Summary of medicine characteristics - ETOLYN 600 MG PROLONGED-RELEASE TABLETS
1 NAME OF THE MEDICINAL PRODUCT
Etolyn600 mg prolonged release tablets
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Each prolonged release tablet contains 600 mg of etodolac.
Excipient with known effect:
Each prolonged release tablet contains 244 mg lactose.
For the full list of excipients, see section 6.1.
3 PHARMACEUTICAL FORM
Prolonged release tablet.
Blue, biconvex, oval shaped film-coated tablets impressed on one side with 600.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Etolyn is indicated for acute or long-term use in rheumatoid arthritis and osteoarthritis.
Etolyn is indicated in adults.
4.2 Posology and method of administration
Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms (see section 4.4)
Posology
Adults:
One tablet daily.
The safety of doses in excess of 600 mg per day has not been established.
No occurrence of tolerance or tachyphylaxis has been reported.
Elderly
No change in initial dosage is generally required in the elderly (see section 4.4).
The elderly are at increased risk of the serious consequences of adverse reactions. If an NSAID is considered necessary, the lowest effective dose should be used and for the shortest possible duration. The patient should be monitored regularly for GI bleeding during NSAID therapy.
Paediatric population
Etolyn should not be used in children.
Method of administration
For oral administration.
To be taken preferably with or after food, swallowed whole with a glass of water.
4.3 Contraindications
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1
Etolyn should not be used in patients with severe heart failure.
Etolyn should not be used in patients with active or history of recurrent peptic ulceration or a history of peptic ulcer disease (with two or more distinct episodes of proven ulceration or bleeding).
NSAIDs are contraindicated in patients who have previously shown hypersensitivity reactions (e.g. asthma, rhinitis angioedema or urticaria) during therapy with ibuprofen, aspirin or other non-steroidal anti-inflammatory drugs.
Severe heart failure, hepatic failure and renal failure (see section 4.4)
During the last trimester of pregnancy (see section 4.6)
History of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy.
4.4 Special warnings and precautions for use
Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms (see section 4.2, and GI and cardiovascular risks below).
The use of Etolyn with concomitant NSAIDs including cyclooxygenase-2-selective inhibitors should be avoided (see section 4.5).
Elderly:
The elderly have an increased frequency of adverse reactions to NSAIDs especially gastrointestinal bleeding and perforation which may be fatal (see section 4.2).
Cardiovascular and cerebrovascular effects:
Appropriate monitoring and advice are required for patients with a history of hypertension and/or mild to moderate congestive heart failure as fluid retention and oedema have been reported in association with NSAID therapy.
Clinical trial and epidemiological data suggest that use of some NSAIDs (particularly at high doses and in long term treatment) may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke). There are insufficient data to exclude such a risk for etodolac.
Patients with uncontrolled hypertension, congestive heart failure, established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease should only be treated with etodolac after careful consideration. Similar consideration should be made before initiating longer-term treatment of patients with risk factors for cardiovascular disease (e.g. hypertension, hyperlipidaemia, diabetes mellitus, smoking).
Respiratory disorders:
Caution is required if etodolac is administered to patients suffering from, or with a previous history of, bronchial asthma since NSAIDs have been reported to precipitate bronchospasm in such patients.
Cardiovascular, Renal and Hepatic Impairment:
In patients with renal, cardiac or hepatic impairment especially those taking diuretics and the elderly, renal function should be monitored in these patients (see also section 4.3). Caution is required since the use of NSAIDs may result in a dose dependent reduction in prostaglandin formation and precipitate renal failure. The dose should be kept as low as possible. However, impairment of renal or hepatic functions due to other causes may alter drug metabolism; patients receiving concomitant long term therapy, especially the elderly, should be observed for potential side effects and their drug doses adjusted as needed, or the drug discontinued.
Gastrointestinal bleeding, ulceration and perforation:
Serious gastrointestinal adverse effects such as bleeding, ulceration and perforation, which can be fatal, has been reported and can occur at any time with or without warning symptoms in patients treated with NSAIDs or a previous history of serious GI events. If any sign of gastrointestinal bleeding occurs, Etolyn should be stopped immediately.
