etodolac: clinical use

Prescribing considerations

• Assess gastrointestinal, cardiovascular, renal, hepatic and bleeding risks before and during treatment.
• Use particular caution in older people and those with asthma, hypertension, fluid retention, inflammatory bowel disease, lupus or mixed connective-tissue disease.
• Consider gastroprotection where ulcer or bleeding risk is increased.
• Avoid concurrent systemic NSAIDs and review interacting medicines.
• The selected products are not recommended for children.

Contraindications and cautions

• Hypersensitivity to etodolac or an excipient
• Previous aspirin- or NSAID-associated asthma, rhinitis, angioedema or urticaria
• Active or recurrent peptic ulceration or bleeding
• Previous NSAID-related gastrointestinal bleeding or perforation
• Severe heart, renal or hepatic failure
• Last trimester of pregnancy
• Previous severe cutaneous adverse reaction associated with etodolac

Monitoring

• Clinical evidence of gastrointestinal bleeding or ulceration
• Blood pressure, oedema and symptoms of heart failure
• Renal function, especially with impairment, diuretics or older age
• Hepatic function and haematological parameters when treatment continues
• Skin or mucosal changes, particularly early in treatment

Clinical pharmacology

Etodolac is an orally absorbed, highly protein-bound NSAID. It inhibits prostaglandin synthesis, with laboratory evidence of preferential COX-2 inhibition; metabolites are primarily excreted in urine.

Formulation and product differences

• Both selected products are modified-release tablets and must be swallowed whole.
• Both contain lactose.
• Lodine SR also contains sodium.
• Etopan XL contains colouring agents including sunset yellow, which may cause allergic reactions.

Modified-release tablet

Route: Oral

Strengths: 600 mg