Summary
Etodolac is a chiral nonsteroidal anti-inflammatory drug (NSAID) that is marketed as the racemate. Currently, the drug is available in several countries for the treatment of arthritis and the alleviation of pain.
Etodolac possesses several unique disposition features mainly due to its stereoselective pharmacokinetics. In plasma, the concentrations of the ‘inactive’ R-enantiomer are about 10-fold higher than those of the active S-enantiomer, an observation that is novel among the chiral NSAIDs. In common with other NSAIDs, the drug is highly plasma protein bound, and undergoes virtually complete biotransformation to oxidised metabolites and acyl-glucuronides. Etodolac is well absorbed, with maximal plasma concentrations attained within 1 to 2 hours in healthy volunteers. The area under the plasma concentration-time curve of racemic etodolac increases linearly with doses used clinically. The elimination half-life of etodolac is between 6 and 8 hours in plasma, and is similar for both enantiomers. The volume of distribution (Vd) of racemic etodolac is higher than that of most other NSAIDs mainly because of the extensive distribution of the S-enantiomer. The very large Vd of the S-enantiomer, compared with its antipode is, at least in part, due to its less extensive plasma protein binding. In addition to the unchanged drug, substantial concentrations of the acyl-glucuronides of etodolac are found in both plasma and the synovial fluid of patients with arthritis.
A limited amount of conjugated etodolac is found in the bile of patients following cholecystectomy. Hepatic cirrhosis has no effect on the pharmacokinetics of racemic etodolac, although the effect of hepatic dysfunction on the pharmacokinetics of the individual enantiomers has yet to be determined. In elderly nonarthritic individuals with excellent kidney function, aging does not affect the pharmacokinetics of etodolac. The pharmacokinetics of the drug in patients with renal failure have not been published, and may be important because the acyl-glucuronides are renally cleared.
Similar content being viewed by others
References
Ariens EJ. Stereochemistry, a basis for sophisticated nonsense in pharmacokinetics and clinical pharmacology. European Journal of Clinical Pharmacology 26: 663–668, 1984
Ariens EJ, Wuis EW. Bias in pharmacokinetics and clinical pharmacology. Clinical Pharmacology and Therapeutics 42: 361–363, 1987
Bartholemew BA. Synovial fluid glycosidase activity. Scandinavian Journal of Rheumatology 1: 69–74, 1972
Benedetti MS, Frigerio E, Tamassia V, Noseda G, Caldwell J. The dispositional enantioselectivity of indobufen in man. Biochemical Pharmacology 43: 2032–2034, 1992
Brocks DR. The stereoselective pharmacokinetics of etodolac in humans and rats, Doctoral Thesis, University of Alberta, Edmonton, Alberta, 1993
Brocks DR, Jamali F. Enantioselective pharmacokinetics of etodolac in the rat: tissue distribution, tissue binding, and in vitro metabolism. Journal of Pharmaceutical Sciences 80: 1058–1061, 1991
Brocks DR, Jamali F. Clinical pharmacokinetics of ketorolac tromethamine. Clinical Pharmacokinetics 23: 415–427, 1992
Brocks DR, Jamali F, Russell AS. Stereoselective disposition of etodolac enantiomers in synovial fluid. Journal of Clinical Pharmacology 31: 741–746, 1991
Brocks DR, Jamali F, Russell AS, Skeith KJ. The stereoselective pharmacokinetics of etodolac in young and elderly subjects, and after cholecystectomy. Journal of Clinical Pharmacology 32: 982–989, 1992
Cayen MN, Kraml M, Ferdinandi ES, Greselin E, Dvornik D. The metabolic disposition of etodolac in rats, dogs, and man. Drug Metabolism Reviews 12: 339–362, 1981
