etodolac

etodolac /eto·do·lac/ (e-to-do´lak) a nonsteroidal antiinflammatory drug used as an analgesic and antiinflammatory, especially to treat arthritis.

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e·to·do·lac (-td-lk)

n.

A nonsteroidal anti-inflammatory medication, used especially in the treatment of osteoarthritis.

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etodolac

[etodo′lak]

a nonsteroidal antiinflammatory drug used as an analgesic and antiinflammatory agent, especially to treat arthritis. It is administered orally.

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etodolac

(ētō´dlak),
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.

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etodolac

a nonsteroidal anti-inflammatory COX-2 inhibitor used for its analgesic effect in dogs, primarily that associated with osteoarthritis.

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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.