[Treatment of acute gout attacks with tolmetin (author's transl)]

In an open trial 15 patients with acute gout attacks were treated with Tolmetin. A statistically significant improvement of several pain values measured as well as subsidence of swellings and redness were observed. By summing up the scores "good" and "moderate", the joint judgement of physician and patients established a 90% success of treatment with regard to efficacy and tolerability. During Tolmetin treatment a statistically significant decrease of mean uric acid levels could be seen.

Analgesic efficacy of zomepirac sodium in patients with pain due to cancer

In a single-dose, a double-blind crossover study in 40 patients with chronic pain due to advanced cancer, zomepirac sodium (Zomax), a new, single-entity, non-narcotic analgesic, was compared to oxycodone with APC (Percodan) and placebo. Both a verbal and a curvilinear visual analog scale were used in the study, and the results obtained were comparable. Zomepirac sodium, 100 mg, provided analgesia equal to oxycodone with APC in all assessments of pain intensity and pain relief. The analgesic activity of zomepirac sodium was apparent by 1 hour, reached a peak between 3 and 4 hours after administration, and lasted at least 6 hours. Zomepirac sodium, 100 mg, appears to be an acceptable alternative to narcotic combinations such as oxycodone with APC in the management of moderate to severe cancer pain. The visual analog scale presented appears to be useful in the evaluation of analgesic efficacy and appears to be acceptable as an alternative to the more conventional verbal scale.

Evaluation of zomepirac sodium

The chemistry, pharmacokinetics, pharmacology, clinical efficacy, adverse effects, physical dependence and tolerance, drug interactions, dosing, and cost of zomepirac sodium (Zomax, McNeil) are reviewed. Zomepirac is a new nonsteroidal anti-inflammatory agent (NSAIA) approved for the treatment of mild to moderately severe pain. The drug is well absorbed when given orally. It undergoes extensive biotransformation in the liver. Zomepirac shares the pharmacology of the other NSAIAs by decreasing prostaglandin synthesis. The efficacy of zomepirac has been demonstrated primarily in acute forms of pain with associated inflammatory processes including postdental-extraction, postpartum, and postoperative pain. Many of these studies have been single-dose evaluations. Zomepirac sodium 100 mg has been reported to be approximately equivalent to one to two tablets of aspirin-phenacetin-caffeine (APC) with codeine 30 mg. In two studies, zomepirac sodium 100 mg compared favorably with morphine sulfate 8 and 16 mg i.m. It has been shown to be superior to aspirin 650 mg in oral-surgery patients. In osteoarthritis, daily doses of zomepirac sodium 400-600 mg are approximately equivalent to aspirin 3200-4800 mg. Zomepirac has side effects similar to high-dose aspirin. Zomepirac is associated with an increased incidence of urogenital symptoms such as dysuria and pyuria. Because of tumorigenicity in rats, the drug is contraindicated in children, pregnant women, and nursing mothers. The drug has not demonstrated any potential for physical dependence, withdrawal, or tolerance. Zomepirac may provide a suitable alternative to aspirin, narcotic/NSAIA combinations, and narcotics in the treatment of mild to moderately severe pain. It is unlikely that zomepirac will replace narcotics in more severe types of pain.

Zomepirac sodium. A new nonaddicting analgesic

Zomepirac sodium (Zomax) is a new orally effective nonopioid analgesic that can relieve mild to severe pain. It is more effective than aspirin or codeine alone and is as effective as analgesic combinations containing codeine or other narcotics. Given orally, zomepirac has provided analgesia comparable with usual intramuscular doses of morphine in postoperative pain. With long-term use, neither tolerance to its analgesic effect nor psychic or physical dependence has been demonstrated. Like aspirin, zomepirac has anti-inflammatory and antipyretic actions and inhibits the synthesis of prostaglandins. Zomepirac is generally well tolerated with both short-term and long-term use; gastrointestinal reactions are the most frequently occurring side effects.

Tolmetin-induced aseptic meningitis

A 21-year-old woman with systemic lupus erythematosus (SLE) had meningismus, conjunctivitis, lymphadenopathy, and elevation of liver function values following ibuprofen therapy. All symptoms and laboratory value abnormalities resolved rapidly when the drug therapy was stopped. Two years later, a similar reaction occurred after taking tolmetin sodium. Fever, adenopathy, aseptic meningitis with a polymorphonuclear pleocytosis, and serum transaminase level elevations resolved rapidly after use of the drug was discontinued. The mechanism of this reaction to nonsteroidal antiinflammatory drugs in patients with SLE is not known.

A comparative endoscopic evaluation of the damaging effects of nonsteroidal anti-inflammatory agents on the gastric and duodenal mucosa

Twenty-five normal volunteers were randomized into five equal parallel groups. Groups I received ibuprofen (2,400 mg./day); group II received tolmetin (2,000 mg./day); group III received indomethacin (150 mg./day); group IV received naproxen (750 mg./day) and group V received placebo (four tablets daily). All drugs were given on a q.i.d. basis except naproxen which was given b.i.d. The doses selected represented the manufacturer's highest recommended dosage for the treatment of arthritic disorders. A single-blind technic was used in which the investigators were unaware of which drug each volunteer was taking. Upper gastrointestinal endoscopy and photography were carried out before and after seven days of administration of each medication. Gastric and duodenal mucosal injury was graded on a 0-4 + scale. Three of the four drugs studied produced essentially equal gastric and duodenal mucosal injury with tolmetin producing the most damage followed by naproxen and indomethacin. Ibuprofen produced gastric mucosal injury equivalent to that seen with naproxen and indomethacin but no duodenal mucosal injury was seen with this drug. Extremely poor correlation was found between subjective symptomatology and endoscopic findings.

A double-blind comparative evaluation of tolmetin versus naproxen in osteoarthritis

A double-blind, between patient trial was carried out in 70 patients with osteoarthritis of the knee or hip joint. Patients were allocated at random to treatment with either 800 mg tolmetin sodium daily or 500 mg naproxen daily over a period of 12 weeks, both drugs being given in identical capsule form in a dosage of 2 capsules twice daily. The results of assessments of functional and subjective parameters before nad during treatment suggest that tolmetin sodium was at least as effective as naproxen in relieving pain and the incidence of side-effects as naproxen in relieving pain and the incidence of side-effects in the two groups was similar.

Orally administered zomepirac and parenterally administered morphine. Comparison for the treatment of postoperative pain

A double-blind study comparing the analgesic efficacy of orally administered zomepirac sodium with intramuscularly (IM) administered morphine sulfate was conducted in 109 patients with acute postoperative pain. Single treatments were administered within 48 hours of surgery, and subjective responses were obtained from patients by specially employed trained nurses. Pain relief achieved with both doses of orally administered zomepirac sodium at 100 mg and 200 mg was similar, and analgesia with each dose of zomepirac was significantly better than that obtained with IM administered morphine sulfate at 8 mg. There were no unusual side effects with either drug.

Nonsteroidal anti-inflammatory intolerance. An anaphylactic reaction to tolmetin

A case of an anaphylactic reaction to tolmetin sodium was proven by rechallenge. The nature of allergic-like reactions to nonsteroidal anti-inflammatory drugs is unclear. Caution is advised in treating a patient experiencing such a reaction.