Etodolac

Etodolac is a prescription nonsteroidal anti-inflammatory drug (NSAID) belonging to the pyranocarboxylic acid class. It is specifically formulated to provide effective management of pain and inflammation associated with osteoarthritis and rheumatoid arthritis. By selectively inhibiting cyclooxygenase-2 (COX-2) more than cyclooxygenase-1 (COX-1), etodolac offers a favorable balance of anti-inflammatory efficacy and gastrointestinal tolerability. It is available in both immediate-release and extended-release formulations, allowing for tailored therapeutic regimens based on individual patient needs and severity of symptoms.

Features

• Active Ingredient: Etodolac
• Available Strengths: 400 mg, 500 mg, 600 mg tablets; 400 mg, 500 mg, 600 mg extended-release tablets
• Pharmacologic Class: Nonsteroidal Anti-inflammatory Drug (NSAID), selective COX-2 inhibitor
• Administration: Oral
• Half-life: Approximately 7.3 hours (may be prolonged in elderly patients or those with hepatic impairment)
• Bioavailability: Over 80%
• Protein Binding: >99%
• Metabolism: Hepatic, primarily via CYP2C9 and CYP3A4
• Excretion: Urine (72%) and feces (16%)

Benefits

• Provides potent anti-inflammatory and analgesic effects for chronic arthritic conditions
• Demonstrates selective COX-2 inhibition, potentially reducing risk of gastrointestinal adverse events compared to non-selective NSAIDs
• Offers flexible dosing with both immediate and extended-release formulations for individualized treatment
• Effective in improving physical function and reducing joint stiffness in osteoarthritis patients
• May be used for management of acute pain when appropriate
• Generally well-tolerated with established safety profile in appropriate patient populations

Common use

Etodolac is primarily indicated for the management of signs and symptoms of osteoarthritis and rheumatoid arthritis in adults. It is used to reduce pain, inflammation, and stiffness associated with these conditions, thereby improving mobility and quality of life. The medication may also be prescribed off-label for other painful inflammatory conditions when deemed appropriate by the treating physician. Clinical studies have demonstrated etodolac’s effectiveness in improving Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and reducing tender joint counts in rheumatoid arthritis patients.

Dosage and direction

For osteoarthritis and rheumatoid arthritis:

• Immediate-release tablets: 300 mg twice daily or 200 mg three times daily
• Extended-release tablets: 400 mg to 1000 mg once daily
• Maximum recommended daily dose: 1200 mg for immediate-release, 1000 mg for extended-release

Dosage should be individualized based on the severity of symptoms, patient response, and risk factors. The lowest effective dose should be used for the shortest duration consistent with treatment goals. Tablets should be swallowed whole with a full glass of water, preferably with food or milk to minimize gastrointestinal upset. Patients should remain upright for at least 30 minutes after administration.

Precautions

Patients should be monitored for signs and symptoms of gastrointestinal ulceration and bleeding, particularly those with history of peptic ulcer disease or gastrointestinal bleeding. Renal function should be assessed periodically, especially in elderly patients, those with dehydration, heart failure, hepatic dysfunction, or taking diuretics or ACE inhibitors. Blood pressure should be monitored during treatment, as NSAIDs can lead to new onset or worsening of hypertension. Hepatic function tests should be performed periodically in patients receiving long-term therapy. Patients should be advised to report any signs of skin rash, mucosal lesions, or other symptoms of hypersensitivity reactions.

Contraindications

Etodolac is contraindicated in patients with known hypersensitivity to etodolac or any components of the formulation. It should not be used in patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Contraindicated in the setting of coronary artery bypass graft (CABG) surgery. Should not be used in patients with active peptic ulcer disease or recent gastrointestinal bleeding. Avoid use in patients with severe heart failure, advanced renal disease, or severe hepatic impairment.

Possible side effect

Common adverse reactions (≥1%):

• Dyspepsia (10-15%)
• Abdominal pain (5-10%)
• Nausea (5-10%)
• Diarrhea (3-7%)
• Headache (3-5%)
• Dizziness (3-5%)
• Peripheral edema (2-4%)

Serious adverse reactions:

• Gastrointestinal bleeding and perforation
• Cardiovascular thrombotic events
• Hepatotoxicity
• Renal injury
• Severe skin reactions
• Anaphylactic reactions
• Hematologic toxicity

Drug interaction

Significant interactions include:

• Anticoagulants: Increased risk of bleeding with warfarin
• Aspirin: Reduced etodolac efficacy and increased GI toxicity
• ACE inhibitors/ARBs: Reduced antihypertensive effect and risk of renal impairment
• Diuretics: Reduced diuretic efficacy and risk of renal impairment
• Lithium: Increased lithium levels and toxicity risk
• Methotrexate: Increased methotrexate toxicity
• Cyclosporine: Increased nephrotoxicity risk
• SSRIs/SNRIs: Increased risk of gastrointestinal bleeding
• Corticosteroids: Increased risk of gastrointestinal ulceration

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed dose. Patients should be advised to maintain a consistent dosing schedule to ensure stable therapeutic levels.

Overdose

Symptoms of overdose may include lethargy, drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, hypertension, acute renal failure, respiratory depression, and coma. Management is supportive and symptomatic. There is no specific antidote. Gastric lavage or activated charcoal may be considered if presented within 4 hours of ingestion. Hemodialysis is not effective due to high protein binding. Forced diuresis, alkalinization of urine, or hemoperfusion may not be useful.

Storage

Store at controlled room temperature 20°C to 25°C (68°F to 77°F). Keep in original container, tightly closed. Protect from moisture and light. Keep out of reach of children and pets. Do not use after expiration date. Do not transfer to other containers as this may affect stability. Do not flush medications down the toilet or pour down a drain unless instructed to do so.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Etodolac is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Patients should consult their physician for proper diagnosis and treatment recommendations. The information provided here may not include all possible uses, directions, precautions, or interactions. Always follow the prescribing information provided by the manufacturer and the instructions of your healthcare provider.

Reviews

Clinical studies have demonstrated etodolac’s efficacy in managing arthritic symptoms. In a 12-week randomized controlled trial involving osteoarthritis patients, etodolac 600 mg daily showed significant improvement in pain scores and physical function compared to placebo. Another study in rheumatoid arthritis patients demonstrated comparable efficacy to naproxen with potentially better gastrointestinal tolerability. Patient reviews generally report effective pain relief with manageable side effects, though individual experiences vary. Many patients appreciate the once-daily dosing option with extended-release formulations for convenience.