OVERVIEW

Etodolac is a nonsteroidal anti-inflammatory drug (NSAID) commonly used to treat pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and sometimes post-operative pain.

DOSAGE

MECHANISM OF ACTION

COX inhibition:

Etodolac primarily inhibits the enzyme COX-2, which is heavily involved in inflammatory processes. However, it also has some activity against COX-1, which is involved in protecting the stomach lining and maintaining kidney function. This selective inhibition of COX-2 reduces inflammation and pain and the risk of gastrointestinal side effects is somewhat lower than with non-selective NSAIDs.

Reduction of prostaglandin synthesis:

By inhibiting the COX enzyme, etodolac reduces the production of prostaglandins. Lower levels of prostaglandins result in reduced inflammation, pain and fever.

Analgesic and anti-inflammatory effects:

Through the reduction of prostaglandins, etodolac provides relief from pain and inflammation associated with conditions such as osteoarthritis, rheumatoid arthritis and post-operative pain.

SIDE EFFECTS

Common side effects

• Gastrointestinal problems: Nausea, indigestion, stomach pain, heartburn, and diarrhea.
• Dizziness: Some individuals may experience mild headache or dizziness.
• Headache: Mild to moderate headache.
• Drowsiness or fatigue: Feeling tired or sleepy.
• Skin reactions: Mild rash or itching.

Less common but notable side effects

• Fluid retention: Swelling (edema) in the hands and feet due to water retention.
• High blood pressure: NSAIDs can sometimes raise blood pressure.
• Photosensitivity: Increased sensitivity to sunlight, leading to easier sunburn.
• Appetite changes: Some people may have a loss of appetite.
• Mild weight gain: Related to fluid retention in some cases.

Serious side effects (seek medical help immediately)

• Gastrointestinal bleeding: Symptoms may include black or bloody stools, vomiting blood, or severe stomach pain. 
• Cardiovascular risks: The risk of heart attack, stroke, and blood clots is increased, especially with high doses or long-term use.
• Kidney impairment: Symptoms include decreased urine volume, swelling in the legs, and fatigue. NSAIDs can reduce blood flow to the kidneys, potentially causing damage.
• Liver problems: Symptoms may include yellowing of the skin or eyes (jaundice), dark urine, and pain in the upper right side of the abdomen.
• Severe skin reactions: Rare but serious skin reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis, which is marked by severe rash, blistering, and peeling.
• Allergic reactions: Swelling of the face, lips, or throat, hives, difficulty breathing.

DRUG-DRUG INTERACTIONS

• Anticoagulants: Increased risk of bleeding. Etodolac may enhance the anticoagulant effect of these medications, increasing the chance of bleeding complications.
• Antiplatelet Agents: The risk of gastrointestinal bleeding increases. Combining etodolac with antiplatelet drugs may further decrease the ability of blood to clot, increasing the risk of bleeding.
• NSAIDs and Corticosteroids: The risk of gastrointestinal side effects, such as ulcers and bleeding, is increased. Using etodolac with other NSAIDs or corticosteroids may increase their adverse effects on the gastrointestinal tract.
• Antihypertensives: Decreased efficacy of blood pressure control. NSAIDs such as etodolac may reduce the efficacy of these medications and cause fluid retention, thereby worsening hypertension.
• Diuretics: Increased risk of kidney damage. Etodolac can reduce kidney function, especially when combined with diuretics, which put a strain on the kidneys.
• Lithium: Increased lithium levels and possible toxicity. Etodolac may decrease the clearance of lithium from the body, leading to higher concentrations and increasing the risk of lithium toxicity.
• Methotrexate: Increased methotrexate toxicity. Etodolac may decrease the clearance of methotrexate, increasing levels of the drug in the bloodstream and potentially causing toxic effects.
• Cyclosporine and Tacrolimus: Increased risk of kidney damage. Etodolac may enhance the nephrotoxic effects of these immunosuppressant drugs, which are often used in transplant patients.
• Digoxin: Increased digoxin levels and possible toxicity. NSAIDs such as etodolac may increase blood levels of digoxin, leading to potentially toxic effects, particularly in elderly patients.

USE

• Osteoarthritis: To relieve joint pain, stiffness and swelling in patients with osteoarthritis (a degenerative disease of the joints).
• Rheumatoid Arthritis: To manage the symptoms of rheumatoid arthritis, which is an autoimmune condition that causes swelling, pain, and stiffness in the joints.
• Acute Pain Management: To relieve moderate pain caused by injury, surgery, or other acute conditions.
• Juvenile Rheumatoid Arthritis: To treat pain and inflammation in children with juvenile rheumatoid arthritis (usually older than 6 years of age).