Tolectin


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Related to Tolectin: tolmetin sodium

Tolectin

 [tol´ek-tin]
trademark for a preparation of tolmetin sodium; a nonsteroidal antiinflammatory drug.

tolmetin

(tole-met-in) ,

Tolectin

(trade name)

Classification

Therapeutic: antirheumatics
Pregnancy Category: UK

Indications

Management of inflammatory disorders including:
  • Rheumatoid arthritis,
  • Juvenile rheumatoid arthritis,
  • Osteoarthritis.

Action

Inhibits prostaglandin synthesis.

Therapeutic effects

Suppression of pain and inflammation.

Pharmacokinetics

Absorption: Well absorbed from the GI tract following oral administration.
Distribution: Unknown.
Protein Binding: >99%.
Metabolism and Excretion: Mostly metabolized by the liver; 20% excreted unchanged by the kidneys.
Half-life: 1 hr.

Time/action profile (anti-inflammatory effects)

ROUTEONSETPEAKDURATION
POwithin 7 days1–2 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Cross-sensitivity may exist with other NSAIDs, including aspirin; Active GI bleeding or ulcer disease; Perioperative pain from coronary artery bypass graft (CABG) surgery.
Use Cautiously in: Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, especially with prolonged use); History of ulcer disease; Severe hepatic or renal impairment (dosage ↓ recommended); Geriatric: ↑ risk of GI bleeding; Obstetric / Lactation: Safety not established; avoid use during 2nd and 3rd trimesters.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • headache (most frequent)
  • drowsiness
  • mental depression
  • sleep disturbances

Ear, Eye, Nose, Throat

  • tinnitus
  • visual disturbances

Cardiovascular

  • edema (most frequent)
  • hypertension

Gastrointestinal

  • drug-induced hepatitis (life-threatening)
  • GI bleeding (life-threatening)
  • diarrhea (most frequent)
  • discomfort (most frequent)
  • dyspepsia (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • constipation
  • flatulence

Genitourinary

  • renal failure

Dermatologic

  • exfoliative dermatitis (life-threatening)
  • stevens-johnson syndrome (life-threatening)
  • toxic epidermal necrolysis (life-threatening)
  • rash (most frequent)

Hematologic

  • prolonged bleeding time

Musculoskeletal

  • muscle weakness

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

↑ risk of bleeding with warfarin, heparin,, cefoperazone, cefotetan, valproates, thrombolytic agents, clopidogrel, ticlopidine, abciximab, tirofiban, or eptifibatide.↑ GI side effects with aspirin, corticosteroids, and other NSAIDs.May ↓ response to antihypertensives or diuretics.May ↑levels and risk of toxicity from lithium.May ↑ risk of hematologic toxicity from antineoplastics or radiation therapy.↑ risk of adverse renal effects with gold compounds, cyclosporine, or chronic use of acetaminophen.May ↑ risk of hypoglycemia frominsulin or oral hypoglycemic agents.↑ anticoagulant effect and bleeding risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others.

Route/Dosage

Oral (Adults) 400 mg 3 times daily initially, followed by maintenance dose of 600–1800 mg/day in 3–4 divided doses (not to exceed 2000 mg/day).
Oral (Children >2 yr) 20 mg/kg/day in 3–4 divided doses initially, followed by maintenance dose of 15–30 mg/kg/day in 3–4 divided doses.

Availability (generic available)

Tablets: 200 mg, 600 mg
Capsules: 400 mg

Nursing implications

Nursing assessment

  • Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Monitor for rhinitis, asthma, and urticaria.
  • Assess patient for skin rash frequently during therapy. Discontinue tolmetin at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped.
  • Assess pain and range of motion prior to and weekly during therapy.
  • Lab Test Considerations: Evaluate BUN, serum creatinine, CBC, and liver function periodically in patients receiving prolonged therapy.
    • Serum potassium, BUN, AST, and ALT may show ↑ levels.
    • Hemoglobin and hematocrit may be ↓. Bleeding time may be prolonged for up to 2 days after discontinuation.
    • May cause false-positive results for urinary protein.

Potential Nursing Diagnoses

Acute pain (Indications)
Impaired physical mobility (Indications)

Implementation

  • Administration in higher than recommended doses does not provide increased effectiveness but may cause increased side effects. Use lowest effective dose for shortest period of time.
  • Oral: May be administered with food, milk, or antacids to decrease GI irritation. Tablets may be crushed and capsules opened and mixed with fluids or food.

Patient/Family Teaching

  • Advise patient to take tolmentin with a full glass of water and to remain in an upright position for 15–30 min after administration.
  • Instruct patient to take medication as directed. Take missed doses as soon as remembered but not if almost time for the next dose. Do not double doses.
  • May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Caution patient to avoid the concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC or herbal products without consulting health care professional.
  • Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
  • Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
  • Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs.

Evaluation/Desired Outcomes

  • Decrease in pain.
  • Improved joint mobility. Partial arthritic relief is usually seen within 7 days, but maximum effectiveness may require 1–2 wk of continuous therapy. Patients who do not respond to one NSAID may respond to another.

Tolectin®

Tolmetin, see there.
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"Now, if that sounds like war, well, in our world of selling that's what it is." Explaining the name "Operation 111," the mailgram said that McNeil hoped to reap $111 million in annual sales of sister drugs Zomax and Tolectin. For the next 10 weeks, the mailgram instructed, the sales force was to concentrate exclusively on the two products.
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