Is nabumetone (Nonsteroidal Anti-Inflammatory Drug (NSAID)) used in adolescents?

Use of Nabumetone in Adolescents

Nabumetone is not specifically FDA-approved for use in adolescents, but it has been studied and can be used in juvenile rheumatoid arthritis (JRA) at a dose of 30 mg/kg/day (up to 2000 mg/day) with demonstrated safety and efficacy. 1

Evidence for Use in Adolescents

• Nabumetone has been studied in children and adolescents with juvenile rheumatoid arthritis (JRA) in an open-label study that established dosing recommendations of 30 mg/kg/day (up to 2000 mg/day) 1
• The study included children aged 2-16 years, demonstrating a safe profile with no loss of efficacy compared to previous NSAID treatments 1
• 93% of patients showed no flare in disease activity during the nabumetone treatment period, suggesting good efficacy 1
• The adverse event profile in children was similar to that reported for nabumetone in adults 1

Clinical Applications in Adolescents

• Nabumetone can be used in adolescents primarily for inflammatory conditions such as juvenile rheumatoid arthritis 1
• It can be administered as a tablet or as a slurry by suspending tablets in warm water, making it more versatile for pediatric administration 1
• The once-daily dosing regimen (facilitated by the long half-life of 20-24 hours of its active metabolite) may improve medication adherence in adolescents 2

Pharmacological Considerations

• Nabumetone is a non-acidic prodrug that undergoes extensive first-pass metabolism to form its active metabolite 6-methoxy-2-naphthylacetic acid (6-MNA) 3
• The active metabolite preferentially inhibits COX-2, which may contribute to its favorable gastrointestinal safety profile compared to some other NSAIDs 3, 2
• Unlike many other NSAIDs, nabumetone does not undergo enterohepatic recirculation, which may have implications for reduced gastrointestinal toxicity 2

Safety Considerations

• The most common adverse effects in all age groups include diarrhea, dyspepsia, headache, abdominal pain, and nausea 3
• Nabumetone appears to have a lower incidence of gastrointestinal perforations, ulcerations, and bleeding compared to nonselective COX inhibitors 3
• As with all NSAIDs, caution should be exercised in patients with renal impairment, although several short-term studies have shown little to no effect on renal function 3

Clinical Context and Limitations

• While nabumetone has been studied in JRA, it is not specifically mentioned in the 2019 American College of Rheumatology/Arthritis Foundation guideline for juvenile idiopathic arthritis, which does recommend NSAIDs as a class for various presentations 4
• NSAIDs as a class are recommended for treatment of active sacroiliitis and enthesitis in children and adolescents with JIA 4
• There is no evidence for the use of nabumetone in the prevention of migraine in children and adolescents, where ibuprofen is the recommended first-line NSAID 4

Conclusion

Nabumetone can be used in adolescents with juvenile rheumatoid arthritis at a dose of 30 mg/kg/day (up to 2000 mg/day), administered once daily as either a tablet or slurry. Its favorable gastrointestinal safety profile and once-daily dosing make it a reasonable option for adolescents requiring NSAID therapy for inflammatory conditions.