fenoprofen

Absorption: Well absorbed from the GI tract.

Distribution: Unknown.

Protein Binding: >99%.

Metabolism/Excretion: Mostly metabolized by the liver. 2–5% excreted unchanged by the kidneys.

Half-Life: 3 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO (analgesic activity)	15–30 min	1–2 hr	4–6 hr
PO (anti-inflammatory activity)	several days	2–3 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to fenoprofen, aspirin, or other NSAIDs;
Active GI bleeding or ulcer disease;
Severe renal impairment;
Coronary artery bypass graft surgery;
Recent MI;
HF;
OB: Avoid use after 30 wk gestation.

Use Cautiously in:

Renal impairment;
Hepatic impairment;
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);
History of long duration of NSAID use, smoking, alcohol use, advanced liver disease, coagulopathy, or poor general health (↑ risk of GI bleeding);
History of peptic ulcer disease and/or GI bleeding;
Bleeding tendency or concurrent anticoagulant therapy;
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;
Lactation: Safety not established in breastfeeding;
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, MI, palpitations

Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), EXFOLIATIVE DERMATITIS, GENERALIZED BULLOUS FIXED DRUG ERUPTION, pruritus, rash, STEVENS-JOHNSON SYNDROME , TOXIC EPIDERMAL NECROLYSIS, sweating

EENT: blurred vision, hearing loss, tinnitus

F and E: hyperkalemia

GI: dyspepsia, abdominal pain, constipation, diarrhea, GI BLEEDING, GI PERFORATION, GI ULCERATION, HEPATITIS, nausea, vomiting

GU: cystitis, dysuria, hematuria, renal failure

Hemat: prolonged bleeding time

Neuro: confusion, dizziness, drowsiness, headache, STROKE, tremor

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND SERIOUS SKIN REACTIONS)

Interactions ⬆ ⬇

Drug-drug:

Aspirin or antacids may ↓ effectiveness.
Additive adverse GI effects with aspirin, other NSAIDs, potassium supplements, corticosteroids, or alcohol.
May ↓ the effectiveness of diuretics or antihypertensives.
May ↑ levels and risk of toxicity of lithium and methotrexate.
↑risk of GI bleeding with anticoagulants, aspirin, clopidogrel, ticagrelor, prasugrel, corticosteroids, fibrinolytics, SNRIs, or SSRIs.
↑risk of adverse hematologic reactions with antineoplastics or radiation therapy.
Phenobarbital may ↓ levels and effectiveness.
May ↑ the risk of nephrotoxicity withcyclosporine.

Drug-Natural Products:

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

Route/Dosage ⬆ ⬇

Rheumatoid Arthritis/Osteoarthritis

PO (Adults ): 400–600 mg 3–4 times daily (not to exceed 3.2 g/day).

Mild to Moderate Pain

PO (Adults ): 200 mg every 4–6 hr.

Availability ⬆ ⬇

(Generic available)

Capsules: 200 mg; 300 mg; 400 mg

Assessment ⬆ ⬇

Monitor for signs/symptoms of anaphylaxis (rhinitis, asthma, urticaria), especially in patients with asthma, aspirin-induced allergy, and nasal polyps.
Assess for serious skin reactions. If rash is severe or associated with fever, malaise, fatigue, muscle or joint pain, blisters, oral lesions, conjunctivitis, hepatitis, or eosinophilia, discontinue fenoprofen.
Monitor for signs/symptoms of eosinophilia and DRESS (fever, rash, lymphadenopathy, facial swelling) periodically during therapy. At first sign of symptoms, discontinue fenoprofen.
Assess arthritis pain and range of movement before and 1–2 hr after administration.
Assess BP during initiation and throughout therapy. May cause new onset or worsening hypertension.
Monitor for GI ulceration, bleeding, and perforation during therapy. If symptoms occur, discontinue fenoprofen until serious GI event is ruled out.

Lab Test Considerations:

May ↓ hemoglobin, hematocrit, leukocytes, and platelets.
- Monitor liver function tests periodically during long-term therapy. May ↑ serum alkaline phosphatase, LDH, AST, and ALT.
- Monitor BUN, creatinine, and electrolytes periodically during therapy. May ↑ BUN, creatinine, and potassium.

Implementation ⬆ ⬇

Administration in higher-than-recommended doses does not provide ↑ effectiveness but may cause ↑ side effects. Use lowest effective dose for shortest duration to minimize risk of cardiovascular thrombotic events.
- Correct dehydration or hypovolemia prior to initiation.
- Coadminister with acetaminophen and/or opioids for additive analgesic effect and to lower opioid dose.
PO: Administer 30 min before or 2 hr after meals. Administer with food to ↓ gastric irritation.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Advise patient to take with food or a full glass of water or milk and to remain upright for 15–30 min after dose. Do not double doses.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications, especially aspirin, acetaminophen, other NSAIDs and alcohol.
May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
Instruct patient to notify health care provider of medication regimen before treatment or surgery.
Inform patient of ↑ risk of MI and stroke. Use lowest effective dose for shortest time. Advise patient to notify health care provider immediately if signs/symptoms (shortness of breath or trouble breathing, chest pain, weakness in one part or side of body, slurred speech, swelling of the face or throat) occur.
Advise patient to notify health care provider promptly if signs/symptoms of GI toxicity (abdominal pain, black stools) occur.
Advise patient to consult health care provider if visual disturbances, tinnitus, weight gain, edema, or persistent headache occur.
Advise patient to stop fenoprofen and notify health care provider if signs of liver dysfunction (nausea, fatigue, diarrhea, pruritus, jaundice, right upper quadrant pain, flu-like symptoms, rash) occur.
Instruct patient to discontinue therapy immediately and notify health care provider for fever, lymphadenopathy, or rash. Therapy may mask inflammation and fever.
Rep: May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Advise patient to avoid fenoprofen at 30 wk gestation and after; may cause premature closure of the fetal ductus arteriosus. Use of fenoprofen after 20 wk may cause fetal renal impairment leading to oligohydramnios. May cause reversible infertility in women.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