ETODOLAC

ETODOLAC
(e-to'do-lac)
Classifications: analgesic, nonsteroidal antiinflammatory agent (nsaid); antipyretic;
Therapeutic:nsaid, analgesic; antipyretic
Prototype: Ibuprofen
Pregnancy Category: C

Availability

400, 500 mg tablets; 200 mg, 300 mg capsules; 400, 500 mg, 600 mg sustained release tablets

Action

Inhibits cyclooxygenase (COX-1 and COX-2) enzyme activity and prostaglandin synthesis. NSAIDs may also suppress production of rheumatoid factor.

Therapeutic Effect

Produces analgesic and antiinflammatory effects of an NSAID.

Uses

Osteoarthritis and acute pain, rheumatoid arthritis.

Unlabeled Uses

Temporal arteritis.

Contraindications

Hypersensitivity to NSAIDS, salicylates; ulceration or inflammation; perioperative CABG pain; pregnancy (category C), lactation. Safety and efficacy in children <6 y are not established.

Cautious Use

Renal impairment, liver function impairment, GI disorders; cardiac disorders; dehydration; diabetes mellitus; patients over 65 y, and lactation.

Route & Dosage

Acute Pain
Adult: PO 200–400 mg q6–8h prn

Osteoarthritis
Adult: PO 600–1200 mg/d in 2–4 divided doses, (max: 1200 mg/d or 20 mg/kg for patients ?60 kg; Lodine XL 400–1000 mg once daily)

Rheumatoid Arthritis
Adult: PO 500 mg b.i.d.

Administration

Oral

Give with food or antacid to reduce risk of GI ulceration.
Ensure that sustained release form of drug is not chewed or crushed. It must be swallowed whole.
Store at 15°–25° C (59°–77° F); tablets and capsules in bottles; sustained release capsules in unit-dose packages. Protect all forms from moisture.

Adverse Effects (≥1%)

CV: Fluid retention, edema. CNS: Dizziness, headache, drowsiness, insomnia. GI: Dyspepsia, nausea, vomiting, diarrhea, indigestion, heartburn, abdominal pain, constipation, flatulence, gastritis, melena, peptic ulcer, GI bleeding. Hematologic: Thrombocytopenia, increased bleeding time. Skin: Rash, pruritus. Urogenital: Urinary frequency. Metabolic: Hepatotoxicity. Special Senses: Blurred vision; tinnitus. Respiratory: Asthma.

Diagnostic Test Interference

May cause a false-positive urinary bilirubin test and a false-positive ketone test done with the dipstick method. May cause a small decrease (1 to 2 mg/dL) in serum uric acid levels.

Interactions

Drug: May reduce effects of diuretics and antihypertensive effects of beta blockers and other antihypertensive medications. May increase digoxin and lithium levels and nephrotoxicity due to cyclosporine. Herbal: Feverfew, garlic, ginger, ginkgo may increase bleeding.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 30 min. Peak: 1–2 h. Duration: 4–12 h. Distribution: Widely distributed; 99% protein bound; not known if crosses placenta or if distributed into breast milk. Metabolism: Extensively in liver. Elimination: 72% in urine, 16% in feces. Half-Life: 6–7 h.

Nursing Implications

Assessment & Drug Effects

Assess for signs of GI ulceration and bleeding. Risk factors include high doses of etodolac, history of peptic ulcer disease, alcohol use, smoking, and concomitant use of aspirin.
Assess carefully for fluid retention by monitoring weight and observing for edema in patients with a history of CHF.
Monitor for decreased BP control in hypertensive patients.
Lab tests: Periodic CBC and kidney and liver function.
Monitor for drug toxicity when used concurrently with either digoxin or lithium.
Monitor for rhinitis, urticaria, or other signs of allergic reactions. Discontinue drug and notify physician when present.
Monitor carefully increases in etodolac dosage with older adult patients; adverse effects are more pronounced.
Monitor for headaches, especially at high doses. Discontinuation of therapy may be indicated.

Patient & Family Education

Learn S&S of GI ulceration. Stop medication in presence of bleeding and contact the physician immediately.
Do not take aspirin, which may potentiate ulcerogenic effects.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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