Tolmetin Sodium
Pronouncation: (TOLE-mee-tin SO-dee-uhm)Class: NSAID
Trade Names:
Tolmetin Sodium
- Tablets 200 mg (as sodium)
- Tablets 600 mg (as sodium)
- Capsules 400 mg (as sodium)
Pharmacology
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Feedback for Tolmetin Sodium
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Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis.
Pharmacokinetics
Absorption
Tolmetin is rapidly and completely absorbed. T max is about 30 to 60 min and C max is about 40 mcg/mL.
Metabolism
Tolmetin is recovered in urine partially as an inactive oxidative metabolite.
Elimination
Almost all of the tolmetin dose is recovered in urine in 24 h.
Indications and Usage
Treatment of chronic and acute rheumatoid arthritis and osteoarthritis and juvenile rheumatoid arthritis.
Contraindications
Hypersensitivity to aspirin, iodides, or any NSAID.
Dosage and Administration
Osteoarthritis/Rheumatoid ArthritisAdults
PO 400 mg 3 times daily initially; titrate to 600 to 1600 mg/day for osteoarthritic patients or 600 to 1800 mg/day in divided doses for rheumatoid arthritis patients. Daily doses exceeding 1800 mg/day are not recommended.
Juvenile Rheumatoid ArthritisChildren 2 yr or older
PO 20 mg/kg/day in 3 to 4 divided doses initially; titrate to 15 to 30 mg/kg/day (max, 30 mg/kg/day).
Storage/Stability
Store at room temperature. Do not expose to sunlight or moisture.
Drug Interactions
AnticoagulantsMay increase effect of anticoagulants due to decreased plasma protein binding. May increase risk of gastric erosion and bleeding.
CyclosporineMay potentiate nephrotoxicity of both agents.
MethotrexateMay increase methotrexate levels.
Laboratory Test Interactions
May prolong bleeding time. May produce false-positive test result for proteinuria using sulfosalicylic acid. Increases in serum uric acid, LFTs, serum creatinine, BUN.
Adverse Reactions
Cardiovascular
Edema; sodium retention; hypertension; CHF.
CNS
Dizziness; drowsiness; lightheadedness; confusion; increased sweating; vertigo; headache; nervousness; migraine; anxiety; aggravated Parkinson's disease or epilepsy; paresthesia; peripheral neuropathy; myalgia; fatigue; asthenia; depression.
Dermatologic
Rash; pruritus; urticaria; purpura; erythema multiforme; skin irritation; sweating.
EENT
Blurred vision; tinnitus; visual disturbances.
GI
Nausea; dyspepsia; abdominal pain or discomfort; flatulence; diarrhea; constipation; vomiting; gastritis; anorexia; glossitis; stomatitis; mouth ulcers; peptic ulcer; GI distress.
Genitourinary
Hematuria; proteinuria; dysuria; elevations in BUN; acute renal insufficiency; interstitial nephritis; hyperkalemia; hyponatremia; renal papillary necrosis; UTIs.
Hematologic
Increased bleeding time; anemia; decreases in Hgb or Hct; leukopenia; thrombocytopenia; hemolytic anemia.
Hepatic
Hepatitis; increased LFT results; elevated liver enzymes.
Metabolic
Weight decrease or increase.
Respiratory
Bronchospasm; laryngeal edema; rhinitis; dyspnea; pharyngitis; hemoptysis; shortness of breath.
Precautions
Pregnancy
Category C .
Lactation
Excreted in breast milk.
Children
Safety and efficacy not established in children under 2 yr.
Elderly
Increased risk of adverse reactions.
Renal Function
Use drug with caution in patients with compromised cardiac function, hypertension, or other conditions predisposing to fluid retention.
GI effects
Serious GI toxicity (eg, bleeding, ulceration, perforation) can occur at any time with or without warning symptoms.
Anaphylactoid reactions
Have occurred in patients with aspirin hypersensitivity and in patients who discontinued tolmetin, then restarted it.
Overdosage
Symptoms
Drowsiness, dizziness, mental confusion, paresthesia, vomiting, abdominal pain, intense headache, tinnitus, sweating, convulsions, visual disturbances, elevated serum creatinine and BUN levels, hypotension.
Patient Information
- Explain that product should not be taken with aspirin or other NSAIDs without consulting health care provider.
- Explain that full antirheumatic action may not occur for up to 7 days and may not reach max effect for up to 1 mo after starting therapy.
- Tell patient to avoid taking with food or milk or immediately after meal. If medication causes stomach upset tell patient to take with antacids that do not contain sodium bicarbonate. Instruct patient to call health care provider if pain continues.
- Tell patient to avoid smoking or drinking alcohol while taking this drug.
- Explain that dizziness or black stools should be reported to health care provider immediately.
- Explain that if drowsiness, dizziness, or blurred vision occur, patient should observe caution while driving or performing other tasks requiring alertness.
- Explain that photosensitivity may occur and to use sunscreens and protective clothing when exposed to ultraviolet or sunlight until tolerance is determined.
- Identify potential clinically important adverse reactions: drowsiness, blurred vision, edema, headache, lightheadedness, confusion, fatigue, swelling feet, ringing of ears, nausea, vomiting, mouth ulcers, unusual bleeding or bruising, rash, itching, skin irritation. Tell patient to notify health care provider if persistent or severe.
- Tell patient not to store drug in bathroom but in cool, dry place.
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More Tolmetin Sodium resources:
Tolectin 600 - Includes detailed dosage instructions.
Tolmetin Sodium Drug Interactions
Pain, Rheumatoid Arthritis, Osteoarthritis, Gout -- Acute