Platelets:
Although non-steroidal anti-inflammatory drugs do not have the same direct effects on platelets as does aspirin, all drugs which inhibit the biosynthesis of prostaglandins may interfere, to some extent, with platelet function. Patients receiving Etolyn who may be adversely affected by such actions should be carefully observed.
Patients on long-term treatment with Etolyn should be regularly reviewed as a precautionary measure e.g. for changes in, renal function, haematological parameters, or hepatic function.
The risk of GI bleeding, ulceration or perforation is higher with increasing NSAID doses, in patients with a history of ulcer, particularly if complicated with haemorrhage or perforation (see section 4.3), and in the elderly. These patients should commence treatment on the lowest dose available. Combination therapy with protective agents (e.g. misoprostol or proton pump inhibitors) should be considered for these patients, and also for patients requiring concomitant low dose aspirin, or other drugs likely to increase gastrointestinal risk (see below and section 4.5)
Patients with a history of GI toxicity, particularly when elderly, should report any unusual abdominal symptoms (especially GI bleeding) particularly in the initial stages of treatment.
Caution should be advised in patients receiving concomitant medications which could increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin-reuptake inhibitors or anti-platelet agents such as aspirin (see section 4.5).
When GI bleeding or ulceration occurs in patients receiving Etodolac, the treatment should be withdrawn.
NSAIDs should be given with care to patients with a history of gastrointestinal disease (ulcerative colitis, Crohn's disease) as these conditions may be exacerbated (see section 4.8)
Systemic lupus erythematosus and mixed connective tissue disease:
In patients with systemic lupus erythematous (SLE) and mixed connective tissue disorders there may be an increased risk of aseptic meningitis (see section 4.8).
Dermalogical Safety:
Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs (see section 4.8). Patients appear to be at highest risk for these reactions early in the course of therapy: the onset of the reaction occurring in the majority of cases within the first month of treatment. Etolyn should be discontinued at the first appearance of the skin rash, mucosal lesions, or any other sign of hypersensitivity.
Impaired female fertility:
The use of Etolyn may impair female fertility and is not recommended in woman attempting to conceive. In women who have difficulties conceiving or who are undergoing investigation of Infertility, withdrawal of Etolyn should be considered.
Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
4.5 Interaction with other medicinal products and other forms of interaction Since etodolac is extensively protein-bound, it may be necessary to modify the dosage of other highly protein-bound drugs.
Other analgesics including cyclooxygenase-2 selective inhibitor: Avoid concomitant use of two or more NSAIDs (including aspirin) as this may increase the risk of adverse effects (see section 4.4)
Anti-hypertensives: Reduced anti-hypertensive effect
Diuretics: Reduced diuretic effect. Diuretics can increase the risk of nephrotoxicity of NSAIDs.
Cardiac glycosides: NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma glycoside levels.
Lithium: Decreased elimination of lithium
Methotrexate: Decreased elimination of methotrexate
Ciclosporin: Increased risk of nephrotoxicity
Anti-coagulants: NSAIDs may enhance the effects of anti-coagulants, such as warfarin (see section 4.4)
Anti-platelet agents: and selective serotonin reuptake inhibitors (SSRIs): Increased risk of gastrointestinal bleeding (see section 4.4)
Tacrolimus: Possible increased risk of nephrotoxicity when NSAIDs are given with tacrolimus.
Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with zidovudine. There is a evidence of an increased risk of haemarthroses and haemtoma in HIV(+) haemophiliacs receiving concurrent treatment with zidovudine and ibuprofen.
Bilirubin tests can give a false positive result due to the presence of phenolic metabolites of Etolyn in the urine.
Mifepristone: NSAIDs should not be used for 8–12 days after mifepristone administration as NSAIDs can reduce the effect of mifepristone.
Corticosteroids: increased risk of gastrointestinal ulceration or bleeding (see section 4.4)
Quinolone antibiotics: animal data indicate that NSAIDs can increase the risk of convulsions associated with quinolone antibiotics. Patients taking NSAIDs and quinolones may have an increased risk of developing convulsions.
