Etodolac: Targeted Relief for Osteoarthritis and Rheumatoid Pain
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Synonyms | |||
Etodolac is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the pyranocarboxylic acid class, specifically indicated for the management of acute and chronic pain associated with osteoarthritis and rheumatoid arthritis. It functions by selectively inhibiting cyclooxygenase-2 (COX-2) more potently than cyclooxygenase-1 (COX-1), which contributes to its efficacy in reducing inflammation and pain with a potentially improved gastrointestinal tolerability profile compared to some non-selective NSAIDs. Available in both immediate-release and extended-release formulations, etodolac offers flexible dosing to accommodate varying patient needs and severity of conditions, making it a versatile option in clinical practice for inflammatory arthropathies.
Features
- Selective COX-2 inhibitor with reduced COX-1 activity
- Available in immediate-release (200 mg, 300 mg) and extended-release (400 mg, 500 mg, 600 mg) tablets
- Demonstrated efficacy in reducing joint swelling, tenderness, and morning stiffness
- Biphasic elimination with a terminal half-life of approximately 7.3 hours
- Metabolized hepatically via cytochrome P450 enzymes (primarily CYP2C9 and CYP3A4)
- Excreted predominantly in urine (73%) as metabolites, with minor fecal elimination
Benefits
- Provides significant reduction in pain and inflammation associated with degenerative joint diseases
- Improves physical function and mobility in patients with osteoarthritis and rheumatoid arthritis
- Offers convenient once-daily dosing with extended-release formulation for sustained therapeutic effect
- Demonstrates a favorable gastrointestinal safety profile relative to non-selective NSAIDs
- Allows for individualized dosing based on patient response and tolerability
- Effective as monotherapy or as part of a comprehensive pain management strategy
Common use
Etodolac is primarily prescribed for the management of signs and symptoms of osteoarthritis and rheumatoid arthritis. Its anti-inflammatory, analgesic, and antipyretic properties make it suitable for controlling disease progression and improving quality of life in patients with chronic inflammatory conditions. Clinicians may also utilize etodolac off-label for other painful inflammatory conditions, though such use should be carefully considered against the risk-benefit profile. The medication is particularly valuable for patients who require long-term NSAID therapy but may be at risk for gastrointestinal complications with non-selective agents.
Dosage and direction
For osteoarthritis and rheumatoid arthritis management, the recommended initial dose for immediate-release etodolac is 300 mg twice daily or 200 mg two or three times daily. For extended-release tablets, the typical dosage is 400-1000 mg once daily. Dosage should be individualized based on the patient’s response and the severity of symptoms, with the lowest effective dose used for the shortest duration possible. Patients should be instructed to take etodolac with food or milk to minimize gastrointestinal upset. Tablets should be swallowed whole and not crushed, chewed, or divided. Regular assessment of treatment efficacy and safety is recommended, particularly during long-term therapy.
Precautions
Patients should be advised that etodolac, like other NSAIDs, may cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may increase with duration of use and in patients with cardiovascular disease or risk factors for cardiovascular disease. Etodolac is contraindicated in the setting of coronary artery bypass graft (CABG) surgery. NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a history of peptic ulcer disease and/or gastrointestinal bleeding are at greater risk for serious gastrointestinal events.
Contraindications
Etodolac is contraindicated in patients with known hypersensitivity to etodolac or any components of the drug product. It should not be used in patients who have experienced asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. Severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients. Etodolac is contraindicated in the setting of coronary artery bypass graft (CABG) surgery. It is also contraindicated in patients with a history of prostaglandin-induced asthma and in patients with active gastrointestinal bleeding or active peptic ulcer disease.
Possible side effect
Common adverse reactions (≥1%) include dyspepsia (10%), nausea (9%), abdominal pain (8%), diarrhea (7%), flatulence (4%), vomiting (3%), constipation (3%), and headache (4%). Serious side effects may include cardiovascular thrombotic events, gastrointestinal bleeding/ulceration/perforation, hepatotoxicity (elevations of ALT and/or AST observed in approximately 15% of patients), renal toxicity including acute renal failure, hypertension, heart failure, and hematologic effects such as anemia. Dermatological reactions including rash, pruritus, and photosensitivity may occur. Patients should be monitored for signs of these serious adverse events throughout treatment.
Drug interaction
Etodolac may interact with several medication classes. Concomitant use with aspirin may decrease etodolac levels and increase gastrointestinal toxicity. Anticoagulants (warfarin) may have enhanced effects, increasing bleeding risk. Concurrent use with ACE inhibitors, angiotensin receptor blockers, or diuretics may reduce antihypertensive effects and impair renal function. Etodolac may increase lithium and methotrexate levels, potentially leading to toxicity. CYP2C9 inhibitors (fluconazole, amiodarone) may increase etodolac concentrations, while inducers (rifampin) may decrease levels. Corticosteroids may increase gastrointestinal ulcer risk. Careful monitoring and dose adjustments are recommended when these medications are co-administered.
Missed dose
If a dose is missed, patients should take it as soon as they remember, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed one. Healthcare providers should educate patients about the importance of consistent dosing for maintaining therapeutic effect while cautioning against excessive dosing that could increase adverse effects.
Overdose
Symptoms of etodolac overdose may include lethargy, drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, coma, hypotension, acute renal failure, and respiratory depression. In case of suspected overdose, seek immediate medical attention. Management is supportive and symptomatic. There is no specific antidote. Gastric lavage or activated charcoal may be considered if presented early after ingestion. Hemodialysis is not effective due to high protein binding. Forced diuresis, alkalinization of urine, or hemoperfusion may not be useful due to extensive protein binding.
Storage
Store etodolac tablets at controlled room temperature 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original container, tightly closed, and protect from moisture and light. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly discard any unused medication through medication take-back programs or according to FDA-recommended disposal methods if no take-back program is available.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Etodolac is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Patients should not initiate, discontinue, or change dosage without consulting their physician. The information provided here may not include all possible uses, directions, precautions, interactions, or adverse effects. Healthcare providers should reference the complete prescribing information before administering this medication. Individual results may vary based on patient-specific factors and disease state.
Reviews
Clinical studies demonstrate etodolac’s efficacy in managing arthritis symptoms, with many patients reporting significant improvement in pain scores and functional status. In a 12-week randomized controlled trial involving osteoarthritis patients, etodolac 600 mg daily showed superior pain relief compared to placebo (p<0.001) and comparable efficacy to naproxen 500 mg twice daily. Rheumatologists frequently note etodolac’s favorable benefit-risk profile, particularly for patients requiring long-term NSAID therapy. Some clinicians report better gastrointestinal tolerability compared to non-selective NSAIDs, though monitoring remains essential. Patient satisfaction surveys indicate improved quality of life measures, though individual responses vary based on disease severity and concomitant therapies.