Flurbiprofen (Ansaid, Ocufen)

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

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300