Nabumetone

About Nabumetone

Nabumetone is a prodrug: the liver converts it to an active form, 6MNA, a potent inhibitor of prostaglandin synthesis (prostaglandins are chemical signals involved in pain and inflammation). It is labeled for relief of the signs and symptoms of osteoarthritis and rheumatoid arthritis; safety and effectiveness in children have not been established. The usual starting dose is 1,000 mg as a single dose, with or without food; some people get more relief from 1,500 to 2,000 mg a day, taken once a day or split in two, and doses above 2,000 mg have not been studied. People under 50 kg are less likely to need more than 1,000 mg, and with moderate or severe kidney impairment the starting dose is no more than 750 mg or 500 mg once a day.

The boxed warnings say NSAIDs raise the risk of serious heart attacks and strokes, which can be fatal, a risk that may begin early in treatment and grow with longer use, and of bleeding, ulcers and perforation of the stomach or intestines, which can be fatal, can occur at any time without warning symptoms and is greater in older adults. Nabumetone must not be used around coronary artery bypass graft (CABG) surgery, by anyone allergic to it, by people who have had asthma, hives or an allergic-type reaction after aspirin or another NSAID, or by anyone who has had a serious skin reaction to an NSAID. It can also raise blood pressure, worsen heart failure and swelling, harm the kidneys, raise liver enzymes, and rarely cause severe allergic reactions or serious skin reactions, including DRESS, and it may make the skin more reactive to sun. Diarrhea, indigestion and abdominal pain are the most common side effects, and the label calls for the lowest effective dose for the shortest time.

In pregnancy, NSAIDs used from about 20 weeks can cause rare but serious kidney problems in the unborn baby, leading to low amniotic fluid, and from about 30 weeks they can close a fetal blood vessel (the ductus arteriosus) too early; the label says to avoid them from about 30 weeks and to limit use between 20 and 30 weeks, and the FDA advises against NSAIDs from 20 weeks unless a health care professional recommends one. Blood pressure is monitored closely at the start and throughout treatment. The original Relafen brand is no longer on the market, and Relafen DS is a 1,000 mg tablet.

Taking Nabumetone

How to take it

Once or twice a day as prescribed, with or without food. Use the lowest dose that works for the shortest time your prescriber advises, and avoid unnecessary or prolonged sun exposure, wearing protective clothing, sunglasses and sunscreen outdoors.

If you miss a dose

Take the missed dose as soon as you remember, unless it is almost time for the next one; then skip it. Do not take a double dose.

Storage

At room temperature, away from excess heat and moisture, out of reach of children. Use a take-back program rather than flushing it.

Interactions to know about

Taking it with aspirin is generally not recommended, and warfarin and other anticoagulants, corticosteroids, SSRIs and SNRIs raise the risk of bleeding. It can weaken ACE inhibitors and diuretics such as furosemide and thiazides, raises lithium levels, and calls for caution with methotrexate. Do not start other NSAIDs, such as ibuprofen or naproxen, without asking your prescriber, and alcohol use adds to the risk of stomach bleeding.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Nabumetone differs from pharmacy to pharmacy

For generic 500 and 750 mg tablets, quotes differ mainly by the pharmacy’s dispensing fee and markup, and whether nabumetone is on a pharmacy’s flat-price generic list varies. Daily doses of 1,000 to 2,000 mg can mean several tablets a day, which adds up where a pharmacy prices per tablet.

A product sold under a brand name, such as Relafen DS, can be priced differently from plain generic tablets even though it is marketed under a generic approval, and a pharmacy that does not stock the 1,000 mg strength may need to order it. A prescription that names Relafen DS and blocks substitution limits the pharmacy to that product.

Ways to pay less for Nabumetone without insurance

• Ask for generic nabumetone, and make sure the prescription does not require a named product such as Relafen DS.
• If your dose is 1,000 mg, compare quotes for one 1,000 mg tablet and for two 500 mg tablets, and ask the prescriber to write the one that suits you.
• Once your dose is settled, ask for a ninety-day supply, and compare more than one pharmacy.
• If it is quoted high, ask the prescriber whether another generic NSAID, such as naproxen or meloxicam, would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Nabumetone

1. 1.Is it safe with my heart, kidney or blood pressure conditions?
2. 2.Can I take it with my aspirin, blood thinner, antidepressant or water pill?
3. 3.Which stomach or bleeding symptoms mean I should stop it and get help?
4. 4.Should I take my dose once a day or split it in two?

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