Tolmetin

Aka: Tolmetin, Tolectin

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II. Indications

  1. See NSAID
  2. FDA Approved Indications in adults
    1. Rheumatoid Arthritis
    2. Osteoarthritis
  3. FDA Approved Indications in children
    1. Juvenile Rheumatoid Arthritis

III. Contraindications

  1. See NSAID

IV. Mechanism

  1. See NSAID
  2. NSAID in the acetic acid class (indole)

V. Medications

  1. Tolmetin (Tolectin)
    1. Tablets: 200 mg (scored), 600 mg
    2. Capsules: 400 mg

VI. Dosing: Adult

  1. Start 200 to 400 mg orally three times daily
  2. May increase to 600 mg orally three times daily
  3. Maximum: 1800 mg/day

VII. Dosing: Child (age >= 2 years old)

  1. Juvenile Rheumatoid Arthritis
    1. Start: 20 mg/kg/day orally divided three to four times daily
    2. Range: 15 to 30 mg/kg/day divided three to four times daily
    3. Maximum: 2000 mg/24 hours

VIII. Adverse Effects

  1. See NSAID
  2. Anaphylaxis

IX. Safety

  1. See NSAID
  2. Considered safe in Lactation
  3. Avoid NSAIDs in pregnancy outside the first part of the second trimester (13 to 20 weeks)
    1. Teratogenic in first trimester
    2. Risk of premature ductus arteriosus closure in the fetus in third trimester
    3. Most NSAIDs carry a legacy system Pregnancy Category B or C designation (aside from third trimester)
      1. However, many obstetricians avoid NSAIDs entirely in pregnancy (even in second trimester)

X. Resources

  1. Tolmetin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=740a0f37-aa95-4558-b415-be516b8c40a3

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