Cosyns L, Spain M, Kraml M. Sensitive high performance liquid chromatographic method for the determination of etodolac in serum. Journal of Pharmaceutical Sciences 72: 275–277, 1983
Demerson CA, Humber LG, Abraham NA, Schilling G, Martel RR, et al. Resolution of etodolac and anti-inflammatory activity and prostaglandin synthetase inhibiting properties of the enantiomers. Journal of Medicinal Chemistry 26: 1778–1780, 1983
Demerson CA, Humber LG, Philipp AH, Martel RR. Etodolac acid and related compounds. Chemistry and antiinflammatory actions of some potent di- and trisubstituted l,3,4,9-tetrahydropyrano[3,4-b]indole-l-acetic acids. Journal of Medicinal Chemistry 19: 391–395, 1976
Dey M, Enever R, Marino M, Michelucchi J, Weierstall R, et al. Sustained-release etodolac bioavailability and dose proportionality: correlation between in vivo and in vitro performance. International Journal of Pharmaceutics 49: 121–128, 1989
Drayer DE. Pharmacodynamic and pharmacokinetic differences between drug enantiomers in humans: an overview. Clinical Pharmacology and Therapeutics 40: 125–133, 1986
Editorial. Etodolac. Medical Letter on Drugs and Therapeutics 33: 79–80, 1991
Evans AM. Enantioselective pharmacodynamics and pharmacokinetics of chiral non-steroidal anti-inflammatory drugs. European Journal of Clinical Pharmacology 42: 237–256, 1992
Evans AM, Nation RL, Sansom LN, Bochner F, Somogyi AA. Stereoselective drug disposition: potential for misinterpretation of drug disposition data. British Journal of Clinical Pharmacology 26: 771–780, 1988
Ferdinandi ES, Cochrane D, Gedamke R. Identification of the etodolac metabolite, 4-ureidoetodolac, in mouse, rat, dog, and man. Drug Metabolism and Disposition 15: 921–924, 1987
Ferdinandi ES, Sehgal SN, Demerson CA, Dubuc J, Zilber J, et al. Disposition and biotransformation of 14C-etodolac in man. Xenobiotica 16: 153–166, 1986
Foster RT, Jamali F, Russell AS, Alballa SR. Pharmacokinetics of ketoprofen enantiomers in young and elderly arthritic subjects following single and multiple doses. Journal of Pharmaceutical Sciences 78: 191–195, 1988a
Foster RT, Jamali F, Russell AS, Alballa SR. Pharmacokinetics of ketoprofen enantiomers in healthy subjects following single and multiple doses. Journal of Pharmaceutical Sciences 77: 70–73, 1988b
Hayball PJ, Wrobel J, Tamblyn JG, Nation RL. The pharmacokinetics of ketorolac enantiomers following intramuscular administration of the racemate. British Journal of Clinical Pharmacology 37: 75–78, 1994
Humber LG. On the classification of NSAIDs. Drug News & Perspectives 5: 102–103, 1992
Humber LG, Demerson CA, Swaminathan P, Bird PH. Etodolac (1,8-diethyl-l,3,4,9-tetrahydropyrano[3,4-b]indole-l-acetic acid): a potent antiinflammatory drug. Conformation and absolute configuration of its active enantiomer. Journal of Medicinal Chemistry 29: 871–874, 1986
Humber LG, Ferdinandi ES, Demerson CA, Ahmed S, Shah U, et al. Etodolac, a novel antiinflammatory agent. The synthesis and biological evaluation of its metabolites. Journal of Medicinal Chemistry 31: 1712–1719, 1988
Hutt AJ, Caldwell J. The importance of stereochemistry in the clinical pharmacokinetics of the 2-arylpropionic acid non-steroidal anti-inflammatory drugs. Clinical Pharmacokinetics 9: 371–373, 1984
Jamali F. Pharmacokinetics of enantiomers of chiral non-steroidal anti-inflammatory drugs. European Journal of Drug Metabolism and Pharmacokinetics 13: 1–9, 1988
Jamali F. Stereochemistry and bioequivalence. Journal of Clinical Pharmacology 32: 930–934, 1992
