nabumetone: clinical use

Prescribing considerations

• Assess gastrointestinal, renal and cardiovascular risk before prescribing, especially in older people.
• Avoid concurrent NSAIDs, including COX-2 inhibitors.
• Use particular caution with hypertension, heart failure, vascular disease, inflammatory bowel disease, asthma, SLE, dehydration or impaired renal or hepatic function.
• Nabumetone may mask signs of infection and may impair female fertility.
• Review promptly if a rash, mucosal lesion, visual disturbance or unexplained liver-test abnormality develops.

Contraindications and cautions

• Hypersensitivity to nabumetone or any excipient
• Previous aspirin- or NSAID-associated asthma, rhinitis, angioedema or urticaria
• Active or recurrent peptic ulceration, gastrointestinal haemorrhage or perforation
• Previous gastrointestinal bleeding or perforation associated with NSAID treatment
• Severe heart, liver or kidney failure
• Current cerebrovascular or other haemorrhage
• Third trimester of pregnancy
• Breastfeeding

Monitoring

• Renal function, particularly in older, dehydrated or renally impaired patients and with interacting antihypertensives or diuretics
• Liver function where clinically indicated and after abnormal results or hepatic symptoms
• Blood pressure, oedema and signs of worsening heart failure
• Symptoms or signs of gastrointestinal ulceration or bleeding
• Early severe skin reactions and hypersensitivity
• Visual symptoms requiring ophthalmological assessment

Clinical pharmacology

Nabumetone is a non-acidic NSAID that undergoes extensive first-pass hepatic conversion to 6-MNA, a potent prostaglandin-synthesis inhibitor. The active metabolite is highly protein-bound, is eliminated mainly after metabolism through the urine and has a plasma half-life of about one day.

Formulation and product differences

• The selected product is an oral film-coated tablet intended to be swallowed whole.
• It is described as essentially sodium-free.
• No clinical data support use of the selected product in children.

Tablet

Route: Oral

Strengths: 500 mg