COX-2 inhibitors are NSAIDs (nonsteroidal anti-inflammatory drugs) which selectively block the COX-2 enzyme and not the COX-1 enzyme (an enzyme that helps with the production of the protective stomach lining).
Because they selectively block the COX-2 enzyme and not the COX-1 enzyme, these nonsteroidal anti-inflammatory drugs are uniquely different from traditional NSAIDs that commonlly block both COX-1 and COX-2 enzymes.
COX-2 is an enzyme responsible for inflammation and pain and is constitutively expressed in the kidney, in the brain, in bone, and in the female reproductive system.
COX-2 Selective NSAIDs are used for treating:
- rheumatoid arthritis;
- ankylosing spondylitis;
- acute pain (for instance, sports injuries);
- menstrual cramps;
- juvenile rheumatoid arthritis.
COX-2 selective nonsteroidal anti-inflammatory drugs are associated with fewer gastrointestinal adverse effects than nonselective NSAIDs. According to research, the absolute risk of serious upper gastrointestinal bleeding and ulceration is reduced by 50 to 60 percent or more compared to other nonsteroidal anti-inflammatory drugs.
But, the improved tolerance of the COX-2 selective inhibitors may posses an increased risk of thrombosis in people with ischaemic heart disease, especially if they are not taking aspirin.
Here is a comparison between Etodolac and Meloxicam, two types of COX-2 inhibitors:
It is a member of the pyranocarboxylic acid class of NSAIDs and is approved by the US FDA for treating acute pain in adults.
Meloxicam is a nonsteroidal anti-inflammatory drug that is only available with a prescription. The Food and Drug Administration approved it for use in the United States in 2000.
Etodolac is prescribed for the treatment of pain and inflammation associated with rheumatoid arthritis, osteoarthritis, tendinitis, bursitis, juvenile rheumatoid arthritis, and menstrual cramps. Also, it may be used for the relief of:
- pain or inflammation caused by knee pain, back pain, or foot pain;
- symptoms of systemic lupus erythematosus;
- gout symptoms;
- fibromyalgia symptoms.
Meloxicam eases pain and swelling in long-term conditions such as ankylosing spondylitis and rheumatoid arthritis. Additionally, it may be prescribed for a shorter period of time in osteoarthritis.
Mechanism of Action
Etodolac works by blocking the enzyme which makes prostaglandins. This leads to a lower concentration of prostaglandins.
Meloxicam works by blocking lipids which are involved in the body’s response to perceived injury, leading to blood clotting and inflammation around the wound site. The drug has a half-life of 20 to 24 hours and a bioavailability of 89 percent after oral intake.
Possible side effects of etodolac include:
- problems with vision or balance;
- muscle weakness;
- black or tarry stools;
- bloating, gas;
- chest pain;
- severe tingling;
- slurred speech;
- shortness of breath;
- ringing in your ears;
- rapid weight gain;
- coughing up blood;
- blurred vision;
- urinating less than usual;
- stuffy nose;
- jaundice (yellowing of the skin or eyes);
- sore throat;
- mild heartburn or stomach pain;
- clay-colored stools;
- skin itching or rash;
- dark urine;
- seizure (convulsions);
- loss of appetite;
- upset stomach;
- purple spots on the skin;
- low fever;
- increased sensitivity to light.
Possible side effects of meloxicam include:
- sore throat;
- unusual aftertaste;
- bloating or gas;
- abnormal dreaming;
- stomach upset;
- difficulty falling asleep;
- ringing in the ears;
- increased appetite;
- thinning hair;
- burning or dry eyes;
- rapid breathing;
- pinprick sensations;
- changes in vision;
- trouble concentrating.
When using immediate-release tablets or capsules, for general pain relief, the usual recommended dose of etodolac is 200 to 400 mg every 6-8 hours. The maximum recommended dose is 1,000 mg per day. It is best to take your doses with food.
The usual recommended dose of meloxicam is one tablet per day.
Warnings & Precautions
Before taking this drug, tell your healthcare provider if you are allergic to any drugs, or if you have:
- a history of stroke, heart attack, or blood clot;
- a bleeding or blood clotting disorder;
- high blood pressure;
- heart disease;
- polyps in your nose;
- congestive heart failure;
- kidney disease;
- a history of stomach ulcers;
- liver disease;
- if you smoke cigarettes.
Do not use this medication if you have a history of allergic reaction to aspirin or other nonsteroidal anti-inflammatory drugs. Also, do not give this drug to a child younger than 6 years old without the advice of a healthcare professional.
Before you start taking this drug, it is important that your healthcare professional knows if you:
- are a smoker;
- have asthma or any other allergic disorder;
- have ever had an allergic reaction to any other nonsteroidal anti-inflammatory drugs or to any other medicine;
- if you have an inflammatory bowel disorder, like ulcerative colitis or Crohn’s disease;
- have ever had a stomach or duodenal ulcer;
- are taking any other medicines;
- have systemic lupus erythematosus;
- are pregnant, trying for a baby or breastfeeding an infant;
- have ever had blood clotting problems;
- have liver problems;
- have kidney problems;
- have high blood sugar or cholesterol levels;
- have high blood pressure;
- have a problem with your blood vessels or circulation;
- have a heart condition.
Etodolac may interact in a negative way with the following medications:
- prednisone (a synthetic glucocorticoid drug);
- Lexapro (escitalopram);
- Cymbalta (duloxetine).
Meloxicam may interact in a negative way with the following medications:
- lithium (primarily used as a psychiatric medication);
- drugs to lower potassium levels;
- medications for heart conditions;
- other nonsteroidal anti-inflammatory drugs;
- anti-anxiety drugs;
- blood thinner medications;
- other medications to treat arthritis.
Do not drink alcohol while taking nonsteroidal anti-inflammatory drugs since alcohol can increase your risk of stomach bleeding.
Is It Safe During Pregnancy or Breastfeeding?
These medications may be harmful to an unborn baby. Do not take these nonsteroidal anti-inflammatory drugs during pregnancy unless your doctor has told you to.
It is not known whether these nonsteroidal anti-inflammatory drugs pass into breast milk. Tell your doctor if you are breastfeeding before using these NSAIDs.
Etodolac vs Meloxicam – Which Is Better?
Etodolac is a nonsteroidal anti-inflammatory drug approved in the US for the treatment of acute pain and for managing the symptoms of osteoarthritis and rheumatoid arthritis. It works by blocking the effect of cyclo-oxygenase (COX) enzymes, natural substances in the human body.
Meloxicam is an enolcarboxamide with preferential COX-2 inhibitory activity. It is prescribed for the treatment of joint inflammation and pain, usually from osteoarthritis or rheumatoid arthritis.
According to a 2008 review of the cost-effectiveness and clinical effectiveness of cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs, meloxicam and etodolac were found to be similar to non-selective nonsteroidal anti-inflammatory drugs for the symptomatic relief of rheumatoid arthritis and osteoarthritis.
Sources https://onlinelibrary.wiley.com/doi/abs/10.1002/cam4.512 https://www.tandfonline.com/doi/abs/10.1185/03007998709108963 https://www.ncbi.nlm.nih.gov/pubmed/9035017 https://cdn-pubs.acs.org/doi/10.1021/cg100514g