Names and pronunciation
(ee-toe′doe-lak) Ultradol
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Drug reference
(ee-toe′doe-lak) Ultradol
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Func. class.: Nonsteroidal antiinflam- matory/nonopioid analgesic
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ACTION: Inhibits COX-1, COX-2; anal- gesic, anti-inflammatory
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USES: Mild to moderate pain, osteoar- thritis, rheumatoid arthritis, arthralgia, myalgia, juvenile rheumatoid arthritis
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CONTRAINDICATIONS: Hyper- sensitivity; patients in whom aspirin, iodides, or NSAIDs have produced asthma; urticaria; coronary artery bypass graft sur- gery (CABG) Precautions: Edema, renal/hepatic dis- ease, children, GI ulcers, geriatric patients, bronchospasm, nasal polyps, alcoholism, bone marrow suppression, MI, hemophilia, neutropenia, ulcerative colitis, pregnancy, breastfeeding
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Black Box Warning: GI bleeding, perfo- ration, MI, stroke Black Box Warning: Increase: GI toxic- ity—aspirin, NSAIDs Decrease: effect of etodolac—antacids Decrease: effect of beta-blockers, diuretics Drug/Lab Test Increase: BUN, creatinine Decrease: Hb/Hct, WBC Black Box Warning: For GI bleeding: black stools, hematemesis • Pregnancy/breastfeeding: avoid use unless benefit outweighs risks; avoid in third trimester due to constriction of fetal ductus arteriosus; do not breastfeed Black Box Warning: To avoid aspirin, NSAIDs, acetaminophen, alcoholic bever- ages while taking this medication E HIGH ALERT
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SIDE EFFECTS CNS: Dizziness, headache, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression, light headedness, vertigo CV: Tachycardia, peripheral edema, fluid retention, palpitations, dysrhythmias, HF EENT: Tinnitus, hearing loss, blurred vision, photophobia GI: Nausea, anorexia, vomiting, diar- rhea, jaundice, cholestatic hepati- tis, constipation, flatulence, cramps, dry mouth, peptic ulcer, dyspepsia, GI bleeding GU: Nephrotoxicity: dysuria, hematuria, oliguria, azotemia, cystitis, UTI HEMA: Blood dyscrasias INTEG: Erythema, urticaria, purpura, rash, pruritus, sweating, Stevens-John- son syndrome SYST: Angioedema, anaphylaxis
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INTERACTIONS Increase: toxicity—cycloSPORINE, digoxin, lithium, methotrexate, phenytoin, cidofovir, aminoglycosides
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DOSAGE AND ROUTES Osteoarthritis • Adult: PO 300 mg bid-tid, or 400- 500 mg bid initially, then adjust dosage to 600-1200 mg/day in divided doses; max 1200 mg/day; extended release 400-1000 mg daily Rheumatoid arthritis • Adult: PO 300 mg bid-tid or 400-500 mg bid (regular release); maintenance PO 400-1000 mg/day (extended re- lease) or 600-1000 mg/day divided 2-4 times, max 1200 mg/day (regular re- lease) Analgesia • Adult: PO 200-400 mg q6-8hr up to 1000 mg daily; max 1200 mg/day; pa- tients <60 kg, max 20 mg/kg; extended release 400-1000 mg daily
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Available forms: Capsules 200, 300 mg; tablets 400, 500 mg; extended release 400, 500, 600 mg
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Administer: Without regard to food • Store at room temperature
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Assess: • Pain: location, frequency, characteris- tics; relief after medication • Blood, renal, liver tests: BUN, creatinine, AST, ALT, Hb, platelets prior to treatment, periodically thereafter
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Evaluate: • Therapeutic response: decreased pain, stiffness, swelling in joints, ability to move more easily
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report blurred vision or ringing, roaring in the ears; might indicate toxicity • Not to break, crush, or chew ex- tended-release tablets • To report change in urine pattern, weight increase, edema, pain increase in joints, fever, blood in urine; indicates nephrotoxicity • That therapeutic effects can take up to 1 mo
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PHARMACOKINETICS Peak 11/2-2 hr, serum protein binding >99%, half-life 7 hr; metabolized by liver (metabolites excreted in urine)
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• Adult: PO 300 mg bid-tid, or 400- 500 mg bid initially, then adjust dosage to 600-1200 mg/day in divided doses; max 1200 mg/day; extended release 400-1000 mg daily Rheumatoid arthritis
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• Adult: PO 300 mg bid-tid or 400-500 mg bid (regular release); maintenance PO 400-1000 mg/day (extended re- lease) or 600-1000 mg/day divided 2-4 times, max 1200 mg/day (regular re- lease) Analgesia
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• Adult: PO 200-400 mg q6-8hr up to 1000 mg daily; max 1200 mg/day; pa- tients <60 kg, max 20 mg/kg; extended release 400-1000 mg daily
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