Side Effects of Lodine (etodolac)

Lodine (etodolac) is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation associated with osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, tendinitis, bursitis, and menstrual cramps. 

Lodine blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower concentrations of prostaglandins. As a consequence, inflammation, pain and fever are reduced. The brand name Lodine is discontinued.

Common side effects of Lodine include

• rash,
• ringing in the ears,
• headaches,
• dizziness,
• drowsiness,
• abdominal pain,
• nausea,
• diarrhea,
• constipation,
• heartburn,
• fluid retention, and
• shortness of breath.

Serious side effects of Lodine include

• reduced ability of blood to clot and increased bleeding after an injury,
• stomach and intestinal bleeding and ulcers,
• impaired kidney function,
• heart attacks,
• high blood pressure (hypertension), and
• heart failure.

Drug interactions of Lodine include

• antidepressants,
• cyclosporine,
• lithium,
• methotrexate,
• blood thinners,
• heart or blood pressure medications,
• diuretics (water pills), and
• steroids. 

In late pregnancy, the third trimester, as with other NSAIDs, Lodine should be avoided because it may cause premature closure of the ductus arteriosus. 

It is unknown if Lodine is excreted in breast milk. Consult your doctor before breastfeeding. 

The most common side effects from etodolac are:

• rash,
• ringing in the ears,
• headaches,
• dizziness,
• drowsiness,
• abdominal pain,
• nausea,
• diarrhea,
• constipation,
• heartburn,
• fluid retention, and
• shortness of breath.

NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury. Etodolac also may cause stomach and intestinal bleeding and ulcers. Sometimes, stomach ulceration and intestinal bleeding can occur without any abdominal pain. Black, tarry stools, weakness, and dizziness upon standing may be the only signs of the bleeding.

People who are allergic to other NSAIDs should not use etodolac. NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients who already have impairment of kidney function or congestive heart failure, and treatment with NSAIDs in these patients should be done cautiously. Individuals with asthma are more likely to experience allergic reactions to etodolac and other NSAIDs.

Other important side effects of NSAIDs include:

• Fluid retention,
• blood clots,
• heart attacks,
• hypertension, and
• heart failure.

In patients taking etodolac or other NSAIDs, the most frequently reported adverse experiences occurring in approximately 1 to 10% of patients are:

• Gastrointestinal experiences including: abdominal pain, constipation, diarrhea, dyspepsia, flatulence, gross bleeding/perforation, heartburn, nausea, GI ulcers (gastric/duodenal), vomiting.
• Other events including: abnormal renal function, anemia, dizziness, edema, elevated liver enzymes, headaches, increased bleeding time, pruritis, rashes, tinnitus.
• Adverse-reaction information for etodolac was derived from 2,629 arthritic patients treated with etodolac capsules and tablets in double-blind and open-label clinical trials of 4 to 320 weeks in duration and worldwide postmarketing surveillance studies. In clinical trials, most adverse reactions were mild and transient. The discontinuation rate in controlled clinical trials, because of adverse events, was up to 10% for patients treated with etodolac.
• New patient complaints (with an incidence greater than or equal to 1%) are listed below by body system. The incidences were determined from clinical trials involving 465 patients with osteoarthritis treated with 300 to 500 mg of etodolac b.i.d. (i.e., 600 to 1000 mg/day). Incidence Greater That or Equal to 1% - Probably Causally Related
• Body as a whole - Chills and fever.
• Digestive system - Dyspepsia (10%), abdominal pain*5, diarrhea*5, flatulence*5, nausea*5, constipation, gastritis, melena, vomiting.
• Nervous system - Asthenia/malaise*5, dizziness*5, depression, nervousness.
• Skin and appendages - Pruritus, rash.
• Special senses - Blurred vision, tinnitus.
• Urogenital system - Dysuria, urinary frequency.
• Drug-related patient complaints occurring in fewer than 3%, but more than 1%, are unmarked. 5*Drug-related patient complaints occurring in 3 to 9% of patients treated with etodolac. Incidence Less Than 1% - Probably Causally Related
• (Adverse reactions reported only in worldwide postmarketing experience, not seen in clinical trials, are considered rarer and are italicized)
• Body as a whole - Allergic reaction, anaphylactic/anaphylactoid reactions (including shock).
• Cardiovascular system - Hypertension, congestive heart failure, flushing, palpitations, syncope, vasculitis (including necrotizing and allergic).
• Digestive system - Thirst, dry mouth, ulcerative stomatitis, anorexia, eructation, elevated liver enzymes, cholestatic hepatitis, hepatitis, cholestatic jaundice, duodenitis, jaundice, hepatic failure, liver necrosis, peptic ulcer with or without bleeding and/or perforation, intestinal ulceration, pancreatitis.
• Hemic and lymphatic system - Ecchymosis, anemia, thrombocytopenia, bleeding time increased, agranulocytosis, hemolytic anemia, leukopenia, neutropenia, pancytopenia.
• Metabolic and nutritional - Edema, serum creatinine increase, hyperglycemia in previously controlled diabetic patients.
• Nervous system - Insomnia, somnolence.
• Respiratory system - Asthma, pulmonary infiltration with eosinophilia.
• Skin and appendages - Angioedema, sweating, urticaria, vesiculobullous rash, cutaneous vasculitis with purpura, Stevens-Johnson Syndrome, toxic epidermal necrolysis, hyperpigmentation, erythema multiforme.
• Special senses - Photophobia, transient visual disturbances.
• Urogenital system - Elevated BUN, renal failure, renal insufficiency, renal papillary necrosis.
• Incidence Less Than 1% - Causal Relationship Unknown
• (Medical events occurring under circumstances where causal relationship to etodolac is uncertain. These reactions are listed as alerting information for physicians)
• Body as a whole - Infection, headache.
• Cardiovascular system - Arrhythmias, myocardial infarction, cerebrovascular accident.
• Digestive system - Esophagitis with or without stricture or cardiospasm, colitis.
• Metabolic and nutritional - Change in weight.
• Nervous system - Paresthesia, confusion.
• Respiratory system - Bronchitis, dyspnea, pharyngitis, rhinitis, sinusitis.
• Skin and appendages - Alopecia, maculopapular rash, photosensitivity, skin peeling.
• Special senses - Conjunctivitis, deafness, taste perversion.
• Urogenital system - Cystitis, hematuria, leukorrhea, renal calculus, interstitial nephritis, uterine bleeding irregularities.

