e·to·do·lac ( -t  d -l k)n. A nonsteroidal anti-inflammatory medication, used especially in the treatment of osteoarthritis. |
etodolac
etodolac [e-to-do´lak]
etodolac
lak), n brand name: Lodine;
drug class: nonsteroidal antiinflammatory;
action: inhibits prostaglandin synthesis by interfering with cyclooxgenase, which is needed for biosynthesis;
uses: mild to moderate pain, osteoarthritis.
etodolac
Apo-Etodolac (CA), Eccoxolac (UK), Ultradol (CA)
Pharmacologic class: Pyranocarboxylic acid, nonsteroidal anti-inflammatory drug (NSAID)
Therapeutic class: Nonopioid analgesic
Pregnancy risk category C (first and second trimesters), D (third trimester)
FDA Boxed Warning
• Drug may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. Risk may increase with duration of use. Patients with cardiovascular disease or risk factors for it may be at greater risk.
• Drug is contraindicated for perioperative pain in setting of coronary artery bypass graft surgery.
• Drug increases risk of serious adverse GI events, including bleeding, ulcers, and perforation of stomach or intestines, which can be fatal. Elderly patients are at greater risk.
Action
Blocks activity of cyclooxygenase (which is needed for prostaglandin synthesis), easing pain and reducing inflammation
Availability
Capsules: 200 mg, 300 mg
Tablets: 400 mg, 500 mg
Tablets (extended-release): 400 mg, 500 mg, 600 mg
⊘Indications and dosages
➣ Osteoarthritis; rheumatoid arthritis
Adults: 300 mg P.O. two or three times daily; or 400 mg, 500 mg, or 600 mg P.O. b.i.d.; or 400 to 1,000 mg P.O. (extended-release tablets) once daily
➣ Mild to moderate pain
Adults: 200 to 400 mg P.O. q 6 to 8 hours, not to exceed 1,200 mg/day
Contraindications
• Hypersensitivity to drug or its components
• Concurrent use of other NSAIDs
• Active GI bleeding or ulcer disease
Precautions
Use cautiously in:
• severe cardiovascular, renal, or hepatic disease
• elderly patients
• breastfeeding patients
• children (safety not established).
Administration
• Give with food or antacids to reduce GI upset.
• Make sure patient swallows extended-release tablets whole without crushing or chewing.
• Withhold drug several days before invasive surgery, as ordered.
| Route | Onset | Peak | Duration |
| P.O. | 30 min | 1-2 hr | 4-12 hr |
| P.O. (extended) | Unknown | 3-12 hr | 6-12 hr |
Adverse reactions
CNS: dizziness, malaise, weakness, depression, nervousness
CV: hypertension
EENT: blurred vision, tinnitus
GI: nausea, vomiting, constipation, diarrhea, flatulence, dyspepsia, peptic ulcer, duodenitis, intestinal ulceration, gastritis, melena
GU: dysuria, urinary frequency, polyuria, renal failure
Hematologic: thrombocytopenia
Hepatic: cholestatic jaundice, cholestatic hepatitis, hepatic necrosis
Skin: rash, skin peeling, cutaneous vasculitis with purpura, hyperpigmentation
Other: fluid retention, chills, fever, allergic reaction
Interactions
Drug-drug. Aminoglycosides: elevated aminoglycoside blood level (in premature infants)
Anticoagulants: prolonged prothrombin time
Beta-adrenergic blockers: reduced antihypertensive effect
Bisphosphonates: increased risk of gastric ulcers
Cholestyramine: decreased etodolac absorption
Cyclosporine: increased risk of nephrotoxicity
Diuretics: decreased diuretic effect
Lithium: increased lithium blood level, greater risk of toxicity
Methotrexate: increased risk of methotrexate toxicity
Phenylbutazone: increased etodolac effects
Phenytoin: increased phenytoin blood level
Salicylates: decreased etodolac blood level
Drug-diagnostic tests. Bleeding time: prolonged
Blood urea nitrogen (BUN), creatinine, hepatic enzymes: increased levels
Urine bilirubin, urine ketones: false-positive results
Drug-herbs. Arnica, chamomile, clove, dong quai, feverfew, garlic, ginkgo, ginseng: increased risk of bleeding
White willow: increased etodolac effects
Drug-behaviors. Alcohol use: increased risk of adverse effects
Sun exposure: phototoxicity
Patient monitoring
• Monitor CBC, liver function tests, BUN, creatinine level, and coagulation studies.
• Assess for GI bleeding and gastric upset. Administer antacids as needed and prescribed.
• Know that drug may cause false-positive urine bilirubin and urine ketone test results.
☞ Monitor patient for signs and symptoms of thrombocytopenia and increased bleeding time.
• Assess for fluid retention and weigh patient daily.
• Watch for decreased blood pressure control in hypertensive patients.
Patient teaching
• Instruct patient to take with meals if possible.
• Tell patient to swallow extended-release tablets whole without crushing or chewing.
☞ Instruct patient to immediately report unusual bleeding or bruising, change in urination pattern, unusual tiredness, or yellowing of skin or eyes.
• Advise patient to avoid activities that can cause injury.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
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