etodolac

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed to tissues.

Protein Binding: >99%.

Metabolism/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‡

‡Up to 24 hr as XL (extended-release) tablet.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Active GI bleeding or ulcer disease;
Cross-sensitivity may exist with other NSAIDs, including aspirin;
Perioperative pain from coronary artery bypass graft surgery;
OB: Avoid use after 30 wk gestation;
Lactation: Lactation.

Use Cautiously in:

Renal impairment;
Hepatic impairment;
Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, especially with prolonged use or use of higher doses);
History of ulcer disease;
OB: Use at or after 20 wk gestation may cause fetal or neonatal renal impairment; if treatment is necessary between 20 wk and 30 wk gestation, limit use to the lowest effective dose and shortest duration possible;
Pedi: Safety and effectiveness not established in children;
Geri: Appears on Beers list. risk GI bleeding or peptic ulcer disease in older adults. Avoid chronic use unless other alternatives are not effective and the patient can take a gastroprotective agent; avoid short-term use in combination with oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents unless other alternatives are not effective and the patient can take a gastroprotective agent.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema, HF, hypertension, MI, palpitations, STROKE

Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), ecchymoses, EXFOLIATIVE DERMATITIS, flushing, hyperpigmentation, pruritus, rash, STEVENS-JOHNSON SYNDROME (SJS), sweating, TOXIC EPIDERMAL NECROLYSIS

EENT: blurred vision, photophobia, tinnitus

GI: dyspepsia, abdominal pain, constipation, diarrhea, dry mouth, flatulence, gastritis, GI BLEEDING, hepatitis, nausea, stomatitis, vomiting

GU: dysuria, renal failure, urinary frequency

Hemat: anemia, prolonged bleeding time, thrombocytopenia

Neuro: depression, dizziness, drowsiness, insomnia, malaise, nervousness, syncope, weakness.

Resp: asthma

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA), chills, fever

Interactions ⬆ ⬇

Drug-drug:

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, valproic acid, thrombolytics, antiplatelet agents, or anticoagulants.
↑risk of adverse hematologic reactions with antineoplastics or radiation therapy.
May ↑ the risk of nephrotoxicity from cyclosporine.

Drug-Natural Products:

↑risk of bleeding with arnica, chamomile, clove, dong quai, fever few, garlic, gingko, and Panax ginseng.

Route/Dosage ⬆ ⬇

PO (Adults ): Analgesia: 200–400 mg every 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: 400 mg; 500 mg; 600 mg

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 SJS. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.
Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, facial swelling) periodically during therapy. Discontinue therapy if symptoms occur.
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.

Implementation ⬆ ⬇

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.
PO: 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.
- DNC: 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.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise women to avoid etodolac in the 3rd trimester of pregnancy (after 29 wk), may cause premature closure of the fetal ductus arteriosus. Use of etodolac after 20 wk may cause fetal renal dysfunction leading to oligohydramnios. May cause reversible infertility in women attempting to conceive; may consider discontinuing etodolac.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