sulfonamide or loop diuretic. We present a case report of such a patient who was successfully treated with a graded-dose challenge to torsemide.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Chemical structures of the loop diuretics. Graphic structures of torsemide (A), furosemide (B), bumetanide (C), and ethacrynic acid (D).
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 9
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.