Rhumacap 200 opv medicine for treating rheumatoid arthritis (10 blisters x 10 tablets)

Synthesis inhibition of prostaglandin and COX - 2: All steroid anti -inflammatory drugs have been shown to inhibit prostaglandin formation. This activity is responsible for both the treatment and side effects of the drug. Etodolac's prostaglandin synthesis is different from other NSAIDs.

In the animal research model, in anti -inflammatory doses, PGE concentration in the gastric mucosa has been shown to decrease with less level and in a shorter time than other NSAIDs. This finding is suitable for printing - vitro research, has found Etodolac selected Cyclo - Oxygenase 2 (COX - 2, related to anti -inflammatory) than COX - 1 (protecting the gastric mucosa).

Moreover, research on the cell model in humans shows that Etodolac inhibits the selective COX - 2. The clinical benefits of Cox - 2 inhibitors are not proven.

Anti -inflammatory effects: The tests have shown that Etodolac has much stronger anti -inflammatory activity that has been clinically defined.

Mechanism of action

Etodolac belongs to nonsteroidal anti -inflammatory drugs (NSAID) with anti -inflammatory, analgesic, fever -reducing activity. The mechanism of action through inhibition of cyclooxygenase enzyme is associated with prostaglandin synthesis.

Prostaglandin synthesis and COX selection - 2

All nonsteroidal anti -inflammatory drugs inhibit the formation of prostaglandin, creating treatment effects as well as some unwanted effects of this group of drugs. Etodolac's prostaglandin synthesis is different from other NSAIDs.

On the animal testing model, the concentration of cell protective cells in the gastric mucosa is reduced at a lower level and shorter time than other NSAIDs. This result is suitable for In vitro studies showing that Etodolac selected on COX - 2 than COX - 1. Human cell studies also show that Etodolac selectively inhibits COX - 2.

Anti -inflammatory effects

Pharmacokinetics

absorption

Etodolac is well absorbed when used orally. With a dose of 200 mg or 300 mg of Etodolac, the peak concentration in the plasma is 10 - 18 mcg/ml and 36 mcg/ml reached for about 1-2 hours. After taking the dosage in the therapy range, the concentration of Etodolac in plasma is only slightly higher after the single dose. Etodolac can be taken with food or drink with antacids due to the level of Etodolac absorption is not affected when taken after meals or when taken with antacids.

Distribution

Etodolac binds more than 99%plasma protein. In patients with arthritis, Etodolac is easily distributed into joint fluid after taken.

Metabolism and elimination

Etodolac is widely metabolized in the liver. About 72% of the dose found in urine in the form of inactive metabolites. 16% of the dose is excreted through feces. Etodolac's plasma sale time is 6 - 7.4 hours.

Studies in the elderly show that pharmacokinetics are similar to young people. It is not necessary to adjust the dose in the elderly. Because the Etodolac clearance depends on the liver function, patients with severe liver failure may be reduced in clearance. There is no kinetic change that has been noticeable in patients with mild kidney failure to fit normal. In the normal dose of Etodolac treatment, it reduces uric acid levels in serum 1 - 2 mg after 4 weeks of medication.

Be cautious when using

Etodolac should be used for patients with water retention, kidney failure, kidney damage, heart failure, liver dysfunction, hypertension, elderly people.

Heart thrombosis

Non -steroid anti -inflammatory drugs (NSAIDs), non -aspirin, using systemic sugar, can increase the risk of cardiovascular thrombosis, including myocardial infarction and stroke, which can lead to death. This risk can appear early in the first few weeks of taking the drug and can increase over time. The risk of cardiovascular thrombosis is recorded mainly at high doses.

Doctors need to periodically evaluate the appearance of cardiovascular events, even if the patient has no previous cardiovascular symptoms. Patients should be warned of symptoms of serious cardiovascular events and need to visit the doctor as soon as they appear.

To minimize the risk of disadvantages, it is necessary to use at the lowest daily dose effectively in the shortest possible time.

Respiratory disorders

Be cautious when using Etodolac for patients with a history of bronchial asthma because NSAIDs have been reported to cause bronchospasm in these patients.

Etodolac can cause serious side effects on the gastrointestinal tract including inflammation, bleeding, ulcers and puncture of the stomach, small intestine or large intestine, which can be fatal.

Etodolac can cause serious side effects on the skin such as flaky dermatitis, Stevens - Johnson syndrome (SJS) and poisoned epidermal necrotic syndrome (Ten).

Patients must be notified of warning signs and symptoms of liver toxicity (such as nausea, fatigue, coma, itching, jaundice, and symptoms like influenza). If these signs or symptoms appear, patients need to be instructed to stop taking the drug and seek medical treatment immediately.

Patients must be notified of signs of anaphylactic reaction (such as shortness of breath or throat). If these signs appear, patients need to be instructed to find emergency immediately.

Safety and efficiency in children under 18 years of age have not been established.

The ability to drive and operate machinery

Etodolac can cause dizziness, drowsiness, fatigue and visual disorders. If affected, patients should not drive or operate machinery.

Pregnancy

Contraindicated for women who are pregnant in the last 3 months of pregnancy. In humans, birth defects have been reported related to NSAID treatment. However, the frequency occurs low and does not occur in any form. According to the known effects of NSAIDs on the fetal cardiovascular system (such as the risk of arteriosclerosis), contraindicated use in the last 3 months of pregnancy. The onset of labor may be delayed and increased by pregnancy with increased hemorrhage in both mother and child. NSAIDs should not be used in the first two triplets of pregnancy or during labor, unless the benefits give the mother higher than the risk of the fetus.

The period of breastfeeding

studies so far are still limited, NSAIDs can appear in breast milk at very low concentrations. Etodolac's safety during breastfeeding has not been verified. If possible, avoid using Etodolac when breastfeeding.

Drug interaction

simultaneous use of Etodolac and other NSAIDs (including sapirin) may increase the risk of unwanted effects.

Anti -hypertension drugs: reduce the effectiveness of hypertension treatment.

Diuretics: reduce diuretic effects. Diuretics can increase the toxicity on the body of NSAID drugs.

cardiac glycosides: NSAID drugs can worsen heart failure, reduce glomerular filtration rate and increase plasma glycosides.

Lithi, Methotrexate: Etodolac reduces the elimination of lithium and methotrexate.

Cyclosporin: Increased risk of kidney toxicity caused by cyclosporin.

Mifepriston: Do not use NSAID within 8-12 days after using Mifepriston because it can reduce the effectiveness of Mifepriston.

corticosteroid: Increased risk of bleeding or digestive ulcers.

Anticoagulant: NSAID can increase the effects of anticoagulants. Coordinate NSAID and Warfarin to extend prothrombin time, resulting in an increased risk of bleeding.

Quinolon antibiotics: Increased risk of convulsions in patients using NSAIDs with Quinolon antibiotics.

Anti -platelet collection substances and Serotonin selective reabsorption inhibitors: Increasing the risk of gastrointestinal bleeding.

tacrotimus: Increasing the risk of kidney poison when in combination with NSAID.

Zidovudin: Increasing risk of hematology when used simultaneously with NSAID.

Testing: It is possible to give false positive results with bilirubin tests due to the presence of phenolic metabolic substances in the urine.