Nabumetone

(nab-YOU-meh-TONE)

Relafen

Class: Analgesic/NSAID

 Action Decreases inflammation, pain and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis.

 Indications Relief of symptoms of chronic and acute rheumatoid arthritis and osteoarthritis.

 Contraindications Hypersensitivity to aspirin, iodides or any NSAID.

 Route/Dosage

Osteoarthritis/Rheumatoid Arthritis

ADULTS: PO 1000 mg initially; may increase to 1500 to 2000 mg daily in 1 to 2 divided doses.

 Interactions

Anticoagulants: May increase effect of anticoagulants. May increase risk of gastric erosion and bleeding. Cyclosporine: Neurotoxicity of both agents may be increased. Lithium: May increase lithium levels. Methotrexate: Increased risk of methotrexate toxicity. Salicylates: Additive GI toxicity.

 Lab Test Interferences May prolong bleeding time.

 Adverse Reactions

CV: Edema; weight gain; congestive heart failure; alterations in blood pressure; vasodilation; palpitations; tachycardia; chest pain; bradycardia. CNS: Dizziness; lightheadedness; drowsiness; confusion; increased sweating; vertigo; headaches; nervousness; migraine; anxiety; aggravated Parkinson’s or epilepsy; paresthesia; peripheral neuropathy; myalgia; tremors; fatigue. DERM: Rash; urticaria; purpura. EENT: Blurred vision; tinnitus; rhinitis; salivation; glossitis; pharyngitis. GI: Diarrhea; ulceration; dry mouth; heartburn; dyspepsia; nausea; vomiting; anorexia; diarrhea; constipation; flatulence; indigestion; appetite changes; abdominal cramps; epigastric pain; hematemesis; peptic ulcer; stomatitis. GU: Acute renal insufficiency; interstitial nephritis; hyperkalemia; hyponatremia; papillary necrosis; melena; menometrorrhagia; impotence; menstrual disorders; hematuria; cystitis; nocturia; proteinuria. HEPA: Hepatitis. HEMA: Increased prothrombin time; bleeding; anemia; neutropenia; leukopenia; pancytopenia; eosinophilia; thrombocytopenia. RESP: Bronchospasm; laryngeal edema; dyspnea; hemoptysis; shortness of breath. OTHER: Photosensitivity.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly patients: Increased risk of adverse reactions. GI effects: Serious GI toxicity (eg, bleeding, ulceration, perforation) can occur at any time, with or without warning symptoms. Hypersensitivity: May occur; use drug with caution in aspirin-sensitive patients because of possible cross-sensitivity. Renal impairment: Lower doses may be necessary.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Give medication with full glass of water, either with or without food.
• Store in tightly-closed, light-resistant container at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note fluid retention, nasal polyps, bronchospastic disease, and hypersensitivity to aspirin or other NSAIDs.
• Obtain baseline assessments of pain and ability to perform activities of daily living.
• For patients undergoing long-term therapy or with history of GI or renal disease, monitor for abnormalities/trends in liver/kidney function test results, hematocrit, hemoglobin, and platelets.
• Use caution if patient is also receiving anticoagulants or thrombolytics.
• Monitor for signs and symptoms of GI distress or bleeding.

OVERDOSAGE: SIGNS & SYMPTOMS   Drowsiness, dizziness, confusion, disorientation, lethargy, numbness, vomiting, gastric irritation, nausea, abdominal pain, headache, tinnitus, sweating, convulsions, blurred vision, renal failure, coma

 Patient/Family Education

• Remind patient to take medication with full glass of water, either with or without food.
• Explain that therapeutic effects may take up to 1 mo to be noted.
• Instruct patient to report the following symptoms to physician: Rash, visual disturbance, ringing in ears, dark stools, persistent headache or abdominal pain, unusual bleeding or bruising, decreased urinary output, weight gain, edema. Caution patient to avoid intake of alcoholic beverages and to avoid smoking.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
• Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.

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