Flurbiprofen dosing

A 23-year-old man with chest pain noted skin eruptions on his hands, lips, mouth, and penis 24-36 hours after he had taken flurbiprofen (dose not stated). The electrocardiogram showed widespread ST elevation and cardiac markers (troponin I, creatine kinase) were raised... 

Other arylpropionic acids include naproxen, ketopro-fen and flurbiprofen. They share most of the properties of ibuprofen. The daily oral dose of ketoprofen is 50-150 mg, 150-200 mg for flurbiprofen and 250-1000 mg for naproxen. Whereas the plasma elimination half-life of ketoprofen and flurbiprofen are similar to that of ibuprofen (1.5-2.5 h and 2.4-4 h, respectively), naproxen is eliminated much more slowly with a half-life of 13-15 h. 

Eideriy Age appears to increase the possibility of adverse reactions to NSAIDs. The risk of serious ulcer disease is increased this risk appears to increase with dose. Ketorolac is cleared more slowly by the elderly use caution and reduce dosage. Pregnancy Category B (ketoprofen, naproxen, naproxen sodium, flurbiprofen, diclofenac, fenoprofen, ibuprofen, indomethacin, meclofenamate, sulindac). 

Flurbiprofen (Ansaid) is indicated for the treatment of rheumatoid arthritis and osteoarthritis. Its half-life, longer than that of many of the NSAIDs, allows for twice daily dosing. The most common adverse effects of flurbiprofen are similar to those of the other acidic NSAIDs. Flurbiprofen inhibits both COX isoforms about equally. 

Losartan (25 mg dose) has been proposed as a safer alternative to tolbutamide. The determination of losartan/E3174(oxidized metabolite) ratio in 0-8 hour urine or in plasma at 6 hours post dosing have been proposed (Yasar 2002 Sekino 2003). However, in a comparative study in sixteen subjects, a better correlation between genotyping and phenotyping was found with tolbutamide, as compared to losartan or flurbiprofen, though there was no subject with the C9 2/ 3 or C9 3/ 3 variants (Lee 2003). 

Flurbiprofen, 100 mg three times daily, is a well-established first-line NSAID providing there is no evidence of vascular closure or scleral destruction on biomicroscopy. Flurbiprofen should provide pain relief within 2 days and improvement in clinical signs within 1 week. Indomethacin SR fiarmulation, 75 mg twice daily, is a well-established second-choice drug when flurbiprofen is not effective but has also been used as first line. NSAIDs that have shown efficacy and are now available in over-the-counter formulations include naproxen, 500 mg twice daily, and ibuprofen, 600 mg four times daily. If a simplified dosing schedule is a consideration, then pirox-icam, 20 mg/day, may be considered. Once effective control is established, a lower maintenance dose may suffice until the scleritis enters remission. To reduce the risk of gastrointestinal side effects, patients should be instructed to take NSAIDs with food or antacids. 

Fenoprofen (200 to 300 mg in divided doses b.i.d. or t.i.d.) is indicated for acute or long-term treatment of the signs and symptoms of rheumatoid arthritis and osteoarthritis. Fenoprofen is a propionic acid derivative and, similar to ibupro-fen, naproxen, flurbiprofen, or ketoprofen, has analgesic, antipyretic, and antiinflammatory properties (see also Table 3). 

Akhter, S.A. and Barry, B.W. (1985). Absorption through human skin of ibuprofen and flurbiprofen effect of dose variation, deposited drag films, occlusion and the penetration enhancer A-methyl-2-pyrrolidone, Journal of Pharmacy and Pharmacology, 37, 27-37. 

A placebo-controlled study in 11 healthy subjects who were given Ginkgo biloba leaf (Ginkgold) 120 mg twice daily for three doses, followed by a single 100-mg dose of flurbiprofen, found that the pharmacokinetics of flurbiprofen were unchanged. ... 

In 30 patients with rheumatoid arthritis cimetidine 300 mg three times daily for 2 weeks inereased the maximum serum level of flurbiprofen 150 to 300 mg daily, but ranitidine 150 mg twice daily had no effect. The ef-fieaey of the flurbiprofen (assessed by Ritchie score, 50 foot walking time, grip strength) was not altered. Another study in healthy subjeets found that cimetidine 300 mg four times daily slightly increased the serum levels of a single 200-mg dose of flurbiprofen, and raised the flurbiprofen AUC by 13%." No statistically significant interaction occurred with ran-... 

A total of 17 Japanese patients have been identified, with apparently no previous history of seizures, who in the 1986 to 1987 period developed convulsions when given fenbufen 400 mg to 1.2 g daily with enoxacin 200 to 800 mg. Two case reports of this interaction have been published. An 87-year-old Japanese woman taking enoxacin 200 mg also had convulsions after receiving a single 50-mg intravenous dose of flurbiprofen. ... 

However, a patient stabilised on warfarin, ferrous sulfate, phenobarbital and sulfasalazine had a marked increase in his prothrombin time ratio from about 3.2 to 10 after taking sulindac 100 mg twice daily for 5 days. There are 4 similar cases of this interaction on record. One of the patients had a gastrointestinal bleed after taking only three 100-mg doses of sulindac, although this patient was also taking flurbiprofen. Another patient was stabilised on about a 40% lower dose of warfarin with continuation of the sulindac. Another patient had a potassium-losing renal tubular defect, which was thought to contribute to the interaction. ... 

A study in 6 patients taking low doses of methotrexate 10 to 25 mg weekly found no important changes in methotrexate levels when they were given flurbiprofen 100 mg three times daily. In another study of 10 patients with rheumatoid arthritis taking methotrexate 7.5 to 17.5 mg weekly and flurbiprofen 3 mg/kg daily, methotrexate oral and renal clearance were similarly unaffected by flurbiprofen. ... 

Skeith KJ, Russell AS, Jamah F, Coates J, Friedman H. Lack of significant interaction between low dose methotre mte and ibiqrrofen or flurbiprofen in patients with arthritis. JRheu-... 

A study in 10 patients with hypertension found that flurbiprofen 100 mg daily for 7 days did not affeet the pharmaeokineties of single-doses of either propranolol 80 mg or atenolol 100 mg. However, the hypotensive effects of propranolol hut not atenolol were redueed hy the flurbiprofen. ... 

Webster J, Petrie JC, McLean I, Hawksworth GM. Flurbiprofen interacticm with single doses of atenolol and propranolol BrJ Ctin Pharmacol (1984) 18, 861-6. 

A study in 7 healthy subjects found that the increase in renal osmolal clearance of a standard water load in response to furosemide 40 mg orally or 20 mg intravenously fell from 105% to 19% and from 140% to 70%, respectively, after flurbiprofen 100 mg was given. A single-dose study in 10 healthy subjects found that flurbiprofen 100 mg reduced the urinary volume, urinary sodium and urinary potassium, in response to oral furosemide 80 mg by 10%, 9%, and 12%, respectively." ... 

In healthy volunteers orally administered flurbiprofen after three doses of 120 mg standardized (24/6) ginkgo leaf extract in a 24-hour period, no significant changes in... 

Anderson JA, Chen CC (1988) Multiple dosing increases the ocular bioavailability of topically administered flurbiprofen. Arch Ophthalmol 106 1107-9... 

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