Etodolac should be avoided by patients with a history of asthma attacks, hives , or other allergic reactions to aspirin or other NSAIDs. Rare but severe allergic reactions have been reported in such individuals. It also should be avoided by patients with peptic ulcer disease or poor kidney function , since this medication can worsen both conditions. Etodolac is used with caution in patients taking blood thinning medications ( anticoagulants ), such as warfarin (Coumadin), because it increases the risk of bleeding . Patients taking both lithium and etodolac may develop toxic blood lithium levels. Additionally, etodolac has been found to interact with certain anti-depressant medications, such as sertraline or fluoxetine , which can increase risks of stroke, heart attack, and other cardiovascular conditions. Patients also taking ciclosporin (Sandimmune) can develop kidney toxicity. Use in children has not been adequately studied. Etodolac is not habit-forming. NSAIDs should be discontinued prior to elective surgery because of a mild interference with clotting that is characteristic of this group of medicines. Etodolac is best discontinued at least four days in advance of surgery.
In the meantime, these new data raise understandable concern over prolonged usage of acid-suppressive medications and we recognize our patients’ apprehension over this matter. Our practice evaluates each patient’s need for PPI use on a case by case basis. We consider potential risks involved and weigh them against the benefits that PPi therapy may provide. There are circumstances in which the usage of PPI therapy is essential and withdrawal of PPI therapy may lead to serious consequences, such as in patients on anticoagulation and patients with ulcer disease. We recommend using PPI therapy at the lowest possible dose and no longer than is absolutely necessary. Each patient on PPI therapy should be re-evaluated by a doctor every 3 months to determine the need for continued PPI use. Your long-term health is our absolute priority. We will continue to update you on the latest data in regards to PPI use as it becomes available.
Sixty-five trials met the inclusion criteria for this review . Fifty-six trials (19 paediatric trials) contributed data (representing total of 10,005 adults and 3,333 children); 21 trials were of high methodological quality; 44 were published in full-text. All trials pertained to patients with mild or moderate persistent asthma. Trial durations varied from four to 52 weeks. The median dose of inhaled corticosteroids was quite homogeneous at 200 µg/day of microfine hydrofluoroalkane-propelled beclomethasone or equivalent (HFA-BDP eq). Patients treated with anti-leukotrienes were more likely to suffer an exacerbation requiring systemic corticosteroids (N = 6077 participants; risk ratio ( RR ) , 95% confidence interval ( CI ) , ). For every 28 (95% CI 15 to 82) patients treated with anti-leukotrienes instead of inhaled corticosteroids, there was one additional patient with an exacerbation requiring rescue systemic corticosteroids. The magnitude of effect was significantly greater in patients with moderate compared with those with mild airway obstruction ( RR , 95% CI , versus RR , 95% CI , ), but was not significantly influenced by age group (children representing 23% of the weight versus adults), anti-leukotriene used, duration of intervention , methodological quality, and funding source. Significant group differences favouring inhaled corticosteroids were noted in most secondary outcomes including patients with at least one exacerbation requiring hospital admission (N = 2715 participants; RR ; 95% CI to ), the change from baseline FEV 1 (N = 7128 participants; mean group difference ( MD ) 110 mL, 95% CI 140 to 80) as well as other lung function parameters, asthma symptoms, nocturnal awakenings, rescue medication use, symptom-free days, the quality of life, parents' and physicians ' satisfaction. Anti-leukotriene therapy was associated with increased risk of withdrawals due to poor asthma control (N = 7669 participants; RR ; 95% CI to ). For every thirty one (95% CI 22 to 47) patients treated with anti-leukotrienes instead of inhaled corticosteroids, there was one additional withdrawal due to poor control . Risk of side effects was not significantly different between both groups.