flurbiprofen

Absorption: Well absorbed after oral administration.

Distribution: Unknown.

Protein Binding: 99%.

Metabolism/Excretion: Mostly metabolized by the liver, primarily by the CYP2C9 isoenzyme. Patients who are poor CYP2C9 metabolizers may have reduced metabolism of flurbiprofen, which may lead to ↑ toxicity. 20–25% excreted unchanged by the kidneys.

Half-Life: 3–6 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO (anti-inflammatory)	few days–1 wk	1–2 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Cross-sensitivity may exist with other NSAIDs, including aspirin;
Active GI bleeding or ulcer disease;
Coronary artery bypass graft surgery;
OB: Avoid use after 30 wk gestation;
Lactation: Lactation.

Use Cautiously in:

Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, MI, and stroke, especially with prolonged use or use of higher doses); avoid use in patients with recent MI or HF;
Severe renal impairment;
Severe hepatic impairment;
History of ulcer disease;
Diabetes mellitus;
Bleeding disorders;
OB: Use at or after 20 wk gestation may cause fetal or neonatal renal impairment; if treatment is necessary between 20 wk and 30 wk gestation, limit use to the lowest effective dose and shortest duration possible;
Pedi: Safety and effectiveness not established in children;
Geri: Appears on Beers list. risk GI bleeding or peptic ulcer disease in older adults. Avoid chronic use unless other alternatives are not effective and the patient can take a gastroprotective agent; avoid short-term use in combination with oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents unless other alternatives are not effective and the patient can take a gastroprotective agent.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema, HF, hypertension, MI, palpitations

Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), EXFOLIATIVE DERMATITIS, ↑sweating, rash, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS

EENT: blurred vision, corneal opacities, tinnitus

F and E: hyperkalemia

GI: abdominal pain, heartburn, nausea, bloated feeling, constipation, diarrhea, GI BLEEDING, hepatitis, stomatitis

GU: incontinence

Hemat: blood dyscrasias, prolonged bleeding time

MS: myalgia

Neuro: depression, dizziness, drowsiness, headache, insomnia, psychic disturbances, STROKE

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), chills, fever

Interactions ⬆ ⬇

Drug-drug:

Concurrent use withaspirin may ↓ effectiveness.
↑adverse GI effects with aspirin, other NSAIDs, potassium supplements, corticosteroids, or alcohol.
Chronic use with acetaminophen may ↑ risk of adverse renal reactions.
May ↓ effectiveness of diuretics or antihypertensives.
May ↑ hypoglycemic response to insulins or oral hypoglycemic agents.
May ↑ serum levels and risk of toxicity from lithium and methotrexate.
Probenecid may ↑ risk of toxicity.
↑risk of bleeding with anticoagulants, aspirin, clopidogrel, ticagrelor, prasugrel, corticosteroids, fibrinolytics, SNRIs, or SSRIs.
↑risk of adverse hematologic reactions with antineoplastics or radiation therapy.
↑risk of nephrotoxicity with cyclosporine.

Drug-Natural Products:

↑bleeding risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others.

Route/Dosage ⬆ ⬇

PO (Adults ): Anti-inflammatory: 200–300 mg daily in 2–4 divided doses (not to exceed 300 mg/day or 100 mg/dose). Dysmenorrhea: 50 mg every 4–6 hr as needed (unlabeled).

Availability ⬆ ⬇

(Generic available)

Tablets: 50 mg; 100 mg

Assessment ⬆ ⬇

Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Monitor for rhinitis, asthma, and urticaria.
Assess pain and range of movement before and periodically during therapy.
Assess for rash periodically during therapy. May cause SJS. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.
Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, facial swelling) periodically during therapy. Discontinue therapy if symptoms occur.

Lab Test Considerations:

May cause prolonged bleeding time; effects may persist for <1 day.
- May cause ↓ hemoglobin, hematocrit, leukocyte, and platelet counts.
- Monitor liver function tests periodically during therapy. May cause ↑ serum alkaline phosphatase, LDH, AST, and ALT concentrations.
- Monitor BUN, serum creatinine, and electrolytes periodically during therapy. May cause ↑ BUN, serum creatinine, and electrolyte concentrations and ↓ urine electrolyte concentrations.

Implementation ⬆ ⬇

Administration in higher-than-recommended doses does not provide increased effectiveness but may cause increased side effects. Use lowest effective dose for shortest period of time to minimize risk of cardiovascular thrombotic events.
PO: For rapid initial effect, administer 30 min before or 2 hr after meals. Administer after meals or with food or an antacid containing aluminum or magnesium to minimize gastric irritation.

Patient/Family Teaching ⬆ ⬇

Advise patient to take flurbiprofen with a full glass of water and to remain in an upright position for 15–30 min after administration.
- Instruct patient to take medication as prescribed. Take missed doses as soon as remembered, but not if almost time for next dose. Do not double doses.
- May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to medication is known.
- Caution patient to avoid the concurrent use of alcohol, aspirin, other NSAIDs, acetaminophen, or other OTC or herbal products without consulting health care professional.
- Advise patient to inform health care professional of medication regimen before treatment or surgery.
- Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise women to avoid flurbiprofen in the 3rd trimester of pregnancy (after 29 wk), may cause premature closure of the fetal ductus arteriosus. Use of flurbiprofen after 20 wk may cause fetal renal dysfunction leading to oligohydramnios. May cause reversible infertility in women attempting to conceive; may consider discontinuing flurbiprofen.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