Jamali F, Mehvar R, Lemko C, Eradiri O. Application of a stereospecific high-performance liquid chromatography assay to a pharmacokinetic study of etodolac enantiomers in humans. Journal of Pharmaceutical Sciences 77: 963–966, 1988
Jamali F, Mehvar R, Pasutto FM. Enantioselective aspects of drug action and disposition: therapeutic pitfalls. Journal of Pharmaceutical Sciences 78: 695–715, 1989
Kraml M, Cosyns L, Hicks DR, Simon J, Mullane JF, et al. Bioavailability studies with etodolac in dogs and man. Biopharmaceutics and Drug Disposition 5: 63–74, 1984
Kraml M, Hicks DR, McKean M, Panagides J, Furst J. The pharmacokinetics of etodolac in serum and synovial fluid of patients with arthritis. Clinical Pharmacology and Therapeutics 43: 571–576, 1988
Lasseter K, Shamblen E, Murdoch A, Marino M, Minor M, et al. Pharmacokinetics of etodolac in patients with hepatic cirrhosis. Abstract. Journal of Clinical Pharmacology 28: 933, 1988
Lee EDJ, William K, Day R, Graham G, Champion D. Stereoselective disposition of ibuprofen enantiomers in man. British Journal of Clinical Pharmacology 19: 669–674, 1985
Lin JH, Cocchetto DM, Duggan DE. Protein binding as a primary determinant of the clinical pharmacokinetic properties of non-steroidal anti-inflammatory drugs. Clinical Pharmacokinetics 12: 402–432, 1987
Molina-Martinez IT, Herrero R, Gutierrez JA, Iglesias JM, Fabregas JL, et al. Bioavailabilty and bioequivalence of two formulations of etodolac (tablets and suppositories). Journal of Pharmaceutical Sciences 82: 211–213, 1993
Muller NM, Lapicque F, Monot C, Payan E, Dropsy R, et al. Stereoselective binding of etodolac to human serum albumin. Chirality 4: 240–246, 1992
Rubin A, Knadler MP, Ho PPK, Bechtol LD, Wolen RL. Stereoselective inversion of (R)-fenoprofen to (S)-fenoprofen in humans. Journal of Pharmaceutical Sciences 74: 82–84, 1985
Scatina J, Hicks D, Kraml M, Weidler D, Garg D, et al. Etodolac kinetics in the elderly. Clinical Pharmacology and Therapeutics 39: 550–553, 1986
Shinohara Y, Magara H, Baba S. Stereoselective pharmacokinetics and inversion of suprofen enantiomers in humans. Journal of Pharmaceutical Sciences 80: 1075–1078, 1991
Singh NN, Jamali F, Pasutto FM, Coutts RT. Stereoselective gas chromatographic analysis of etodolac enantiomers in human plasma and urine. Journal of Chromatography 382: 331–337, 1986
Singh NN, Jamali F, Pasutto FM, Russell AS, Coutts RT, et al. Pharmacokinetics of the enantiomers of tiaprofenic acid in humans. Journal of Pharmaceutical Sciences 75: 439–442, 1986
Sioufi A, Colussi D, Marfil F, Dubois JP. Determination of the (+)-and (−)-enantiomers of pirprofen in human plasma by high-performance liquid chromatography. Journal of Chromatography 414: 131–137, 1987
Smith PC, Song WQ, Rodriguez RJ. Covalent binding of etodolac acyl glucuronide to albumin in vitro. Drug Metabolism and Disposition 20: 962–965, 1992
Wallis WJ, Simkin PA. Antirheumatic drug concentrations in human synovial fluid and synovial tissue: observations on extravascular pharmacokinetics. Clinical Pharmacokinetics 8: 496–522, 1983
Wright MR, Jamali F. Limited extent of stereochemical conversion of chiral NSAIDs during assays using ethylchroroformate as derivatizing agent. Journal of Chromatography 616: 59–65, 1993
Wyeth-Ayerst. Etodolac prescribing information, US, 1992
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Brocks, D.R., Jamali, F. Etodolac Clinical Pharmacokinetics. Clin. Pharmacokinet. 26, 259–274 (1994). https://doi.org/10.2165/00003088-199426040-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003088-199426040-00003