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Etodolac

Class
Nonsteroidal anti-inflammatory drugs
Subclass
Acetates
Substance name
Etodolac
Common formulations
Tablet
Dosage and administration
Adults patients
Osteoarthritis
•
300 mg PO BID
Rheumatoid arthritis
•
300 mg PO BID
Other off-label uses
•
Treatment of gout
Indications for use
Labeled indications
Adults
•
Treatment of osteoarthritis
•
Treatment of rheumatoid arthritis
Off-label indications
Adults
•
Treatment of gout
Safety risks
Contraindications
A history of or active Gastrointestinal disease including peptic ulcer disease, ulcerative colitis, Gastrointestinal perforation, or Gastrointestinal bleeding
•
Administer Etodolac at the lowest effective dose for the shortest duration, and consider co-prescribing gastroprotective agents for patients at higher risk of gastrointestinal bleeding.
Peri-operative pain in the setting of CABG surgery
•
Avoid using Etodolac in patients undergoing CABG surgery due to the heightened risk of stroke.
Pre-existing conditions such as congestive HF or hypertension
•
Monitor BP regularly in patients taking Etodolac, especially those with hypertension risk factors.
Salicylate hypersensitivity or NSAID hypersensitivity
•
Prior to prescribing Etodolac, assess patients for any history of drug hypersensitivity reactions.
Warnings and precautions
Cardiac arrhythmias
•
Use caution with a history of cardiac disease. Monitor their cardiac status during treatment. Promptly discontinue the medication, perform an ECG to assess the arrhythmia type and severity, and initiate appropriate treatment based on the specific arrhythmia diagnosis.
Exacerbation of anemia
•
Use extreme caution with pre-existing Anemia. Monitor hemoglobin levels regularly in patients taking Etodolac, especially those with pre-existing anemia or at risk of anemia. Assess the severity, consider adjusting the Etodolac dosage or discontinuing the medication, and provide appropriate medical management for anemia, under medical supervision.
Exacerbation of hematologic disorder
•
Use extreme caution with pre-existing hematological disease (e.g., coagulopathy or hemophilia) or thrombocytopenia. Monitor patients' CBC periodically during Etodolac treatment, especially in those with a history of hematologic disorders. Discontinue the medication, perform relevant blood tests to diagnose the specific disorder, and initiate tailored medical treatment based on the diagnosis, potentially involving a hematologist's expertise.
Jaundice
•
Use caution with a history of hepatic disease. Monitor liver function regularly during Etodolac treatment, especially in patients with a history of liver disease or jaundice risk factors. Promptly discontinue Etodolac, evaluate liver function, provide appropriate medical management for jaundice and underlying liver issues, under medical supervision.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Avoid use as much as possible. Avoid high doses. Monitor serum creatinine. Monitor renal function.
eGFR 10-20 mL/min/1.73 m²
•
Avoid use as much as possible. Avoid high doses.
eGFR < 10 mL/min/1.73 m²
•
Avoid use as much as possible. Avoid high doses.
Renal replacement therapy
Continuous renal replacement
•
Avoid use as much as possible. Monitor serum creatinine. Monitor for reduction in intrarenal autocoid synthesis.
Intermittent hemodialysis
•
Avoid use as much as possible. Monitor serum creatinine. Monitor for reduction in intrarenal autocoid synthesis.
Peritoneal dialysis
•
Avoid use as much as possible. Monitor serum creatinine. Monitor for reduction in intrarenal autocoid synthesis.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required. Monitor serum aminotransferases.
Pregnancy and breastfeeding
Pregnancy
< 20 weeks of gestation
•
Use only if benefits outweigh potential risks.
20-30 weeks of gestation
•
Use only if benefits outweigh potential risks. Monitor for oligohydramnios. If oligohydramnios occurs, discontinue NSAID and treat it appropriately.
> 30 weeks of gestation
•
Avoid use. Avoid etodolac use during the third trimester of pregnancy (starting at 30 weeks of gestation) due to the risk of premature closure of the fetal ductus arteriosus and persistent pulmonary hypertension in the neonate.
Breastfeeding
Little information available on breastfeeding safety.
•
Consider alternative agents that may be safer.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Acute liver failure, acute cystitis, acute pancreatitis, agranulocytosis, alopecia, anaphylaxis, anemia, angioedema, aplastic anemia, aseptic meningitis, bronchospasm, cholestasis, colitis, conjunctivitis, ↓ WBC count, ↓ blood neutrophil count, ↓ platelet count, diaphoresis, ecchymosis, erythema multiforme, esophageal stricture, esophagitis, exacerbation of arrhythmia, exfoliative dermatitis, gastritis, gastrointestinal bleeding, gastrointestinal perforation, heart failure, hemolytic anemia, hepatic necrosis, hepatitis, hyperpigmentation, hypertension, ↑ BUN, ↑ blood eosinophil count, ↑ blood glucose, ↑ liver enzymes, ↑ urine protein, interstitial nephritis, jaundice, leukorrhea, maculopapular rash, myocardial infarction, nephrolithiasis, pancytopenia, peptic ulcer disease, pharyngitis, photosensitivity of skin, purpura, renal failure, renal papillary necrosis, abdominal pain, arthralgia, asthenia, blurred vision, confusion, constipation, depression, diarrhea, dizziness, dry mouth, dysgeusia, dyspepsia, dyspnea, dysuria, fatigue, flatulence, hearing loss, hematuria, insomnia, irritability, itching, loss of appetite, low urine output, malaise, melena, myalgia, nausea, palpitations, paresthesia, photophobia, polyuria, pyrosis, skin flushing, skin rash, syncope, tinnitus, urinary frequency, visual disturbances, vomiting, weight gain, weight loss, sinusitis, Stevens-Johnson syndrome, stomatitis, stroke, toxic epidermal necrolysis, urticaria, vasculitis
Unknown frequency
•
Coma, DRESS syndrome, ↓ serum sodium, glossitis, ↑ serum potassium, ↑ serum uric acid, lymphadenopathy, nephrotic syndrome, platelet dysfunction, anxiety, dysphagia, hallucinations, headache, hematemesis, odynophagia, seizure, vertigo, respiratory depression, sinus tachycardia, thromboembolism, tremor
Interactions
Drug(s)
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