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Etodolac Uses, Dosage, Side Effects

Etodolac

(e-to′do-lac)

Classifications: ANALGESIC, NONSTEROIDAL ANTI-INFLAMMATORY AGENT (NSAID); DISEASE-MODIFYING ANTIRHEUMATIC DRUG (DMARD)

Therapeutic: ANALGESIC, NSAID; DMARD; ANTIPYRETIC

Prototype: Ibuprofen

Pregnancy Category: C first and second trimester; D third trimester

AVAILABILITY

Tablet; capsule; sustained release tablet

ACTION & THERAPEUTIC EFFECT

Inhibits cyclooxygenase (COX-1 and COX-2) enzyme activity and prostaglandin synthesis. NSAIDs may also suppress production of rheumatoid factor. Produces analgesic and anti-inflammatory effects of an NSAID.

USES

Osteoarthritis and acute pain, rheumatoid arthritis.

CONTRAINDICATIONS

Hypersensitivity to NSAIDS, salicylates; ulceration or inflammation; perioperative CABG pain; asthma, urticaria, or other allergic reactions to aspirin or other NSAIDs; S&S of developing liver disease; use in labor and delivery; pregnancy (category D

third trimester).

CAUTIOUS USE

Renal impairment, liver function impairment, GI disorders, history of GI ulceration, GI bleeding; cardiac disorders including fluid retention, hypertension, heart failure; dehydration; preexisting hematologic diseases (e.g., coagulopathy and hemophilia) or thrombocytopenia; IM injections; dental work; diabetes mellitus; surgery when hemostasis is required; immunosuppression, neutropenia; patients over 65 y, pregnancy (category C first and second trimester), lactation. Safe use in children younger than 6 y not established.

ROUTE & DOSAGE

Acute Pain

Adult: PO 200–400 mg q6–8h prn

Osteoarthritis

Adult: PO 600–1200 mg/day in divided doses, (max: 1200 mg/ day. Extended release: 400– 1000 mg daily)

Juvenile Rheumatoid Arthritis

Adolescent/Child (over 6): PO Dose based on weight 20–30 kg: 400 mg 31–45 kg: 600 mg 46–60 kg: 800 mg over 60 kg: 1000 mg

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 unitdose packages. Protect all forms from moisture.

Etodolac Uses, Dosage, Side Effects

Related for Nursing Implications and Drugs Guide Information

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 falsepositive 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 betablockers

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

Black Box WarningEtodolac has been associated with increased risk of serious, potentially fatal GI bleeding and cardiovascular events (e.g., MI & CVA); risk may increase with duration of use and may be greater in the older adult and those with risk factors for CV disease.

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.
Monitor for and report promptly S&S of CV thrombotic events (i.e., angina, MI, TIA, or stroke).
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.
Monitor for drug toxicity when used concurrently with either digoxin or lithium.
Monitor for rhinitis, urticaria, or other signs of allergic reactions.
Monitor carefully increases in etodolac dosage with older adult patients; adverse effects are more pronounced.
Monitor lab tests: Periodic CBC, kidney function tests and LFTs.

Patient & Family Education

Learn S&S of GI ulceration. Stop medication in presence of bleeding and contact the prescriber immediately.
Stop taking drug and report promptly to prescriber if you experience chest pain, shortness of breath, weakness, slurring of speech, or other signs of a cardiac or neurologic problem.
Do not take aspirin, which may potentiate ulcerogenic effects.

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