Etodolac

A to Z Drug Facts

Etodolac

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(EE-toe-DOE-lak)

Lodine, Lodine XL

Class: Analgesic/NSAID

Action Decreases inflammation, pain and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis.

Indications Management of pain (Lodine only); management of signs and symptoms of osteoarthritis and rheumatoid arthritis. Unlabeled use(s): Control of symptoms of rheumatoid arthritis; treatment of temporal arteritis.

Contraindications Patients in whom aspirin, iodides or any NSAID has caused allergic-type reactions.

Route/Dosage

Analgesia

ADULTS: PO 200 to 400 mg q 6 to 8 hr prn. Do not exceed 1200 mg/day. Patients £ 60 kg should not exceed 20 mg/kg.

Osteoarthritis/Rheumatoid Arthritis

ADULTS: PO 300 mg bid, tid, or 400 mg or 500 mg bid. The dose may be increased to 1200 mg/day when a higher level of therapeutic activity is required.

Interactions

Anticoagulants: May increase prothrombin time. Watch for signs and symptoms of bleeding. Beta-blockers: May decrease antihypertensive effect of beta-blockers. Lithium: May increase lithium levels and effects. Loop diuretics: May decrease diuretic effect. Methotrexate: May increase methotrexate levels. Salicylates: Plasma concentrations of NSAIDs may be decreased when taken with salicylates. There is no therapeutic advantage to this combination, but adverse GI effects may be increased.

Lab Test Interferences Serum uric acid levels: Drug may cause small decrease. Urinary bilirubin test: Drug may cause false-positive results. Urinary dipstick tests: Drug may cause results that are false positive for ketones.

Adverse Reactions

CV: Fluid retention; edema; hypertension; flushing; CHF; syncope; palpitations. CNS: Dizziness; headaches; drowsiness; insomnia; asthenia; malaise; depression; nervousness. DERM: Rash; pruritus; Stevens-Johnson syndrome; hyperpigmentation; urticaria; purpura. EENT: Blurred vision; photophobia; visual changes; tinnitus. GI: Dyspepsia; nausea; vomiting; diarrhea; indigestion; heartburn; abdominal pain; constipation; flatulence; gastritis; melena; dry mouth; anorexia; stomatitis; peptic ulcers. GU: Urinary frequency; dysuria. HEMA: Anemia; leukopenia; pancytopenia; thrombocytopenia; increased bleeding time; agranulocytosis; hemolytic anemia; neutropenia. HEPA: Jaundice; cholestatic jaundice; hepatitis. META: Weight gain; hypouricemia. RESP: Asthma. OTHER: Chills; fever.

Precautions

Pregnancy: Category C: Lactation: Undetermined. Children: Safety and efficacy not established. Elderly or debilitated patients: Increased risk of adverse reactions. GI effects: Serious GI toxicity (eg, bleeding, ulceration, perforation) can occur at any time, with or without warning symptoms. Hypersensitivity: May occur; use caution in aspirin sensitive individuals because of possible cross-sensitivity. Renal effects: Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia and renal papillary necrosis may occur. Renal impairment: Assess renal function before and during therapy.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Do not give more than 20 mg/kg to patients weighing £ 60 kg.
Food delays peak action of medication by 1–4 hr.
Give with food, milk or antacids if stomach upset occurs.
Store at room temperature in tightly closed container. Protect from moisture.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies, especially to aspirin, iodides or other NSAIDs. Note history of GI bleeding.
Assess location, duration and intensity of pain before and 60 min after administration.
Monitor hematocrit and hemoglobin levels in patients on long-term therapy.
Monitor for signs of agranulocytosis (sore throat, fever).
Monitor renal function.
Monitor for edema and weight gain in patients with CHF and renal impairment.
Monitor PT/APTT levels of patients taking anticoagulants.
Monitor elderly patients carefully for possible adverse reactions.
Review liver function test results, and report signs of hepatic dysfunction to the physician.
Discontinue drug if hypersensitivity develops.
Inform physician of decreased renal function, hyponatremia and hyperkalemia laboratory values.

Extended-release

After satisfactory response is achieved, usually after 1 to 2 wks, assess patient to determine if dose needs to be adjusted.

OVERDOSAGE: SIGNS & SYMPTOMS
	Respiratory depression, hypotension, epigastric pain, drowsiness, lethargy, GI irritation/bleeding, nausea, vomiting, tinnitus, sweating, acute renal failure

Patient/Family Education

Advise patient to take medication with full glass of water and to remain upright for 15–30 min after administration.
Encourage patient on long-term therapy to have regular eye examinations.
Advise patient to inform physician or dentist of medication regimen before treatment or surgery.
Instruct patient to report these symptoms to physician: rash, stomach problems, tinnitus, dizziness or visual disturbances, black tarry stools, increased bruises or bleeding.
Caution patient not to use aspirin or other otc medications or drink alcoholic beverages while taking this medication.
Advise patient that drug may cause drowsiness and to use caution while driving or performing tasks requiring mental alertness.
Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.