Additional Adverse Reactions Reported with NSAIDs

• Body as a whole - Sepsis, death.
• Cardiovascular system - Tachycardia.
• Digestive system - Gastric ulcers, gastritis, gastrointestinal bleeding, glossitis, hematemesis.
• Hemic and lymphatic system - Lymphadenopathy.
• Nervous system - Anxiety, dream abnormalities, convulsions, coma, hallucinations, meningitis, tremors, vertigo.
• Respiratory system - Respiratory depression, pneumonia.
• Urogenital system - Oliguria/polyuria, proteinuria.

Drug Interactions ACE-inhibitors

• Reports suggest that NSAIDs may diminish the antihypertensive effect of ACE-inhibitors.
• This interaction should be given consideration in patients taking NSAIDs concomitantly with ACE-inhibitors.

Antacids

• The concomitant administration of antacids has no apparent effect on the extent of absorption of etodolac.
• However, antacids can decrease the peak concentration reached by 15% to 20% but have no detectable effect on the time-to-peak.

Aspirin

• When etodolac is administered with aspirin, its protein binding is reduced, although the clearance of free etodolac is not altered.
• The clinical significance of this interaction is not known; however, as with other NSAIDs, concomitant administration of etodolac and aspirin is not generally recommended because of the potential of increased adverse effects.

Cyclosporine, Digoxin, Methotrexate

• Etodolac, like other NSAIDs, through effects on renal prostaglandins, may cause changes in the elimination of these drugs leading to elevated serum levels of cyclosporine, digoxin, methotrexate, and increase toxicity.
• Nephrotoxicity associated with cyclosporine may also be enhanced.
• Patients receiving these drugs who are given etodolac, or any other NSAID, and particularly those patients with altered renal function, should be observed for the development of the specific toxicities of these drugs.
• NSAIDs have been reported to competitively inhibit methotrexate accumulation in rabbit kidney slices.
• This may indicate that they could enhance the toxicity of methotrexate.
• Caution should be used when NSAIDs are administered concomitantly with methotrexate.

Diuretics

• Etodolac has no apparent pharmacokinetic interaction when administered with furosemide or hydrochlorothiazide.
• Nevertheless, clinical studies, as well as post marketing observations have shown that etodolac can reduce the natriuretic effect of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis.
• During concomitant therapy with NSAIDs, the patient should be observed closely for sings of renal failure, as well as to assure diuretic efficacy.

Glyburide

• Etodolac has no apparent pharmacokinetic interaction when administered with glyburide.

Lithium

• NSAIDs have produced an elevation of plasma lithium levels and a reduction in renal lithium clearance.
• The mean minimum lithium concentration increased 15% and the renal clearance was decreased by approximately 20%.
• These effects have been attributed to inhibition of renal prostaglandin synthesis by the NSAID.
• Thus, when NSAIDs and lithium are administered concurrently, subjects should be observed carefully for signs of lithium toxicity.

Phenylbutazone

• Phenylbutazone causes increase (by about 80%) in the free fraction of etodolac.
• Although in vivo studies have not been done to see if etodolac clearance is changed by coadministration of phylbutazone, it is not recommended that they be coadministered.

Phenytoin

• Etodolac has no apparent pharmacokinetic interaction when administered with phenytoin.

Warfarin

• The effects of warfarin and NSAIDs on GI bleeding are synergistic, such that users of both drugs together have a risk of serious GI bleeding higher than that of users of either drug alone.
• Short-term pharmacokinetic studies have demonstrated that concomitant administration of warfarin and etodolac results in reduced protein binding of warfarin, but there was no change in the clearance of free warfarin.
• There was no significant difference in the pharmacodynamic effect of warfarin administered alone and warfarin administered with etodolac as measured by prothrombin time.
• Thus, concomitant therapy with warfarin and etodolac should not require dosage adjustment of either drug.
• However, caution should be exercised because there have been a few spontaneous reports of prolonged prothrombin times, with or without bleeding, in etodolac-treated patients receiving concomitant warfarin therapy.

Drug/Laboratory Test Interactions

• The urine of patients who take etodolac can give a false-positive reaction for urinary bilirubin (urobilin) due to the presence of phenolic metabolites of etodolac.
• Diagnostic dip-stick methodology, used to detect ketone bodies in urine, has resulted in false-positive findings in some patients treated with etodolac.
• Generally, this phenomenon has not been associated with other clinically significant events. No dose relationship has been observed.
• Etodolac treatment is associated with a small decrease in serum uric acid levels.
• In clinical trials, mean decreases of 1 to 2 mg/dL were observed in arthritic patients receiving etodolac (600 mg to 1000 mg/day) after 4 weeks of therapy. These levels then remained stable for up to 1 year of therapy.