We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comments, Opinions, and Brief Case Reports |

Ethacrynic Acid and the Sulfa-Sensitive Patient

Geoffrey C. Wall, PharmD, BCPS; Dori Bigner, MD, MS; Steven Craig, MD
Arch Intern Med. 2003;163(1):116-117. doi:10.1001/archinte.163.1.116.
Text Size: A A A
Published online


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.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption

Chemical structures of the loop diuretics. Graphic structures of torsemide (A), furosemide (B), bumetanide (C), and ethacrynic acid (D).

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

13 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Collections
PubMed Articles