Lodine
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etodolac
(ee-toe-doe-lak) ,Lodine
(trade name),Lodine XL
(trade name)Classification
Therapeutic: antirheumaticsPharmacologic: pyranocarboxylic acid
Indications
Osteoarthritis.Rheumatoid arthritis.Mild to moderate pain (not XL tablets).
Action
Inhibits prostaglandin synthesis.
Also has uricosuric action.
Therapeutic effects
Suppression of inflammation.
Decreased severity of pain.
Pharmacokinetics
Absorption: Well absorbed after oral administration.
Distribution: Widely distributed.
Protein Binding: >99%.
Metabolism and Excretion: Mostly metabolized by the liver; <1% excreted unchanged in urine.
Half-life: 6–7 hr (single dose); 7.3 hr (chronic dosing).
Time/action profile (analgesic effect)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO (analgesic) | 0.5 hr | 1–2 hr | 4–12 hr |
| PO (anti-inflammatory) | days–wk | unknown | 6–12 hr† |
Contraindications/Precautions
Contraindicated in: Hypersensitivity;Active GI bleeding or ulcer disease;Cross-sensitivity may exist with other NSAIDs, including aspirin; Obstetric: Use during second half of pregnancy can result in premature closure of ductus arteriosis.
Use Cautiously in: Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, especially with prolonged use)Renal or hepatic disease;History of ulcer disease; Lactation: Limited information available; use other safer NSAID; Pediatric: Safety not established; Geriatric: ↑ risk of GI bleeding.
Adverse Reactions/Side Effects
Central nervous system
- depression
- dizziness
- drowsiness
- insomnia
- malaise
- nervousness
- syncope
- weakness
Ear, Eye, Nose, Throat
- blurred vision
- photophobia
- tinnitus
Respiratory
- asthma
Cardiovascular
- chf (life-threatening)
- edema
- hypertension
- palpitations
Gastrointestinal
- gi bleeding (life-threatening)
- dyspepsia (most frequent)
- abdominal pain
- constipation
- diarrhea
- drug-induced hepatitis
- dry mouth
- flatulence
- gastritis
- nausea
- stomatitis
- thirst
- vomiting
Genitourinary
- dysuria
- renal failure
- urinary frequency
Dermatologic
- exfoliative dermatitis (life-threatening)
- stevens-johnson syndrome (life-threatening)
- toxic epidermal necrolysis (life-threatening)
- ecchymoses
- flushing
- hyperpigmentation
- pruritus
- rashes
- sweating
Hematologic
- anemia
- prolonged bleeding time
- thrombocytopenia
Miscellaneous
- allergic reactions including anaphylaxis (life-threatening)
- angioedema (life-threatening)
- chills
- fever
Interactions
Drug-Drug interaction
Concurrent use with aspirin may ↓ effectiveness.↑ adverse GI effects with aspirin, other NSAIDs, potassium supplements, corticosteroids, antiplatelet agents, or alcohol.Chronic use with acetaminophen may ↑ risk of adverse renal reactions.May ↓ effectiveness of diuretic or antihypertensive therapy.May ↑ serum lithium levels and ↑ risk of toxicity.↑ risk of toxicity from methotrexate.↑ risk of bleeding with cefotetan, cefoperazone, valproic acid, thrombolytics, antiplatelet agents, or anticoagulants.↑ risk of adverse hematologic reactions with antineoplastics or radiation therapy.May ↑ the risk of nephrotoxicity from cyclosporine.↑ risk of bleeding with arnica, chamomile, clove, dong quai, fever few, garlic, ginko, and Panax ginseng.Route/Dosage
Oral (Adults) Analgesia—200–400 mg q 6–8 hr (not to exceed 1200 mg/day). Osteoarthritis/rheumatoid arthritis—300 mg 2–3 times daily, 400 mg twice daily, or 500 mg twice daily; may also be given as 400–1200 mg once daily as XL tablets.
Availability (generic available)
Capsules: 200 mg, 300 mg
Tablets: 400 mg, 500 mg
Extended-release tablets (XL): 400 mg, 500 mg, 600 mg
Nursing implications
Nursing assessment
- Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Monitor for rhinitis, asthma, and urticaria.
- Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.
- Osteoarthritis/Rheumatoid Arthritis: Assess pain and range of movement before and 1–2 hr after administration.
- Pain: Assess location, duration, and intensity of the pain before and 60 min after administration.
- Lab Test Considerations: May cause ↓ hemoglobin, hematocrit, leukocyte, and platelet counts.
- Monitor liver function tests within 8 wk of initiating etodolac therapy and periodically during therapy. May cause ↑ serum alkaline phosphatase, LDH, AST, and ALT concentrations.
- Monitor BUN, serum creatinine, and electrolytes periodically during therapy. May cause ↑ BUN, serum creatinine, and electrolyte concentrations and ↓ urine electrolyte concentrations.
- May cause ↓ serum and ↑ urine uric acid concentrations.
Potential Nursing Diagnoses
Acute pain (Indications)Impaired physical mobility (Indications)
Implementation
- Do not confuse Lodine (etodolac) with codeine or iodine.
- Administration in higher-than-recommended doses does not provide increased effectiveness but may cause increased side effects.
- Use lowest effective dose for shortest period of time.
- Oral: For rapid initial effect, administer 30 min before or 2 hr after meals. May be administered with food, milk, or antacids containing aluminum or magnesium to decrease GI irritation.
- Do not break, crush, or chew extended-release tablets.
Patient/Family Teaching
- Advise patients to take etodolac with a full glass of water and to remain in an upright position for 15–30 min after administration.
- Instruct patient to take medication as directed. Take missed doses as soon as possible within 1–2 hr if taking twice/day, or unless almost time for next dose if taking more than twice/day. Do not double doses.
- Etodolac may occasionally cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
- Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, NSAIDs, or other OTC medications without consultation with health care professional.
- Advise patient to inform health care professional of medication regimen before treatment or surgery.
- Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs.
Evaluation/Desired Outcomes
- Decreased severity of pain.
- Improved joint mobility. Patients who do not respond to one NSAID may respond to another. May require 2 wk or more for maximum anti-inflammatory effects.
Lodine
(lō′dēn′) A trademark for the drug etodolac.