FLURBIPROFEN SODIUM
| FLURBIPROFEN SODIUM (flure-bi'proe-fen) Ansaid, Ocufen Classifications: analgesic, nonsteroidal antiinflammatory drug (nsaid); cox-1 and cox-2 inhibitor; antipyretic; Therapeutic: nsaid, analgesic; antipyretic Prototype: Ibuprofen Pregnancy Category: B first or second trimester; D third trimester |
Availability
50 mg, 100 mg tablets; 0.03% ophthalmic solution
Action
Inhibits prostaglandin synthesis including in the conjunctiva and uvea by inhibiting the COX-1 or COX-2 enzymes; structurally and pharmacologically related to ibuprofen. When administered prophylactically, ocular flurbiprofen reduces miosis, permitting maintenance of drug-induced mydriasis during surgical procedures.
Therapeutic Effect
An antiinflammatory, nonsteroidal analgesic. Also inhibits migration of leukocytes into inflamed tissues, depresses monocyte function, and may inhibit platelet aggregation.
Uses
Inhibition of intraoperative miosis; arthritis and other inflammatory diseases; mild to moderate pain.
Unlabeled Uses
Management of postoperative ocular inflammation, prevention of postcystoid macular edema.
Contraindications
Epithelial herpes simplex; keratitis; perioperative pain from CABG; pregnancy (category B in first and second trimester, and D in third trimester), lactation. Safety in children is not established. For additional contraindications to oral use, see ibuprofen.
Cautious Use
Concomitant use with other NSAIDs; patient who may be adversely affected by prolonged bleeding time; patient in whom asthma, rhinitis, or urticaria is precipitated by aspirin or other NSAIDs.
Route & Dosage
| Inflammatory Disease Adult: PO 200–300 mg/d in 2–4 divided doses (max: 300 mg/d) Mild to Moderate Pain Adult: PO 50–100 mg q6–8h Inhibition of Intraoperative Miosis Adult: Topical 1 drop in eye approximately q30min beginning 2 h before surgery for a total of 4 drops per affected eye |
Administration
Topical- Instill ophthalmic preparation with great care to avoid contamination of solution. Do not touch eye surface with dropper.
- Use the 300 mg dose for initiation of therapy or for acute exacerbations of disease.
- Store at 15°–30° C (59°–86° F) in tight, light-resistant container.
Adverse Effects (≥1%)
Special Senses: Mild ocular stinging, burning, itching, or foreign body sensation (transient). Other: Slowed corneal healing; increased bleeding time. For adverse effects to oral preparations, see ibuprofen.Interactions
Drug: oral anticoagulants, heparin may prolong bleeding time; actions and side effects of both flurbiprofen and phenytoin, sulfonylureas, or sulfonamides may be potentiated. Herbal: Feverfew, garlic, ginger, gingko may increase bleeding potential.Pharmacokinetics
Absorption: 80% absorbed from GI tract. Onset: 2 h. Peak: 2 h. Duration: 6–8 h. Distribution: Small amounts distributed into breast milk. Metabolism: In liver. Elimination: Primarily in urine; some biliary excretion. Half-Life: 5 h.Nursing Implications
Assessment & Drug Effects
- Observe patients with history of cardiac decompensation closely for evidence of fluid retention and edema.
- Lab tests: Baseline and periodic evaluations of Hgb, renal and hepatic function, and auditory and ophthalmologic examinations are recommended in patients receiving prolonged or high-dose therapy.
- Monitor for GI distress and S&S of GI bleeding.
- Note: Symptoms of acute toxicity in children include apnea, cyanosis, response only to painful stimuli, dizziness, and nystagmus.
Patient & Family Education
- Report ocular irritation that persists after flurbiprofen use during surgery (tearing, dry eye sensation, dull eye pain, photophobia) to physician.
- Be alert for bleeding tendency and report unexplained bleeding, prolongation of bleeding time, or bruises. Minor systemic absorption may temporarily increase bleeding time.
- Notify physician immediately of passage of dark tarry stools, "coffee ground" emesis, frankly bloody emesis, or other GI distress, as well as blood or protein in urine, and onset of skin rash, pruritus, jaundice.
- Do not drive or engage in potentially hazardous activities until response to the drug is known.
- Do not self-medicate with OTC drugs without consulting physician.
- Avoid alcohol and NSAIDs unless otherwise advised by physician. Concurrent use may increase risk of GI ulceration and bleeding tendencies.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug