Adult Dosing
Osteoarthritis, rheumatoid arthritis
- 1000 mg PO qd divided qd-bid; Max: 2000 mg/day
- Use lowest effective dose during chronic therapy
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- 30 to 49 mL/min: Start 750 mg PO qd; Max 1500 mg/day
- <30 mL/min: Start 500 mg qd; Max 1000 mg/day
Hepatic Dose Adjustment
- Severe impairment: Dose adjustments not defined, caution advised
- Serious and potentially fatal cardiovascular thrombotic events, MI, and stroke may occur with the use of therapy. Such risk is increased in patients with cardiovascular disease or cardiovascular disease risk factors. Therapy is contraindicated for CABG peri-operative pain [US Black Box Warning]
- Therapy may cause serious GI adverse events including bleeding, ulceration, and stomach or intestine perforation, which can be fatal. Such events may occur at any time during use and without warning symptoms. Cautiously administer in elderly patients because they are at greater risk for serious GI events [US Black Box Warning]
- Serious and potentially fatal cardiovascular thrombotic events, MI, and stroke may occur with the use of therapy. Such risk is increased in patients with cardiovascular disease or cardiovascular disease risk factors. Therapy is contraindicated for CABG peri-operative pain [US Black Box Warning]
- Use the lowest effective dose for the shortest duration possible in patients with known CV disease or risk factors for CV disease as it may cause serious cardiovascular thrombotic events, myocardial infarction, and stroke
- Nabumetone may cause inflammation, bleeding, ulceration, and perforation of the stomach, small intestine or large intestine. Restrict use in patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding
- If a serious GI adverse event is suspected, discontinue the therapy and promptly institute an alternative therapy
- Avoid long term therapy with the drug, concomitant use of oral corticosteroids or anticoagulants, smoking, use of alcohol
- Severe hepatotoxicity can occur any time during treatment, closely monitor (ALT and AST) levels periodically in patients receiving continued therapy. Use the lowest effective dose for the shortest duration possible to minimize the potential risk of hepatotoxicity
- Avoid concomitant use of drugs known to be potentially hepatotoxic
- May lead to the onset of hypertension, or worsening of pre-existing hypertension, closely monitor blood pressure before initiating and during the treatment
- Use with caution in patients already taking thiazides or loop diuretics as it may hamper the therapeutic response of thiazides or loop diuretics. Closely monitor BP during the therapy
- Use cautiously in patients with fluid retention or heart failure, as this product causes fluid retention and edema
- Monitor for renal toxicity in long term treatment, including renal papillary necrosis and other renal injury. Avoid use in advanced renal disease
- Restrict administration in patients with aspirin triad
- Discontinue the treatment at the first appearance of skin rash or any other sign of hypersensitivity like anaphylactoid reactions
- Do not administer in pregnant female after 30 weeks as it causes premature closure of the ductus arteriosus in the fetus
- Check hematologic profile including hemoglobin or hematocrit at regular intervals in patients on long-term treatment with NSAIDs as it may cause anemia due to fluid retention, occult or gross GI blood loss
- Diclofenac inhibits platelet aggregation and prolongs bleeding time in some patients, closely monitor those patients with coagulation disorders or those receiving anticoagulants
- Cautiously administer in patients with pre-existing asthma/aspirin-sensitive asthma as it may exacerbate the symptoms
- Monitor for signs of GI bleeding. Perform CBC and other blood chemistries, liver function test and renal function test periodically
- Use with caution in older age, poor general health status, debilitated patients
- Concomitant use of ACEI, thiazides, loop diuretics cause increased risk of renal toxicity
- Third trimester use may cause premature closure of the ductus arteriosus
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Cardiovascular disease
- Cardiac disease risk
- HTN
- CHF
- Fluid retention
- GI bleed or PUD history
- Corticosteroid use
- Anticoagulant use
- Coagulation disorder
- Alcohol use
- Smoker
- Elderly or debilitated patients
- Dehydration
- Concurrent diuretics
- ACEI or ARB use
- Asthma
- Prolonged use
Pregnancy Category:C
Breastfeeding: Safety unknown. Because no information is available on the use of nabumetone during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 6 April 2011). Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Nabumetone 750 MG TABS [Bottle] (SANDOZ)
60 mg = $71.99
180 mg = $192.97 - Nabumetone 500 MG TABS [Bottle] (SANDOZ)
60 mg = $42.99
180 mg = $116.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