4.6 Fertility, pregnancy and lactation
Pregnancy
Drugs which inhibit prostaglandin biosynthesis may cause dystocia and delayed parturition as evidenced by studies in pregnant animals.
Congenital abnormalities have been reported in association with NSAID administration in man; however, these are low in frequency and do not appear to follow any discernible pattern. In view of the known effects of NSAIDs on the foetal cardiovascular system, some inhibitors of prostaglandin biosynthesis have been shown to interfere with the risk of closure of the ductus arteriosus, use in the last trimester of pregnancy is contraindicated. The onset of labour may be delayed and the duration increased with an increased bleeding tendency in both mother and child (see section 4.3). NSAIDs should not be used during the first two trimesters of pregnancy or labour unless the potential benefit to the patient outweighs the potential risk to the foetus.
Breast-feeding
In limited studies so far available, NSAIDs can appear in breast milk in very low concentrations. NSAIDs should, if possible, be avoided when breastfeeding.
Fertility
See section 4.4 regarding female fertility.
4.7 Effects on ability to drive and use machines
Etolyn has moderate influence on the ability to drive and use machines. Etolyn can cause dizziness, drowsiness, fatigue or abnormal vision. Patients need to be aware of how they react to this medicine before driving or operating machines.
4.8 Undesirable effects
Summary of the safety profile
The most reported undesirable effects are gastrointestinal effects.
List of adverse reactions
Undesirable effects are listed below by system organ class and frequency.
Frequencies are defined as:
very common (>1/10), common (>1/100 to <1/10), uncommon (>1/1,000 to <1/100), rare (>1/10,000 to <1/1,000), very rare (<1/10,000), not known (cannot be estimated from the available data).
Blood and lymphatic system disorders
Uncommon: Thrombocytopenia, neutropenia, agranulocytosis, aplastic anaemia and haemolytic anaemia.
Immune system disorder
Not known: Hypersensitivity reactions have been reported following treatment with NSAIDs. These may consists of (a) non-specific allergic reactions and anaphylaxis (b) respiratory tract reactivity comprising asthma, aggravated asthma, bronchospasm or dyspnoea, or © assorted skin disorders, including rashes of various types, pruritus, urticaria, purpura, angioedema and more rarely exfoliative and bullous dermatoses (including epidermal necrolysis and erythema multiforme).
Nervous system disorders
Common: malaise, headaches, vertigo, dizziness, fatigue.
Uncommon: insomnia, drowsiness.
Not known: paraethesia, reports of aseptic meningitis (especially in patients with existing auto-immune disorders, such as systemic lupus erythematous, mixed connective tissue disease), with symptoms such as stiff neck, headache, febre, nausea, vomitiong, fever or disorientation (See section 4.4), depression, confusion, hallucinations.
Eye disorders
Common: Visual disturbances
Not known: optic neuritis
Ear and labyrinth disorders
Common: tinnitus
Cardiac disorders
Common: Oedema, hypertension and cardiac failure have been reported in association with NSAID treatment.
Not known: Clinical trial and epidemiological data suggest that use of some NSAIDs (particularly at high doses and in long term treatment) may be associated with an increased risk of arterial thrombotic events (for example myocardial infarction or stroke) (see section 4.4).
Gastrointestinal disorders
Common: nausea, diarrhoea, flatulence, abdominal pain, constipation, vomiting, ulcerative stomatitis, dyspepsia, haematemesis, melaena, exacerbation of colitis and Crohn's disease (See section 4.4)
Uncommom: gastritis
Very rare: Pancreatitis
Not known: epigastric pain, indigestion, heartburn, rectal bleeding, vasculitis,
Hepatobiliary disorders
Not known: jaundice, abnormal liver function, hepatitis
Skin and subcutaneous tissue disorders
Uncommon: photosensitivity
Very rare: bullous reactions including Stevens Johnson Syndrome and Toxic Epidermal Necrolysis.
Renal and urinary disorders
Not known: abnormal urinary frequency, dysuria, Nephrotoxicity in various forms, including interstitial nephritis, nephrotic syndrome and renal failure.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme. Website: www.mhra.gov.uk/yellowcard.
