Tolmetin (Tolectin, Tolectin DS)

Category:

• Analgesic

Description:

• Nonsteroidal anti-inflammatory (NSAID) drug

Indications:

• Mild to moderate pain, osteoarthritis

• Rheumatoid arthritis, ankylosing spondylitis

Contraindications:

• Asthma, severe renal disease

• Severe hepatic disease, ulcer disease

Precautions:

• Pregnancy category B (D near term), small amounts excreted in breast milk, compatible with breast feeding

• Children, bleeding disorders

• GI disorders, cardiac disorders

• Hypersensitivity to other anti-inflammatory agents, peptic ulcer disease

Adverse Reactions (Side Effects):

• CNS: anxiety, confusion, depression, dizziness, drowsiness, fatigue, insomnia, tremors

• CV: dysrhythmias, hypertension, palpitations, peripheral edema, tachycardia

• EENT: blurred vision, hearing loss, tinnitus

• GI: anorexia, bleeding, cholestatic hepatitis, constipation, cramps, diarrhea, jaundice, nausea, peptic ulcer, perforation, ulceration, vomiting

• GU: azotemia, dysuria, hematuria, nephrotoxicity, oliguria, pseudoproteinuria

• HEME: blood dyscrasias

• SKIN: pruritus, purpura, rash, sweating

Dosage:

Administered orally

• Adult:   PO 400mg 3-4 times daily, not to exceed 2g daily

• Child >2 years: PO 15-30 mg/kg/day in 3 or 4 divided doses

 Drug interactions:

• Methotrexate: potentially increase methotrexate concentrations and toxicity

• Potassium sparing diuretics: potential for acute renal failure (i.e., indomethacin and triamterene)

• Cyclosporine: Other NSAIDs increase cyclosporine concentrations

• Angiotensin-converting enzyme (ACE) inhibitors: inhibits the antihypertensive effects of ACE inhibitors

• Beta-blockers: reduced hypotensive effects of beta-blockers