Category:

• Analgesic

Description:

• NSAID, non-narcotic analgesic

Indications:

• Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis

• Inhibition of inoperative miosis (ophth), cystoid macular edema (non-FDA approved)

• Inflammation after cataract or glaucoma laser surgery or uveitis syndromes (ophth: non-FDA approved)

• Bursitis, primary dysmenorrhea, tendinitis, acute gout (all non-FDA approved)

Contraindications:

• Dendritic keratitis (ophth)

Precautions:

• Pregnancy category C; excreted in breast milk; use caution in nursing mothers

• Bleeding tendencies, peptic ulcer

• Hepatic/renal function impairment, elderly, CHF, hypertension

Adverse Reactions (Side Effects):

• CNS: dizziness, headache, lightheadedness

• CV: chest pain, CHF, dysrhythmias, edema, hyper/hypotension, palpitation, tachycardia

• EENT: burning or stinging upon instillation, dry eyes, hearing disturbances, photophobia, tinnitus, visual disturbances

• GI: abdominal cramps, constipation, diarrhea, dyspepsia, flatulence, gastric or duodenal ulcer with bleeding or perforation, hepatitis, nausea, occult blood in stool, pancreatitis, vomiting

• GU: renal failure

• HEME: agranulocytosis, eosinophilia, leukopenia, pancytopenia, thrombocytopenia

• METAB: hyperglycemia, hyperkalemia, hypoglycemia, hyponatremia,

• RESP: bronchospasm, dyspnea

• SKIN: photosensitivity, rash, urticaria

Dosage:

• Administered orally and ophthalmic instillation

• Adult:            

  • Rheumatoid and osteoarthritis: PO 200-300mg daily divided 2-4 times daily

  • Dysmenorrhea: PO 50mg daily

  • Inhibition of intraoperative miosis: OPHTH 1 drop every 30 minutes beginning 2 hours before surgery (total 4 drops)

Drug interactions:

• Warfarin: addition of flurbiprofen associated with excessive hypoprothrombinemia and bleeding; ibuprofen less likely to interact

• Methotrexate: addition of flurbiprofen may interfere with the renal secretion of methotrexate, yielding increased risk of methotrexate toxicity

• Prednisone: increase risk of GI ulceration

• Loop diuretics: reduction in diuretic and antihypertensive effects