EMEDZ.NET

Disclaimer Notice:

Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

The information provided on Emedz.net is for doctors and pharmacists only to manage their patients in the best way and avoid medications-related errors.

Still, for the general population, this should not be considered professional medical advice or a substitute for consultation with a licensed healthcare provider. The content on this blog is not intended to diagnose, treat, cure, or prevent any disease or health condition.

Always seek the advice of a qualified healthcare professional before making any changes to your diet, exercise routine, medication, or any other aspect of your healthcare. We strongly discourage self-medication and self-treatment.

Even though the primary author of emedz.net is an experienced health professional, the blog is not intended to replace medical advice sought at the Doctor’s Clinic.

The authors share personal experiences, research findings, and general knowledge about health and wellness and medications-related topics.

However, individual health situations vary, and what works for one person may not work for another. It's important to consult with a healthcare provider for personalized guidance.

We strive to provide accurate and up-to-date information, but medical knowledge is constantly evolving. Therefore, we do not guarantee the accuracy, completeness, or timeliness of the information presented in this blog.

Emedz.net is not an online pharmacy:

Online pharmacies sell medicines and pharmaceutical products. EMEDZ.net is intended to provide drug-related information to pharmacists and physicians. It is intended to provide authentic information about medicines so as to prevent errors related to prescriptions.

We do not sell medicines, so please don’t ask for them.

We are not affiliated with any pharmaceutical companies:

Emedz.net has no affiliation with any pharmaceutical companies. We do not promote any product. Sometimes brand names are also mentioned in the title of the page, but that is what is called a “Featured Image”. It has nothing to do with selling or promoting that brand. Just to make things easier, generic and brands are mentioned in the blog.

Emedz.net may contain links to external websites or resources for your convenience. We do not endorse or take responsibility for the content of these external sites.

In no event shall Emedz.net, its authors, contributors, or any related parties be liable for any damages or consequences arising from the use of the information provided on this blog.

By using Emedz.net, you acknowledge and agree to this disclaimer and our Terms of Use. If you do not agree with this disclaimer or our Terms of Use, we advise you to refrain from using our website.

Remember, your health is a valuable asset, and decisions about your health should always be made in consultation with a qualified healthcare professional.

Flurbiprofen (Froben) 100 mg, 200 mg Tablets, Eye Drops, Gel

Flurbiprofen (Froben) is a non-selective non-steroidal anti-inflammatory drug that is used in the treatment of mild to moderate pain and inflammatory conditions. Compared to Ibuprofen, it has a longer half-life and therefore it can be taken twice daily. It also has greater anti-inflammatory and antipyretic properties.

Indications of Flurbiprofen (Froben):

Rheumatoid arthritis and osteoarthritis:
- Both osteoarthritis (OA) and rheumatoid arthritis (RA) can be effectively treated with it.
- Canadian labeling: Additional use (not in US labeling):
  - It is used for relieving signs and symptoms of ankylosing spondylitis, pain associated with dysmenorrhea, mild to moderate pain accompanied by inflammation (eg, bursitis, tendonitis, and soft tissue trauma).
Off Label Use of Flurbiprofen in Adults:
- For the management of postoperative pain.

Flurbiprofen (Froben) dose in adults:

Note: The lowest effective dose for the shortest possible duration should b given.

US labeling:

Flurbiprofen (Froben) dose in the treatment of Rheumatoid arthritis and osteoarthritis:

Initial: 200 to 300 mg orally per day, divided into 2 to 4 doses.
100 mg as the maximum single dose (in a multiple-dose daily regimen).

Canadian labeling:

Note: The drug should be taken as soon as remembered in case of a missed dose. A single dose should be taken and the next dose skipped if the next dose is due within 2 hours.

Flurbiprofen (Froben) dose in the treatment of Ankylosing spondylitis, osteoarthritis, and rheumatoid arthritis:

Oral: 200 mg/day in divided doses; some patients may require up to 300 mg/day during symptom exacerbations.
The maximum dose: 300 mg/day.

Flurbiprofen (Froben) dose in Dysmenorrhea:

Oral: 50 mg 4 times daily.

