A patient with heart failure and a documented severe sulfonamide allergy requires a loop diuretic. Which agent is most appropriate?
- A Furosemide
- B Bumetanide
- C Ethacrynic acid ✓
- D Torsemide
Correct answer: C. Ethacrynic acid
Explanation
Ethacrynic acid is the only loop diuretic that is not a sulfonamide derivative, so it can be given to patients with true sulfonamide allergy. Furosemide, bumetanide and torsemide all contain a sulfonamide moiety in their structure. Ethacrynic acid is also the loop diuretic with the greatest ototoxic potential, which limits its routine use despite this indication.
Reference: Katzung Basic and Clinical Pharmacology, 16th ed.
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