Eniva Vitamins, Minerals, Electrolyte Water, and Nutiritional Supplements Etodolac

Interactions with Dietary Supplements

Copper
Supplementation may enhance the anti-inflammatory effects of NSAIDs while reducing their ulcerogenic effects. One study found that when various anti-inflammatory drugs were chelated with copper, the anti-inflammatory activity was increased.¹ Animal models of inflammation have found that the copper chelate of aspirin was active at one-eighth the effective amount of aspirin. These copper complexes are less toxic than the parent compounds, as well.

Iron
NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss.² Iron supplements can cause GI irritation.³ However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency. If both iron and etodolac are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.⁴ Since major changes in lithium blood levels can produce unwanted side effects or interfere with its efficacy, NSAIDs should be used with caution, and only under medical supervision, in people taking lithium supplements.

Potassium
NSAIDs have caused kidney dysfunction and increased blood potassium levels, especially in older people.⁵ People taking NSAIDs, including etodolac, should not supplement potassium without consulting with their doctor.

Sodium
Etodolac may cause sodium and water retention.⁶ It is healthful to reduce dietary salt intake by eliminating table salt and heavily salted foods.

Interactions with Herbs

Licorice (Glycyrrhiza glabra)
The flavonoids found in the extract of licorice known as DGL (deglycyrrhizinated licorice) are helpful for avoiding the irritating actions NSAIDs have on the stomach and intestines. One study found that 350 mg of chewable DGL taken together with each dose of aspirin reduced gastrointestinal bleeding caused by the aspirin.⁷ DGL has been shown in controlled human research to be as effective as drug therapy (cimetidine) in healing stomach ulcers.⁸

White willow bark (Salix alba)
White willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of salicylates like aspirin to individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs.⁹ Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.

Interactions with Foods and Other Compounds

Food
Etodolac should be taken with food to prevent gastrointestinal upset.¹⁰

Alcohol
Etodolac may cause drowsiness, dizziness, or blurred vision.¹¹ Alcohol may intensify these effects and increase the risk of accidental injury. Use of alcohol during etodolac therapy increases the risk of stomach irritation and bleeding. People taking etodolac should avoid alcohol.

Depletion or interference	Iron
Adverse interaction	Lithium* Sodium* White willow*
Side effect reduction/prevention	Copper* Licorice
Supportive interaction	Copper*
Reduced drug absorption/bioavailability	None known
Other (see text)	Potassium

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Sorenson JRJ. Copper chelates as possible active forms of the antiarthritic agents. J Medicinal Chem 1976;19:135–48.

2. Bjarnason I, Macpherson AJ. Intestinal toxicity of non-steroidal anti-inflammatory drugs. Pharmacol Ther 1994;62:145–57.

3. Threlkeld DS, ed. Blood Modifiers, Iron-Containing Products. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jun 1998, 62–9a.

4. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

5. Bailie GR. Acute renal failure. In Applied Therapeutics: The Clinical Use of Drugs, 6th ed. Vancouver, WA: Applied Therapeutics, 1995, 29–33.

6. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1993, 252c.

7. Rees WDW, Rhodes J, Wright JE, et al. Effect of deglycyrrhizinated liquorice on gastric mucosal damage by aspirin. Scand J Gastroenterol 1979;14:605–7.

8. Morgan AG, McAdam WAF, Pascoo C, Darnborough A. Comparison between cimetidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance therapy. Gut 1982;23:545–51.

9. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

10. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1992, 252c.

11. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1992, 252c.

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The information presented in VitaminLore is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.