Flurbiprofen (Froben) dose in mild to moderately severe pain:

Oral: 50 mg every 4 to 6 hours as needed.

Flurbiprofen (Froben) Use in Children:

Dose in children has not been established.

Pregnancy Risk Category: C (D in the third trimester)

Some studies that examined in utero NSAID use revealed birth defects. However, the data is inconsistent.
In utero NSAIDs can cause non-teratogenic effects, such as intracranial bleeding, renal failure, necrotizing collitis, and prenatal constriction.
It is possible to see a postnatal non-closure or resection of the ductus Arteriosus that is resistant to medical treatment.
Flurbiprofen should not be used beginning at 30 weeks of gestation because it can cause premature closure of the ductus arteriosus.
NSAIDs may be used during pregnancy to treat mild rheumatoid-arthritis flares. However, it should be avoided or minimized in the early and later trimesters.
Infertility can occur in women of childbearing years due to the long-term use of NSAIDs. This is reversible after withdrawal.
The drug should not be given to women who are having trouble conceiving or are undergoing fertility treatment.
NSAIDs used during pregnancy can increase the risk of miscarriage.

Flurbiprofen use during breastfeeding:

Flurbiprofen can be found in breast milk.
Flurbiprofen's relative infant dose (RID), is 0.9%. This was calculated by using the highest concentration of breast milk and compared with a 100 mg weight-adjusted maternal dosage.
Breastfeeding can be done if the RID is less than 10%
Breast milk has an estimated infant daily dose of 13.5 mg/kg/day. The highest milk concentration (0.09 mcg/ml) is used.
Flurbiprofen 100mg in one dose was administered to mother and resulted in this milk concentration
Flurbiprofen levels in breast milk reached their maximum level 3 hours after the last dose.
Breastfeeding mothers with thrombocytopenia, deranged platelets or thrombocytopenia should not receive flurbiprofen.
Postpartum women who want to breastfeed may use NSAIDs, but it is possible to use other agents.
The risk of infant exposure and the benefits of breastfeeding to the baby during therapy will all play a role in deciding whether to breastfeed.

Flurbiprofen (Froben) Dose adjustment in renal disease:

US labeling:
- Mild impairment:
  - The labelling on products from the manufacturer does not include dose modifications;
  - use with caution.
- Moderate to severe impairment:
  - The manufacturer's labelling does not mention dosage modifications, however they may be required due to potential metabolite buildup.
  - Flurbiprofen should not be administered to patients with advanced renal disease unless the benefits are anticipated to outweigh the risk of decreasing renal function.
- Continuous ambulatory peritoneal dialysis:
  - Not removed by dialysis.
Canadian labeling:
- CrCl ≥30 mL/minute or 0.5 mL/second:
  - There are no dosage adjustments provided in the manufacturer's labeling; use with extreme caution.
- CrCl <30 mL/minute or 0.5 mL/second:
  - In cases of severe renal impairment (CrCl 30 mL/minute or 0.5 mL/second) or rapidly progressing renal disease, it is contraindicated.
- Continuous ambulatory peritoneal dialysis:
  - Not removed by dialysis.
KDIGO 2012 guidelines provide the following recommendations for NSAIDs:
- eGFR 30 to <60 mL/minute/1.73 m²:
  - In patients with intercurrent disease that increases risk of acute kidney injury, it should be stopped temporarily.
- eGFR <30 mL/minute/1.73 m²:
  - Avoid use.

Flurbiprofen (Froben) Dose adjustment in liver disease:

US labeling:
- Reduced doses might be necessary due to substantial hepatic metabolism; the manufacturer's labelling does not mention any dosage changes.
Canadian labeling:
- Usage is not advised in cases of serious liver disease or impairment.

