From the Guidelines
Nabumetone can increase the risk of bleeding, although data indicate that its GI safety may be superior compared to other nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs). Nabumetone is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting cyclooxygenase enzymes, which reduces prostaglandin production and provides anti-inflammatory, analgesic, and antipyretic effects. However, this same mechanism also inhibits the production of prostaglandins that protect the stomach lining and help maintain normal platelet function. As a result, nabumetone can impair platelet aggregation and prolong bleeding time, as noted in a study published in the Clinical Gastroenterology and Hepatology journal 1.
The risk of bleeding associated with nabumetone may be higher in certain patient populations, including:
- Elderly patients, due to age-related physiologic changes such as decreasing GI prostaglandin concentrations 1
- Patients with a history of gastrointestinal bleeding, as this increases the likelihood of a GI event substantially, with an odds ratio as high as 13.5 1
- Patients taking anticoagulants like warfarin, antiplatelet medications like aspirin or clopidogrel, or corticosteroids, as these can increase the risk of GI complications 1
- Patients taking high-dose NSAIDs or combinations of NSAIDs, including ASA, coxibs, and over-the-counter products, as this can increase the risk of GI complications 1
It is essential for patients to be cautious about this side effect, especially before surgical procedures, and to inform healthcare providers about all medications they are taking. If unusual bleeding or bruising occurs while taking nabumetone, medical attention should be sought promptly. According to the study, the average relative risk of developing a serious GI complication is 3- to 5-fold greater among NSAID users than among nonusers 1.
From the FDA Drug Label
NSAIDs, including nabumetone, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine, which can be fatal NSAIDs inhibit platelet aggregation and have been shown to prolong bleeding time in some patients. Unlike aspirin, their effect on platelet function is quantitatively less, of shorter duration, and reversible Patients receiving nabumetone who may be adversely affected by alterations in platelet function, such as those with coagulation disorders or patients receiving anticoagulants, should be carefully monitored
Bleeding Risk: Yes, nabumetone may increase the risk for bleeding, particularly gastrointestinal bleeding, due to its effect on platelet aggregation and the gastrointestinal tract.
- Key Factors: Patients with a prior history of ulcer disease or gastrointestinal bleeding, concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status are at a greater risk for GI bleeding.
- Monitoring: Patients should be monitored for signs and symptoms of GI ulceration and bleeding during NSAID therapy, and the lowest effective dose should be used for the shortest possible duration. 2 2
From the Research
Risk of Bleeding with Nabumetone
- Nabumetone may increase the risk of gastrointestinal perforations, ulcerations, and bleedings (PUBs), similar to other COX inhibitors 3.
- However, several studies have shown a low incidence of PUBs with nabumetone, comparable to COX-2 selective inhibitors and lower than nonselective COX inhibitors 3.
- The non-acidic chemical properties of nabumetone and its COX-1/COX-2 inhibitor profile may contribute to the lower risk of PUBs 3.
- Nabumetone's metabolite, 6-MNA, has a dose-related effect on platelet aggregation, but no effect on bleeding time in clinical studies 3, 4.
Interaction with Anticoagulants
- Concomitant therapy with warfarin and nabumetone may increase the risk of bleeding due to pharmacodynamic or pharmacokinetic interactions 5.
- A case report described a patient who experienced hemarthrosis after adding nabumetone to their warfarin regimen, highlighting the need for caution and close monitoring when combining these medications 5.