Dosage of Etopan 200 in details
Etopan 200 Dosage
Generic name: Etopan 200
Dosage form: Capsules and Tablets
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Carefully consider the potential benefits and risks of Etopan 200 and other treatment options before deciding to use Etopan 200. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
After observing the response to initial therapy with Etopan 200, the dose and frequency should be adjusted to suit an individual patient's needs. As with other NSAIDs, the lowest dose and longest dosing interval should be sought for each patient. Therefore, after observing the response to initial therapy with Etopan 200, the dose and frequency should be adjusted to suit an individual patient's needs.
Dosage adjustment of Etopan 200 is generally not required in patients with mild to moderate renal impairment. Etopan 200 should be used with caution in such patients, because, as with other NSAIDs, it may further decrease renal function in some patients with impaired renal function.
Analgesia
The recommended total daily dose of Etopan 200 for acute pain is up to 1000 mg, given as 200-400 mg every 6 to 8 hours. Doses of Etopan 200 greater than 1000 mg/day have not been adequately evaluated in well-controlled clinical trials.
Osteoarthritis and Rheumatoid Arthritis
The recommended starting dose of Etopan 200 for the management of the signs and symptoms of osteoarthritis or rheumatoid arthritis is: 300 mg b.i.d., t.i.d., or 400 mg b.i.d., or 500 mg b.i.d. A lower dose of 600 mg/day may suffice for long-term administration. Physicians should be aware that doses above 1000 mg/day have not been adequately evaluated in well-controlled clinical trials.
In chronic conditions, a therapeutic response to therapy with Etopan 200 is sometimes seen within one week of therapy, but most often is observed by two weeks. After a satisfactory response has been achieved, the patient's dose should be reviewed and adjusted as required.
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Consumer resources
- Etopan 200
- Etopan 200 (Advanced Reading)
Professional resources
- Etopan 200 (FDA)
- Etopan 200 (AHFS Monograph)
Other formulations
- Etopan 200 XL
Related treatment guides
- Juvenile Rheumatoid Arthritis
- Osteoarthritis
- Pain
- Rheumatoid Arthritis
What other drugs will affect Etopan 200?
Tell your doctor if you are taking an antidepressant such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor). Taking any of these drugs with Etopan 200 may cause you to bruise or bleed easily.
Before taking Etopan 200, tell your doctor if you are taking any of the following drugs:
- a blood thinner such as warfarin (Coumadin);
- cyclosporine (Gengraf, Neoral, Sandimmune);
- digoxin (digitalis, Lanoxin);
- lithium (Eskalith, Lithobid);
- methotrexate (Rheumatrex, Trexall);
- a diuretic (water pills) such as furosemide (Lasix);
- steroids (prednisone and others);
- aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as diclofenac (Cataflam, Voltaren), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others; or
- an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace), and others.
This list is not complete and there may be other drugs that can interact with Etopan 200. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Etopan 200 interactions
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 Etopan 200. However, antacids can decrease the peak concentration reached by 15% to 20% but have no detectable effect on the time-to-peak.
Aspirin
When Etopan 200 is administered with aspirin, its protein binding is reduced, although the clearance of free Etopan 200 is not altered. The clinical significance of this interaction is not known; however, as with other NSAIDs, concomitant administration of Etopan 200 and aspirin is not generally recommended because of the potential of increased adverse effects.
Cyclosporine, Digoxin, Methotrexate
Etopan 200, 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 Etopan 200, 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
Etopan 200 has no apparent pharmacokinetic interaction when administered with furosemide or hydrochlorothiazide. Nevertheless, clinical studies, as well as post marketing observations have shown that Etopan 200 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
Etopan 200 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 Etopan 200. Although in vivo studies have not been done to see if Etopan 200 clearance is changed by coadministration of phylbutazone, it is not recommended that they be coadministered.
Phenytoin
Etopan 200 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 Etopan 200 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 Etopan 200 as measured by prothrombin time. Thus, concomitant therapy with warfarin and Etopan 200 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 Etopan 200-treated patients receiving concomitant warfarin therapy.
Drug/Laboratory Test Interactions
The urine of patients who take Etopan 200 can give a false-positive reaction for urinary bilirubin (urobilin) due to the presence of phenolic metabolites of Etopan 200. Diagnostic dip-stick methodology, used to detect ketone bodies in urine, has resulted in false-positive findings in some patients treated with Etopan 200. Generally, this phenomenon has not been associated with other clinically significant events. No dose relationship has been observed.
Etopan 200 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 Etopan 200 (600 mg to 1000 mg/day) after 4 weeks of therapy. These levels then remained stable for up to 1 year of therapy.
References
- DailyMed. "ETODOLAC: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- MeSH. "Cyclooxygenase 2 Inhibitors". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
- European Chemicals Agency - ECHA. "(RS)-2-(1,8-Diethyl-4,9-dihydro-3H-pyrano[3,4-b]indol-1-yl)acetic acid: The information provided here is aggregated from the "Notified classification and labelling" from ECHA's C&L Inventory. ". https://echa.europa.eu/information-o... (accessed September 17, 2018).
Reviews
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Information checked by Dr. Sachin Kumar, MD Pharmacology