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Pharmacologic class: Nonsteroidal anti-inflammatory drug (NSAID)
Therapeutic class: Antiarthritic
Pregnancy risk category C (first and second trimesters), D (third trimester)
FDA Box Warning
Drug may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke. Risk may increase with duration of use. Patients with cardiovascular disease or risk factors for it may be at greater risk.
Drug increases risk of serious GI adverse events, including bleeding, ulcers, and stomach or intestinal perforation. These events can occur at any time during use and without warning. Elderly patients are at greater risk.
Drug is contraindicated for treatment of perioperative pain in setting of coronary artery bypass graft surgery.
Unknown. Thought to stimulate anti-inflammatory response and block pain impulses by inhibiting cyclooxygenase, an enzyme needed for prostaglandin synthesis.
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
• 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)
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).
• Give with food or milk to increase absorption.
• In chronic therapy, use lowest effective dosage.
CNS: dizziness, drowsiness, fatigue, headache, insomnia, malaise, nervousness
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
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
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.
• 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.