Tolmetin

TOLECTIN

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What it isNon-selective NSAID; rheumatoid, osteo- and juvenile idiopathic arthritis.

Why this oneOne of the few NSAIDs approved in juvenile idiopathic arthritis.

What limits itAnaphylactoid reactions are reported more often than with other NSAIDs. It raises serum lithium; three-times-daily dosing.

FDA-approved for

Rheumatoid arthritis (1976)
osteoarthritis (1976)
juvenile idiopathic arthritis (1976)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING NSAID class: increased risk of serious cardiovascular thrombotic events (MI, stroke, can be fatal), may occur early and rise with duration; contraindicated for CABG surgery. Serious GI bleeding, ulceration, and perforation, can be fatal, may occur without warning; elderly at greater risk.

FDA dosing	Population	Start	Target	Max
Rheumatoid arthritis / osteoarthritis	Adults	400 mg TID (1200 mg/day), incl. a dose on arising and at bedtime	600–1800 mg/day divided (generally TID)	1800 mg/day
Juvenile rheumatoid arthritis	Peds ≥2 yr	20 mg/kg/day divided TID–QID	15–30 mg/kg/day divided	30 mg/kg/day

Titration Adjust dose per response after 1–2 weeks of initial therapy

Renal Undefined

Hepatic Undefined

Instructions

Use lowest effective dose for shortest duration
For GI symptoms, may take with antacids other than sodium bicarbonate
Bioavailability affected by food or milk

Contraindications

Asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs — severe, rarely fatal anaphylactic-like reactions reported
Setting of coronary artery bypass graft (CABG) surgery

Cautions

Serious cardiovascular thrombotic events (MI, stroke) — risk may increase with duration of use
Serious GI bleeding, ulceration, perforation — can occur any time without warning; elderly at greater risk

Adverse reactions

>1%: nausea (11%), dyspepsia, GI distress, abdominal pain, diarrhea, flatulence, vomiting, constipation, gastritis, peptic ulcer; headache, asthenia, chest pain; elevated BP, edema; dizziness, drowsiness, depression; weight change; tinnitus, visual disturbance; elevated BUN, UTI
<1%: GI bleeding/perforation, hepatitis, anaphylactoid reactions, hemolytic anemia, thrombocytopenia, agranulocytosis, CHF (marginal cardiac function), SJS/TEN, renal failure

Pregnancy Undefined

Lactation Undefined

⚠ BOXED WARNINGS