Nabumetone

(na-byou-muh-tone)

Trade/other name(s): Relafen

Why would this drug be used?

Nabumetone may be used to treat mild to moderate pain from cancer, surgery, or other causes. For severe pain, it is more helpful when used along with other pain-relieving drugs. It is also used to reduce fever and inflammation, as well as for other purposes.

How does this drug work?

Nabumetone is a non-opioid pain medicine, meaning that it is not in the same family as morphine or codeine. It belongs to the general class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). Nabumetone's action is not fully understood, but it helps block the body from making prostaglandins. (Prostaglandins are substances made by most of the cells in the body. They have a role in many body functions, including pain and inflammation.) Nabumetone helps prevent pain receptors from passing pain messages to the brain. Nabumetone helps reduce inflammation. It also reduces fever by helping enlarge blood vessels near the skin so that heat is lost from the body.

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods.
• About any reactions you have had when taking aspirin or other non-steroidal anti-inflammatory medicines in the past. If you have had problems with any of these medicines, you are more likely to have problems taking nabumetone.
• If you have ever had any medical conditions such as asthma, nasal polyps, allergies, high blood pressure, kidney disease, liver disease (including hepatitis), stroke, high cholesterol, diabetes, or heart disease. These conditions increase the risk of serious side effects from or reactions to nabumetone. You may need a different medicine, or need to be watched more closely during treatment.
• If you have congestive heart failure or fluid retention (swelling, usually of the legs and feet). Nabumetone may worsen this problem.
• If you are taking blood pressure medicines. Nabumetone may cause some blood pressure medicines to stop working properly. In some cases, the combination of medicines may damage the kidneys.
• If you have ever had stomach or intestinal ulcers, especially if you had bleeding. Nabumetone can worsen these problems or make them come back.
• If you have hemophilia or any other bleeding problem, or if you are taking blood thinners such as warfarin or heparin. Nabumetone can increase your risk of bleeding from the stomach or intestine.
• If you are pregnant or trying to get pregnant. Taking nabumetone, especially later in pregnancy, can harm the baby and delay delivery.
• If you are breast-feeding. It is not known if nabumetone is excreted in breast milk. If it is, it may affect the baby.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If you take nabumetone while you are taking lithium, your lithium level may go up. This can increase your risk of toxic effects from lithium. You may your lithium levels checked more often while on nabumetone.

Taking nabumetone while using "blood thinners" (such as warfarin and heparin) can increase your risk of serious bleeding.

Probenecid can cause nabumetone to build up in the body. Check with your doctor or pharmacist about taking it while you are taking nabumetone.

Alcohol may increase your risk of stomach irritation or bleeding, as may aspirin. Steroids that are taken by mouth, such as prednisone, prednisolone, hydrocortisone, betamethasone, budesonide, triamcinolone, can also increase this risk.

Medicines for high blood pressure, such as diuretics (water pills) and ACE inhibitors (such as captopril, lisinopril, enalapril, benazepril, and others) may not work as well if taken during treatment with nabumetone. You may need more frequent blood pressure checks and possibly a change of medicines.

Methotrexate may have more toxic effects if nabumetone is taken during the same time.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Nabumetone is a pill or liquid that can be taken by mouth with milk, food, or antacids. It is taken once or twice a day. The dose depends on how well it works for you.

Take this drug exactly as directed by your doctor, or follow the directions on the label for the non-prescription doses. If you do not understand the instructions, ask your doctor or nurse to explain them to you.

Keep the medicine in a tightly closed container away from light, heat, and moisture and out of the reach of children and pets.

Precautions

Avoid aspirin or other non-steroidal anti-inflammatory drugs like ibuprofen while taking nabumetone. It is easy to get aspirin and ibuprofen without knowing it, because they are often added to other medicines. The larger amounts you get if you take extra doses may increase the risk of bleeding or stomach irritation. Ask your pharmacist, doctor, or nurse what is in your prescription drugs before taking nabumetone. Read the ingredient list on any remedies for headache, sinus, cold or flu before taking them, or check with your pharmacist.

Avoid nabumetone if you have or have ever had a stomach or duodenal ulcer. Nabumetone can cause severe bleeding or holes in the intestine.

If you have ever had trouble breathing, rash, itching, or swelling in the mouth or throat after taking aspirin or other anti-inflammatory drugs, do not take nabumetone.

If your blood counts are low due to chemotherapy or radiation, check with your doctor or nurse before taking nabumetone. It may increase your chance of bleeding.

Nabumetone must be stopped at least a few days before any type of surgery. Check with your doctor or dentist at least a week before surgery to be sure of your instructions.

Call your doctor or nurse right away if you are vomiting blood or a coffee-ground material, notice blood in your urine or stools, or your stools appear black and tarry. Talk to your doctor if you have pain in your belly or severe indigestion. Stop taking nabumetone until after you talk with your doctor.

Nabumetone can cause fluid retention and worsen heart failure. If you have unexplained weight gain or swelling, stop the nabumetone and call your doctor.

Rarely, nabumetone can cause damage to the liver. If you notice nausea, tiredness, itching, tenderness below the right side of your rib cage, flu-like symptoms, or yellowing of the skin or eyes, stop the medicine and call your doctor or nurse right away.

Your doctor may want to check your lab work and blood pressure more often if you are taking nabumetone for more than a few weeks. This is to help find problems early, before they worsen.

Nabumetone can increase your risk of heart attack and stroke. If you develop shortness of breath, chest pain, weakness in one part or on one side of the body, or slurred speech, get help right away.

If you have trouble breathing, itchy welts on the skin, or swelling of your mouth, face, or throat, get emergency help. This may mean an allergic reaction.

If you notice any type of rash, especially if you also have flu-like symptoms, fever, or sores in your mouth, nose, or throat, stop the nabumetone and call your doctor right away.

Smoking or drinking alcohol increases your risk of bleeding from the stomach or intestine.

Nabumetone may be used with other medicines for chronic pain in people with cancer. Most cancer pain can be controlled. Keep your doctor or nurse informed about how well your pain medicines are working and any side effects you are having. Your cancer team may need to adjust your medicines several times before they find the medicines that work best for you.

If your doctor prescribes another medicine for pain, ask your doctor or nurse whether you should continue taking nabumetone along with the new medicine. Severe pain usually requires more than one type of medicine to control it.

If you have chronic cancer pain, take your pain medicines on a regular schedule to keep it from worsening. If you wait until the pain is bad, it takes more medicine to get it under control. If pain gets bad between doses, talk to your cancer team about changing your medicine or adding an extra one for "breakthrough" pain.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• heartburn, stomach pain, or nausea

Less common

• diarrhea
• gas
• asthma attacks (more likely in people who have asthma already)
• constipation
• vomiting
• bloating or swelling, especially of the legs and feet*
• peptic (stomach) ulcers*
• bleeding from the stomach or intestines*
• itching
• rash*
• ringing in the ears
• dizziness
• headache
• nervousness
• drowsiness
• dry mouth
• more sensitive to sunburn

Rare

• liver damage, which may cause yellow skin or eyes (jaundice)*
• high blood pressure*
• kidney damage (usually gets better after medicine is stopped)*
• kidney failure
• blood in urine
• allergic reaction with trouble breathing, raised itchy welts on the skin, or swelling of the face, mouth, or throat*
• serious skin reaction with blistering, fever*
• heart attack or stroke*
• weight gain*

*See "Precautions" section for more detailed information

Other side effects not listed above can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1991.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.