Nabumetone

How it works

It is a prodrug that is metabolised to an active metabolite which inhibits cyclo-oxygenase, reducing prostaglandin synthesis and thereby decreasing inflammation and pain.

Prescribing in practice

• Carries the class NSAID risks of gastrointestinal ulceration and bleeding, cardiovascular thrombotic events and renal impairment; use the lowest effective dose for the shortest duration and avoid in active peptic ulceration.
• Use with caution in the elderly, in hypertension, heart failure and in those with established cardiovascular or renal disease.
• Avoid concurrent use with other NSAIDs and use caution when combined with anticoagulants, antiplatelets, ACE inhibitors and diuretics.

Monitoring

Monitor blood pressure, renal function and for signs of gastrointestinal bleeding, particularly in older patients and those on long-term therapy.

Counselling the patient

• Take with or after food and report any black stools, vomiting of blood or persistent indigestion.
• Avoid taking other over-the-counter anti-inflammatory medicines at the same time.

Evidence & guidelines

MHRA guidance and NICE recommend using NSAIDs at the lowest effective dose for the shortest period owing to gastrointestinal and cardiovascular risks.