A 58-year-old woman with decompensated heart failure requires intravenous loop diuretic therapy. She gives a history of a severe cutaneous reaction to cotrimoxazole. Which loop diuretic is most appropriate for her?
- A Ethacrynic acid ✓
- B Bumetanide
- C Torsemide
- D Furosemide
Correct answer: A. Ethacrynic acid
Explanation
Furosemide, bumetanide and torsemide are all sulfonamide derivatives and may cross-react in patients with severe sulfonamide allergy. Ethacrynic acid is the only loop diuretic that is not a sulfonamide, making it the agent of choice in this setting. Its limiting toxicity is gastrointestinal upset and a higher rate of ototoxicity compared with other loop diuretics, so it is reserved for patients who cannot tolerate sulfonamide-containing loops.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
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