Tolmetin
TOLECTIN
Pronunciation: TOEL-met-in
“Tool collectin’”
“The N said... NSAID”
“Tol-” for toluene (tolyl group)
“met-” for methyl group
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
Available strengths
- tab 600 mg
- cap 400 mg
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
Cost
Tolmetin (TOLECTIN)
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 600 mg | tab | 90 TID | not offered |
NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Tolmetin is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.
⚠ BOXED WARNINGS
- Cardiovascular thrombotic events
- Gastrointestinal bleeding, ulceration and perforation
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGI bleeding, renal injury and cardiovascular thrombotic risk
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