tolmetin (Rx)

Brand and Other Names:Tolectin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 200mg
  • 600mg

capsule

  • 400mg
more...

Osteoarthritis

200-600 mg PO q8hr

Not to exceed 1800 mg/day

Rheumatoid Arthritis

200-600 mg PO q8hr

Not to exceed 1800 mg/day

Administration

Take with 8-12 oz water to avoid GI effects

Other Indications & Uses

Pain, juvenile rheumatoid arthritis

Dosage Forms & Strengths

tablet

  • 200mg
  • 600mg

capsule

  • 400mg
more...

Juvenile Idiopathic Arthritis

<2 years

  • Safety and efficacy not established

>2 Years

  • Initial: 20-30 mg/kg/day PO divided q6-8hr
  • Maintenance: 15-30 mg/kg/day divided q6-8hr 

Analgesic (Unlabeled)

20-28 mg/kg/day PO divided q6hr

Administration

Take with 8-12 oz water to avoid GI effects

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Interactions

Interaction Checker

and tolmetin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Increased liver function test (up to 15%)

            1-10%

            Nausea (10%)

            Hypertension (3-9%)

            Myocardial infarction (<2%)

            Edema

            Weight gain, Weight loss

            Abdominal pain

            Diarrhea

            Flatulence

            Indigestion

            Nausea, Vomiting

            Asthenia

            Dizziness

            Headache

            <1%

            Thrombotic tendency observations

            Erythema multiforme

            Scaling eczema

            Stevens-Johnson syndrome

            Toxic epidermal necrolysis

            Gastrointestinal hemorrhage

            Gastrointestinal perforation

            Inflammatory disorder of digestive tract

            Agranulocytosis

            Anemia

            Neutropenia

            Thrombocytopenia

            Jaundice

            Liver failure

            Anaphylactoid reaction

            Cerebrovascular accident

            Acute renal failure

            Hematuria

            Proteinuria

            Bronchospasm

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            Warnings

            Black Box Warnings

            Cardiovascular Risk

            • NSAIDs may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), & stroke, which can be fatal
            • Risk may increase with duration of use
            • Patients with risk factors for or existing cardiovascular disease may be at greater risk
            • NSAIDs are contraindicated for perioperative pain in the setting of coronary artery bypass graft (CABG) surgery (increased risk of MI & stroke)

            Gastrointestinal Risk

            • NSAIDs increase risk of serious GI adverse events including bleeding, ulceration, & perforation of the stomach or intestines, which can be fatal
            • GI adverse events may occur at any time during use & without warning symptoms
            • Elderly patients are at greater risk for serious GI events

            Contraindications

            Absolute: ASA allergy, hepatic disease (severe chronic), hepatitis, jaundice, nursing mother

            Relative: Bleeding disorder, duodenal/gastric/peptic ulcer, stomatitis, SLE, ulcerative colitis, upper GI disease, late pregnancy (may cause premature closure of ductus arteriosus)

            Cautions

            Use caution in asthma (bronchial), cardiac disease, CHF, hepatic impairment, HTN, renal impairment

            Long-term administration of NSAIDs may result in renal papillary necrosis and other renal injury; patients at greatest risk include the elderly, or those with impaired renal function, hypovolemia, heart failure, liver dysfunction, salt depletion, and individuals taking diuretics, ACE inhibitors, or ARBs

            Strong cross-sensitivity may exist for ASA allergic patients

            Food reduces bioavailability

            Heart Failure(HF) risk

            • NSAIDS have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
            • NSAIDS should be avoided or withdrawn whenever possible
            • AHA/ACC Heart Failure Guidelines; Circulation. 2016; 134
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            Pregnancy & Lactation

            Pregnancy Category: C; avoid in late pregnancy, may cause premature closure of ductus arteriosus

            The Quebec Pregnancy Registry identified 4705 women who had spontaneous abortions by 20 weeks' gestation; each case was matched to 10 control subjects (n=47,050) who had not had spontaneous abortions; exposure to nonaspirin NSAIDs during pregnancy was documented in approximately 7.5% of cases of spontaneous abortions and in approximately 2.6% of controls. (CMAJ, September 6, 2011; DOI:10.1503/cmaj.110454)

            Lactation: excreted in breast milk; safety in nursing infants not known

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclooxygenase isoenzymes, cyclooxygenase-1 (COX-1) and -2 (COX-2).

            May inhibit chemotaxis, may alter lymphocyte activity, decrease proinflammatory cytokine activity, and may inhibit neutrophil aggregation.  These effects may contribute to its anti-inflammatory activity.

            Pharmacokinetics

            Peak Plasma Time: 30-60 min

            Concentration: 40 mcg/mL

            Onset of action: 1-2hr

            Half-life elimination: 1 hr

            Protein Bound: 99%

            Vd: 9.1 L

            Metabolism: Liver oxidation

            Metabolites: Dicarboxylic acid metabolite

            Excretion: Urine (approx 100%)

            Enzymes inhibited: Cyclooxygenase

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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