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ETODOLAC (LODINE)

Etodolac is a non-specific prostaglandin synthesis inhibitor which produces ant-inflammatory, antipyretic (anti-fever), and analgesic pharmacologic effects in approximately 30 minutes after an oral doses of 200-400mg for a duration of 4-6 hours. The drug’s absorption is not affected when administered with an antacid or food, however food will reduce its peak concentration blood levels.

Etodolac is metabolized in the liver and primarily excreted via the kidneys. The drug’s dosage however does not need to be reduced in those patients who are elderly, or have mild to moderate renal insufficiency or liver impairment, unless those with severe liver failure as documented by hepatic enzyme blood tests.

The analgesia produced by 200mg is equivalent to aspirin, and at higher doses of 400mg provides the therapeutic benefit of acetaminophen (600mg)/codeine (60mg) apap#4. For the analgesia needed post dental extraction, a study revealed only half of the patients required to have a second dose given 5-6 hours later. In osteoarthritic patients with knee and hip pathology, Etodolac dosed at 600-1000mg per day provided management. Rheumatoid patients receiving 300mg twice daily exhibited therapeutic efficiency to 20mg of piroxicam (Feldene) daily. At 500mg orally twice daily, Etodolac was comparable to ibuprofen (Motrin) 600mg 4 times daily. It may be co administered with gold salts, corticosteroids, Methotrexate, and chloroquine.

INDICATIONS


Etodolac is indicated for the treatment of acute and long-term manifestations of osteoarthritis and rheumatoid arthritis and for relief of pain. The drug should be avoided in patients with a known reaction to aspirin or any of the non-steroidal anti-inflammatory medications, have asthma, or nasal polyps. The drug should not be used in pregnant or lactating women due to the effect of prostaglandin inhibition on the developing fetal cardiovascular system and of the newborn, and is not indicated in the patient less than 18 years of age.

SIDE EFFECTS


Adverse effects may manifest in the gastrointestinal system such as gastritis, peptic ulcerations, bleeding and perforation. Long term usage may cause renal (kidney) changes such as papillary necrosis, medullary alterations, epithelia hyperplasia, and reduced renal perfusion flow due to the reduction of prostaglandins which serve an important role in renal blood flow maintenance, especially those patients on diuretics (water pills), the elderly, and those with heart failure. This may be reversed by discontinuing the medication. Liver enzymes may be elevated in 15% of the patients. Though liver necrosis is rare, significantly elevated enzymes (up to three fold) which do not reverse by discontinuance of the drug, should be evaluated. Those patients with unexplained rash and/or other blood cell changes should also be further evaluated. The prescribing physician should be made aware of other systemic changes such as significant unexplained constant weight gain, blurred vision or other eye problems, and edema.

Patients on long term therapy which exhibit reduction in pain or arthritic symptoms and will continue with Etodolac, should have periodical blood tests including hemoglobin and hematocrit along with previously mentioned labs.

Drug interactions are due to the highly protein bound characteristic of the drug. These include aspirin which will be in competition for the binding sites and thus have a reduction in therapeutic effect, elevated serum levels of digoxin (which may be cardio toxic), lithium and methotrexate both of which may lead to toxic blood levels. Etodolac in short term usage does not interfere or require dosage adjustment with warfarin (coumadin), antacids, phenytoin (for epileptic seizures), and glyburide (an oral hypoglycemic for type 2 diabetes).

DOSAGE


The dosage of Etodolac, as with all medications, should be the lowest for the indication (analgesia, osteoarthritis, rheumatoid arthritis) which provides the desired response. The usual dose for the relief of pain is 200-400mg orally every 6-8 hours up to 1000mg (one gram) daily. Higher blood levels are required for the relief of the osteoarthritis and rheumatoid arthritis and is dosed at 300 or 400mg orally increased up to 1200mg daily. The drug is available as 200mg, 300mg capsules and 400mg and 500mg film-coated tablets. A time released or extended release tablets are available in 400XL, 500XL, and 600XL mg.

REFERENCES

PDR, PHYSICIANS’ DESK REFERENCE, 59th edition

MPR, MONTHLY PRESCRIBING REFERENCE, PODIATRY EDITION 2009.

COMMENTS

My personal experience with Etodolac has been with the extended release formulations of Lodine for those active patients with busy schedules which were in need of pain relief following repeated injury to an arthritic foot or ankle to ascertain patient compliance. I have also found the benefits of Lodine in those patients which would normally require a codeine derivative with documented allergy.



See our other pain medication discussions.




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Hunterville, NC


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NY
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NJ
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Fla
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Ontario, Canada
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Andrew

Fla.
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Judy

(location unknown)
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New York
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Yvette

Memphis, TN
Thanks again so much for the information in the article. Very interesting.

Anna

Scotland
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J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

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J.C. Forbes

Tennessee
Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)
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Pete M.

(location unknown)
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Madison, Alabama
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Denison, TX
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West lafayette, IN
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Tampa, Florida 33624
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Texas
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Michael D. Ebeling

Tampa, Florida 33624


Thanks for a most interesting website, which has helped a lot.

Steve

UK


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Regards,

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Edmonton,Canada


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South Africa


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Matthew W.

Mansfield Ctr, CT


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Steve

Placentia, California


First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


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Pacific Grove, CA


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All the best,

Victoria

Alameda, California


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Anonymous


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Anonymous




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New Zealand


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Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

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Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. http://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
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M P

South Carolina
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Natalie

unknown location


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Arlington, VA


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San Clemente, CA


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Pam

location unknown


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Glen

location unknown


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Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




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Poland




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Seattle, WA


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Bonnie

location unknown




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New Jersey




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Debbie

location unknown




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Chrissy

location unknown




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Evansville, IA




Dear Marc

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Russ W.

location unknown




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location unknown




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San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




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Jill S.

location unknown




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Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




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Michelle

Colorado




Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
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Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
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Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown