Classifications: ANALGESIC, NONSTEROIDAL ANTI-INFLAMMATORY AGENT (NSAID); DISEASE-MODIFYING ANTIRHEUMATIC DRUG (DMARD)
Therapeutic: ANALGESIC, NSAID; DMARD; ANTIPYRETIC
Pregnancy Category: C first and second trimester; D third trimester
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.
Osteoarthritis and acute pain, rheumatoid
arthritis.
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
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.
Adult: PO 200–400 mg q6–8h prn
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
- 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.
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| Etodolac Uses, Dosage, Side Effects |
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- TRETINOIN NURSING IMPLICATIONS
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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.
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.
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.
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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