Tolmetin

Indications

Tolmetin is used for: Rheumatoid arthritis, Osteoarthritis

Adult Dose

Oral Rheumatoid arthritis; Osteoarthritis Adult: Initially, 400 mg tid. Maintenance: 600-1800 mg daily in 3 divided doses. Max: 1800 mg/day. Topical/Cutaneous Osteoarthritis; Rheumatoid arthritis Adult: Apply 5% gel topically.

Child Dose

Oral Juvenile idiopathic arthritis Child: >2 yr: Initially, 20 mg/kg daily in 3-4 divided doses. Maintenance: 15 mg/kg/day. Max: 30 mg/kg/day.

Renal Dose

Renal impairment: Dose adjustment may be needed.

Administration

Should be taken with food. Take w/ or immediately after meals.

Contra Indications

Pregnancy (3rd trimester), hypersensitivity to aspirin and NSAIDs, treatment of perioperative pain in CABG surgery.

Precautions

Lactation, elderly. Impaired renal and hepatic function. CV diseases, fluid retention, heart failure, history of GI bleed or gastric ulcer, dehydration, hypertension. Monitor renal function regularly.

Pregnancy-Lactation

Pregnancy Category: C; avoid in late pregnancy, may cause premature closure of ductus arteriosus Lactation: excreted in breast milk; safety in nursing infants not known

Interactions

Decreases the efficacy of mifepristone. Increased risk of bleeding with anticoagulants, other NSAIDs, antiplatelets, LMWH. Increased risk of convulsions with quinolones. Decreased antihypertensive response to loop diuretics, beta-blockers and ACE inhibitors. Coadmin increased plasma concentrations of lithium, methotrexate and cardiac glycosides. Increased risk of nephrotoxicity with ACE inhibitors, penicillamine, ciclosporin, tacrolimus or diuretics.

Adverse Effects

Side effects of Tolmetin : >10% Increased liver function test (up to 15%) 1-10% Nausea (10%), Hypertension (3-9%), Myocardial infarction (<2%), Edema, Weight gain, Weight loss, Abdominal pain, Diarrhea, Flatulence, Indigestion, Nausea, Vomiting, Asthenia, Dizziness, Headache <1% Thrombotic tendency observations, Erythema multiforme, Scaling eczema, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Gastrointestinal hemorrhage, Gastrointestinal perforation, Inflammatory disorder of digestive tract, Agranulocytosis, Anemia, Neutropenia, Thrombocytopenia, Jaundice, Liver failure, Anaphylactoid reaction, Cerebrovascular accident, Acute renal failure, Hematuria, Proteinuria, Bronchospasm Potentially Fatal: Blood dyscrasias, serious CV thrombotic events, hepatitis, Stevens-Johnson syndrome.

Mechanism of Action

Tolmetin decreases cyclooxygenase activity consequently decreasing formation of prostagladin precursors and inhibiting prostaglandin synthesis.