Warfarin Institute of America
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ETHACRYNIC ACID INTERACTION WITH WARFARIN
Brand name: Edecrin
This is another of the interactions with scant information. The one case report that I found dates to 1975, which was before the current method of managing warfarin by the INR system began. Therefore, it may have little relevance for today. Both of these medications have been around for more than 30 years. If there were a major interaction, I think that it would be widely reported.
However, there is a possibility that something happens when the two are used together that is not a true drug interaction. I have seen many patients who had quite a bit of swelling due to fluid retention. If this causes congestion of the liver, then warfarin is not metabolized very efficiently. When a diuretic such as ethacrynic acid is given, the fluid is removed and the congestion lessens. This allows the blood to flow more efficiently through the liver, the warfarin is metabolized more efficiently and the INR decreases. This is not truly a drug interaction, but the effect is the same. If you can find no other reason for a decreased INR, then this possibility should be studied.
Reference:
Petrick, RJ. et al. Interaction Between Warfarin and Ethacrynic Acid. JAMA 1975;231:843-4.
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Last updated November 7, 2004