Etodolac
Mechanism :
ETODOLAC is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, analgesic, and antipyretic activities in animal models. The mechanism of action like that of other NSAIDs, is not completely understood, but may be related to prostaglandin synthetase inhibition.
Indication :
- Acute pain of Juvenile Idiopathic Arthritis
Contraindications :
Contraindicated in patients with known hypersensitivity, in patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs, in the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery, in active peptic ulceration. Use with caution in renal, cardiac or hepatic impairment.
Dosing :
Under 6 years:
Safety and efficacy not established. Give orally.
6-16 years:
20-30 kg:
400 mg once daily.
31-45 kg:
600 mg once daily.
46-60 kg:
800 mg once daily.
>60 kg:
1000 mg once daily.
Adverse Effect :
Common Reactions: Abdominal pain, dyspepsia, nausea, constipation, peripheral edema, dizziness, headache, rash, ecchymosis, ALT/AST elevation, somnolence, fluid retention, tinnitus, abnormal stools, fatigue, arthralgia, photosensitivity.
Serious Reactions: GI bleeding, GI perforation/ulcer, nephrotoxicity, MI, stroke, thromboembolism, bronchospasm, exfoliative dermatitis, hypertension, congestive cardiac failure, renal papillary necrosis, anemia, leukocytoclastic vasculitis, aplastic anemia, hepatotoxicity, anaphylactoid reaction, Stevens-Johnson syndrome, toxic epidermal
necrolysis, prolonged bleeding time.
Interaction :
ACE-inhibitors: NSAIDs may diminish the antihypertensive effect of ACE-inhibitors. This interaction should be given consideration in patients taking NSAIDs concomitantly with ACE-inhibitors.
Diuretics: Can reduce the natriuretic effect-of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis.
Lithium: When ibuprofen and lithium are administered concurrently, subjects should be observed carefully for signs of lithium toxicity.
Methotrexate: Enhances the toxicity of methotrexate. Caution should be used when NSAIDs are administered concomitantly with methotrexate.
Warfarin: Effects of warfarin and NSAIDs on GI bleeding are synergistic, such that the users of both drugs together have a risk of serious GI bleeding higher than users of either drug alone.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function, but avoid if possible |
| 10-20 | Dose as in normal renal function, but avoid if possible |
| <10 | Dose as in normal renal function, but only use if on dialysis |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function. |
| HD | Not dialysed. Dose as in normal renal function. |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function. |
| CAV/VVHD | Unlikely to be dialysed. Use lowest possible dose |
Hepatic Dose :
In patients with severe decompensated liver disease or hepatic failure: dose reduction may be required as etodolac clearance is dependent on liver function