4.9 Overdose
4.9 OverdoseSymptoms
Symptoms include headache, nausea, vomiting, epigastric pain, gastrointaestinal bleeding, rarely diarrhoea, disorientation, excitation, coma, drowsiness, dizziness, tinnitus, fainting, occasionally convulsions. In cases of significant poisoning acute renal failure and liver damage are possible.
Therapeutic measure
Patients should be treated symptomatically as required.
Within one hour of ingestion of a potentially toxic amount, activated charcoal should be considered. Alternatively gastric lavage should be considered within one hour of indigestion of a potentially life-threatening overdose.
Good urine output should be ensured.
Renal and liver function should be closely montored.
Patients should be observed for at least four hours after ingestion of potentially toxic amounts.
Frequent or prolonged convulsions should be treated with intravenous diazepam.
Other measures may be indicated by the patient's clinical condition.
The standard practices of gastric lavage, activated charcoal administration and general supportive therapy should be undertaken.
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Antiinflammatory and Antirheumatic Products, Antiinflammatory and Antirheumatic Products, Non-Steroids, Acetic acid derivatives and related substances
ATC code: M01AB08
Mechanism of action
Inhibition of prostaglandin synthesis and COX-2 selectivity: All non-steroidal antiinflammatory drugs (NSAIDs) have been shown to inhibit the formation of prostaglandins. It is this action which is responsible both for their therapeutic effects and some of their side-effects. The inhibition of prostaglandin synthesis observed with etodolac differs from that of other NSAIDs. In an animal model at an established anti-inflammatory dose, cytoprotective PGE concentration in the gastric mucosa have been shown to be reduced to a lesser degree and for a shorter period than other NSAIDs. This finding is consistent with subsequent in-vitro studies which have found etodolac to be selective for induced cyclo-oxygenase 2 (COX-2, associated with inflammation) over COX-1 (cytoprotective).
Clinical efficacy and safety
Studies in human cell models have confirmed that etodolac is selective for the inhibition of COX-2.
The clinical benefit of preferential COX-2 inhibition over COX-1 has yet to be proven.
Anti-inflammatory effects: Experiments have shown etodolac to have marked antiinflammatory activity, being more potent than several clinically established NSAIDs.
5.2 Pharmacokinetic properties
Absorption
In man, etodolac is well absorbed following oral administration.
In subjects receiving daily doses of etodolac 400mg or 600mg over a three day period, the peak plasma concentrations were 7.5pg/ml at 7.9 hours and 11.9pg/ml at 7.8 hours.
Distribution
Etodolac is highly bound to serum proteins.
Elimination
The elimination half-life averages seven hours in man. The primary route of excretion is in the urine, mostly in the form of metabolites.
5.3 Preclinical safety data
5.3 Preclinical safety dataEtodolac showed no carcinogenic potential, in rat or mouse, nor genotoxic potential.
In reproductive toxicity studies, the drug did not affect fertility in male or female rats. However, demonstrated ability to decrease in embryo implantation.
Etodolac was not clearly teratogenic in rats or rabbits. Nevertheless drugs which inhibit prostaglandin biosynthesis may cause increased incidence of dystocia and delayed parturition.
6 PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Tablet core
Lactose Monohydrate
Hydroxypropyl methylcellulose
Povidone
Mannitol
Colloidal silicon dioxide
Magnesium stearate
Talc
Film-coating
Hipromelose
Titanium Dioxide (E171)
Polyethylene glycol
FD&C Blue#2
6.2 Incompatibilities
Not applicable.
6.3 Shelf life
2 years
6.4 Special precautions for storage
This medicinal product does not require any special storage conditions.
6.5 Nature and contents of container
PVDC/PVC/aluminium foil Blisters: Packs with10 or 30 prolonged release tablets.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal
6.6 Special precautions for disposalAny unused medicinal product or waste material should be disposed of in accordance with local requirements.
7 MARKETING AUTHORISATION HOLDER
Abdi Farma, Unipessoal Lda
Quinta da Fonte, Rua dos Malhoes,
Edificio D. Pedro I
2770 – 071 Pago de Arcos, Portugal
8 MARKETING AUTHORISATION NUMBER(S)
PL 39360/0011
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
24/02/2015