Generic Name

Flurbiprofen

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Classification

FDA Approved Indications

• Relief of pain and inflammation in osteoarthritis and rheumatoid arthritis

Mechanism of Action

Inhibits cyclooxygenase (COX-1 and COX-2), enzymes involved in the synthesis of prostaglandins that mediate inflammation, pain, and fever.

Dosage and Administration

Adult: 50 mg two to three times daily, with food to minimize gastrointestinal irritation.

Pediatric: Not established; safety and efficacy not determined.

Geriatric: Use with caution due to increased risk of gastrointestinal and cardiovascular side effects; start at lower end of dosing range.

Renal Impairment: Use with caution; dose adjustments may be necessary. Monitor renal function.

Hepatic Impairment: Use with caution; no specific dose adjustment recommended, but monitor liver function.

Pharmacokinetics

Absorption: Well absorbed from the gastrointestinal tract.

Distribution: Widely distributed; crosses the placenta but minimal penetration into the brain.

Metabolism: Metabolized in the liver primarily via hydroxylation and conjugation.

Excretion: Excreted mainly in the urine, some in feces.

Half Life: Approximately 4 hours.

Contraindications

• Hypersensitivity to flurbiprofen or other NSAIDs
• History of asthma or allergic reactions after taking aspirin or other NSAIDs
• Active gastrointestinal bleeding or ulceration

Precautions

• Use with caution in patients with cardiovascular disease, hypertension, renal or hepatic impairment, bleeding disorders, or history of gastrointestinal disease. Increased risk of cardiovascular thrombotic events, myocardial infarction, and stroke, especially with long-term use.

Adverse Reactions - Common

• Gastrointestinal discomfort, nausea, dyspepsia (Common)
• Headache, dizziness (Common)

Adverse Reactions - Serious

• Gastrointestinal bleeding, ulceration, perforation (Less common but serious)
• Cardiovascular thrombotic events, myocardial infarction, stroke (Serious, especially with long-term use)
• Renal impairment, nephrotoxicity (Serious)

Drug-Drug Interactions

• Warfarin, other anticoagulants, corticosteroids, and other NSAIDs increase bleeding risk.
• ACE inhibitors, diuretics—may increase risk of renal impairment.

Drug-Food Interactions

• Food may reduce the rate of absorption but not the extent.

Drug-Herb Interactions

• Potential interactions with ginkgo, ginseng, and other herbs affecting bleeding risk.

Nursing Implications

Patient/Family Teaching

• Take with food or milk to minimize stomach upset.
• Report signs of gastrointestinal bleeding (black stools, vomiting blood), chest pain, weakness, or swelling.
• Use the lowest effective dose for the shortest duration possible.
• Avoid alcohol and other NSAIDs while using this medication.

Special Considerations

Black Box Warnings:

• Increased risk of cardiovascular thrombotic events, including myocardial infarction and stroke.
• Risk of gastrointestinal bleeding, ulceration, and perforation.

Genetic Factors: Rare genetic polymorphisms in metabolizing enzymes may affect drug levels.

Lab Test Interference: NSAIDs may affect liver and kidney function tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, epigastric pain, dizziness, drowsiness, and, in severe cases, gastrointestinal bleeding and renal failure.

Treatment: Supportive care, activated charcoal if within 1 hour of ingestion, and symptomatic treatment. Dialysis is generally not effective for NSAID overdose.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under recommended storage conditions for the shelf life specified by the manufacturer.