Side Effects of Flurbiprofen (Froben):

Cardiovascular:
- Edema
Central Nervous System:
- Amnesia
- Anxiety
- Depression
- Dizziness
- Drowsiness
- Headache
- Hyperreflexia
- Insomnia
- Malaise
- Nervousness
- Vertigo
Dermatologic:
- Skin Rash
Endocrine & Metabolic:
- Weight Changes
Gastrointestinal:
- Abdominal Pain
- Constipation
- Diarrhea
- Dyspepsia
- Flatulence
- Gastrointestinal Bleeding
- Nausea
- Vomiting
Hepatic:
- Increased liver enzymes
Neuromuscular & skeletal:
- Tremor
- Weakness
Ophthalmic:
- Visual disturbance
Otic:
- Tinnitus
Respiratory:
- Rhinitis

Contraindications to Flurbiprofen (Froben):

Hypersensitivity to any ingredient in the formulation, including flurbiprofen
Following the use of any NSAID, including aspirin, urticaria or allergic-like responses may occur.
Together with coronary artery bypass surgery, you can use it (CABG).

Canadian labeling: Additional contraindications not in US labeling

Children and adolescents younger than 18 years old
Pregnancy (last trimester),breastfeeding
Active GI bleeding, active gastric, duodenal, and peptic ulcers
IBD (Inflammatory Bowel Disease)
Grave hepatic and renal impairment
Hyperkalemia
Uncontrolled severe heart failure
Other bleeding disorders or cerebrovascular bleeding

Warnings and precautions

Anaphylactoid reactions
- Patients can develop anaphylactoid reactions even if they have not been exposed to it before.
- Patients who have rhinitis or NSAID therapy and bronchospasm are not advised to use it.
- Patients with the "aspirine triad" (bronchial aspiration, aspirin intolerance, and rhinitis) are at greater risk.
Cardiovascular events: [US Boxed Warn]
- NSAIDs significantly increase the risk of cardiovascular thrombotic events such as stroke and MI.
- Both the risk and the likelihood of major cardiovascular events can be increased or decreased with early treatment. Individuals who have known risk factors for cardiovascular disease are more vulnerable.
- Monitor your BP as it could lead to hypertension new-onset or exacerbation.
- NSAIDs can also cause cardiovascular events by impairing the response to ACE inhibitors, thiazide or loop diuretics.
- Patients with edema should not use it as it can cause salt or water retention.
- It should not be prescribed to patients suffering from heart disease. Patients with a recent MI should not use it unless the benefits outweigh any potential cardiovascular thrombotic events.
- To minimize cardiovascular events, it is important to use the lowest dose of medication for the shortest time. High-risk patients should consider alternate agents.
CNS effects
- It is possible to experience blurred vision, dizziness, drowsiness and other symptoms that can lead to impairments in physical or mental abilities.
- Patients should be warned about driving or operating machinery.
GI events: [US Boxed Warning]
- NSAIDs can increase the risk of serious GI inflammation, bleeding, ulceration, and even death.
- Old age, GI bleeding history and/or a history of peptic ulcer disease are all factors that increase the risk.
- These events can occur without warning and at any time during therapy.
- It should not be given to patients suffering from active GI bleeding.
- Patients with a history or tendency to have acute lower GI hemorhage should not receive non-aspirin NSAIDs, particularly if they are suffering from angioectasia and diverticulosis.
- Combination therapy can increase bleeding risk by using anticoagulants, corticosteroids and/or aspirin.
- The elderly, smokers, drinkers, people with advanced liver disease, and people with coagulopathy should stay away from the medication.
- High-risk patients should receive an alternative treatment to reduce the chance of GI complications.
- Concurrent aspirin therapy can increase the risk of GI complications, such as ulcers. Therefore, additional gastroprotective therapy (e.g., proton pump inhibitor) is recommended.
Genitourinary effects
- NSAID therapy can be used to treat persistent urinary symptoms such as bladder pain, dysuria and urinary frequency.
- These symptoms can occur anytime after therapy has been initiated.
- If symptoms worsen, it is best to stop taking therapy.
Hematologic effects
- Anemia can occur from prolonged NSAID therapy.
- Patients with coagulation disorders and those on anticoagulants need to be closely monitored for prolonged bleeding, reduced platelet adhesion, and aggregation.
- Rarely are fatal blood dyscrasias such as thrombocytopenia, anemia, and agranulocytosis.
Hepatic effects
- Patients with abnormal LFT should be closely monitored as it can lead to transaminitis.
- If you have symptomatic liver disease, stop all therapy immediately.
- Rarely are severe hepatic reactions such as fulminant liver disease, liver necrosis, or hepatic failure.
Hyperkalemia:
- It is important to monitor potassium closely as NSAIDs can increase hyperkalemia risk.
- Old age, DM, kidney disease and concomitant treatment with other agents that induce hyperkalemia (eg ACE inhibitors) are all associated with a significantly higher risk.
- Canadian labeling prohibits the use of hyperkalemia in patients.
Ophthalmic effects
- Blurred or diminished vision due to NSAIDs may occur. Therapy withdrawal must be completed and an ophthalmologic evaluation performed.
Effects on the renal system:
- NSAIDs can cause renal dysfunction by causing a decrease in renal blood flow and a dose-dependent decrease of prostaglandin synthesis.
- Patients with hypokalemia, elderly, impaired renal function, hepatic impairment and heart failure are at greater risk.
- Rehydration and monitoring of renal function are essential before starting therapy.
- Chronic NSAID therapy can be used to treat renal papillary necrosis or other injuries.
Reactions to skin:
- Toxic epidermal necrolysis, Stevens-Johnson syndrome, and exfoliative dermatitis (SJS) can all cause severe skin reactions that call for therapy discontinuation.
Aseptic meningitis
- Patients with SLE and mixed connective tissue disorders (MTC) are at greater risk for aseptic meningitis.
Asthma
- Patients with asthma who are sensitive to aspirin should not take it.
- Patients with other forms or asthma should be cautious.
Coronary bypass surgery for coronary artery bypass: [US Boxed Warn]
- Due to the increased risk of MI or stroke, it is not recommended that you use this medication in conjunction with coronary artery bypass surgery (CABG).
Hepatic impairment
- Due to the high hepatic metabolism, patients with hepatic diseases must reduce their doses.
- When using NSAIDs, patients with advanced liver disease are more likely to experience GI bleeding.
- Canadian labeling prohibits the use of this medication in patients with severe or active hepatic impairment.
Renal impairment
- Due to the possibility of metabolite accumulation, dose reduction may be necessary for patients with severe or moderate impairment.
- Patients with advanced renal disease should not be given this medication unless the benefits outweigh any potential risk to their kidney function. If therapy is required, close monitoring is essential.
- Canadian labeling prohibits the use of this medication in patients with severe kidney impairment (CrCl 30mL/minute, 0.5mL/second or deteriorating renal disease).

