Sandoz

Action

Unknown. Thought to stimulate anti-inflammatory response and block pain impulses by inhibiting cyclooxygenase, an enzyme needed for prostaglandin synthesis.

Availability

Tablets: 500 mg, 750 mg

Indications and dosages

➣ Rheumatoid arthritis; osteoarthritis

Adults: 1,000 mg/day P.O. as a single dose or in two divided doses; may increase up to 2,000 mg/day

Contraindications

• Hypersensitivity to drug

• Active GI bleeding or ulcer disease

• History of aspirin- or NSAID-induced asthma, urticaria, or other allergic-type reaction

• Concurrent use of other NSAIDs

• Pregnancy (third trimester)

Precautions

Use cautiously in:

• severe cardiovascular, renal, or hepatic disease

• history of ulcer disease

• pregnant (first or second trimester) or breastfeeding patients

• children (safety and efficacy not established).

Administration

• Give with food or milk to increase absorption.

• In chronic therapy, use lowest effective dosage.

Adverse reactions

CNS: dizziness, drowsiness, fatigue, headache, insomnia, malaise, nervousness

CV: vasculitis

EENT: abnormal vision, tinnitus

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, stomatitis, dry mouth, GI bleeding

Skin: pruritus, rash, angioedema

Other: edema, fluid retention, allergic reactions including anaphylaxis

Interactions

Drug-drug. Acetaminophen: increased risk of adverse renal reactions (with chronic nabumetone use)

Anticoagulants, cefamandole, cefoperazone, cefotetan, clopidogrel, eptifibatide, plicamycin, thrombolytics, ticlopidine, tirofiban, valproic acid: increased risk of bleeding

Antihypertensives, diuretics: decreased nabumetone efficacy

Antineoplastics: increased risk of adverse hematologic reactions

Aspirin, corticosteroids, other NSAIDs, potassium supplements: additive adverse GI effects

Cyclosporine: increased risk of renal toxicity

Insulins, oral hypoglycemics: increased hypoglycemic effect

Methotrexate: increased risk of methotrexate toxicity

Patient monitoring

Watch closely for signs and symptoms of angioedema, anaphylaxis, or other hypersensitivity reactions (including hives, swelling, shortness of breath, and abdominal pain).

• Monitor GI status. Report nutritional deficiencies.

• Assess vital signs.

• Monitor fluid intake and output.

Patient teaching

• Tell patient he may crush tablet if he can't swallow it whole.

• To minimize GI upset, advise patient to take drug with food; eat small, frequent servings of healthy food; and drink plenty of fluids.

• Advise patient to continue taking drug for entire duration prescribed.

Teach patient to recognize and immediately report signs and symptoms of hypersensitivity reaction and angioedema (hives, swelling, shortness of breath, abdominal pain).

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, strength, and alertness.

• Advise patient not to drink alcohol. Tell him to avoid aspirin, ibuprofen, and over-the-counter preparations (unless prescribed).

• Caution female patient not to take drug, especially during third trimester.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.