Drug Guide
Tolmetin Sodium
Classification
Therapeutic: Nonsteroidal Anti-Inflammatory Drug (NSAID)
Pharmacological: Cyclooxygenase (COX) inhibitor
FDA Approved Indications
- Relief of mild to moderate pain, including arthritis, ankylosing spondylitis, and bursitis/tendinitis
Mechanism of Action
Inhibits cyclooxygenase (COX-1 and COX-2), leading to decreased synthesis of prostaglandins which mediate inflammation, pain, and fever.
Dosage and Administration
Adult: Typically 200 mg every 6 to 8 hours as needed; maximum dose usually not exceeding 600 mg per day. Adjust based on response and tolerability.
Pediatric: Use is generally not recommended for children due to limited data.
Geriatric: Start at lower dose due to increased risk of adverse effects; monitor closely.
Renal Impairment: Adjust dose; use caution as NSAIDs can impair renal function.
Hepatic Impairment: Use with caution; dose adjustment may be necessary.
Pharmacokinetics
Absorption: Well absorbed from gastrointestinal tract.
Distribution: Widely distributed, crosses the placenta, and is present in breast milk.
Metabolism: Metabolized in the liver.
Excretion: Excreted primarily in urine; small amount in feces.
Half Life: Approximately 1.5 hours.
Contraindications
- Hypersensitivity to tolmetin or other NSAIDs, including aspirin.
- History of allergic reactions to NSAIDs.
- Active gastrointestinal bleeding or ulceration.
Precautions
- Use with caution in patients with cardiovascular disease, hypertension, renal or hepatic impairment, or history of gastrointestinal bleeding. May increase risk of cardiovascular thrombotic events, myocardial infarction, and stroke.
Adverse Reactions - Common
- Gastrointestinal discomfort, nausea, dyspepsia (Common)
- Headache, dizziness (Common)
Adverse Reactions - Serious
- Gastrointestinal bleeding or ulceration (Less common but serious)
- Cardiovascular thrombotic events (Rare)
- Allergic reactions including rash, pruritus, angioedema (Rare)
Drug-Drug Interactions
- Other NSAIDs, corticosteroids, anticoagulants, antihypertensive agents
Drug-Food Interactions
- Alcohol may increase gastrointestinal bleeding risk.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for signs of gastrointestinal bleeding, renal function, blood pressure, and allergic reactions.
Diagnoses:
- Risk for gastrointestinal bleeding
- Risk for impaired renal function
- Acute pain related to inflammatory conditions.
Implementation: Administer with food or milk to minimize gastrointestinal irritation. Monitor renal and hepatic function periodically. Use lowest effective dose for shortest duration.
Evaluation: Assess pain relief, inflammation reduction, and monitor for adverse effects.
Patient/Family Teaching
- Take medication with food or milk to reduce stomach upset.
- Report signs of gastrointestinal bleeding (e.g., black stools, vomiting blood), rash, or swelling.
- Avoid alcohol and other NSAIDs without consulting healthcare provider.
- Keep appointments for lab tests to monitor kidney and liver function.
Special Considerations
Black Box Warnings:
- Risk of cardiovascular thrombotic events, myocardial infarction, and stroke.
- Gastrointestinal ulceration, bleeding, and perforation may occur at any time during therapy.
- NSAIDs should be used with caution in the elderly.
Genetic Factors: Genetic variations in COX enzymes may influence response and risk.
Lab Test Interference: May elevate liver enzymes, serum creatinine, and may cause potassium retention.
Overdose Management
Signs/Symptoms: Gastrointestinal bleeding, abdominal pain, nausea, vomiting, dizziness, hypotension.
Treatment: Supportive care; activated charcoal if ingested recently; monitor renal function; and administer IV fluids. Hemodialysis is not effective.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F), away from moisture and light.
Stability: Stable for 24 months when stored properly.