Flurbiprofen (systemic): Drug Interaction

Risk Factor C (Monitor therapy)
5-Aminosalicylic Acid Derivatives	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of 5-Aminosalicylic Acid Derivatives.
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)	May enhance the antiplatelet effect of other Agents with Antiplatelet Properties.
Alcohol (Ethyl)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination.
Aliskiren	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Management: Monitor renal function periodically in patients receiving aliskiren and any nonsteroidal anti-inflammatory agent. Patients at elevated risk of renal dysfunction include those who are elderly, are volume depleted, or have pre-existing renal dysfunction.
Aminoglycosides	Nonsteroidal Anti-Inflammatory Agents may decrease the excretion of Aminoglycosides. Data only in premature infants.
Aminolevulinic Acid (Topical)	Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical).
Angiotensin II Receptor Blockers	May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function.
Angiotensin-Converting Enzyme Inhibitors	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors.
Anticoagulants	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants.
Anticoagulants	Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Anticoagulants.
Beta-Blockers	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Beta-Blockers. Exceptions: Levobunolol; Metipranolol.
Bisphosphonate Derivatives	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern.
Cephalothin	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased.
Collagenase (Systemic)	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased.
Corticosteroids (Systemic)	May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents (Nonselective).
Dasatinib	May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Deferasirox	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased.
Deoxycholic Acid	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.
Desmopressin	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Desmopressin.
Digoxin	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Digoxin.
Drospirenone	Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Drospirenone.
Eplerenone	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone.
Fat Emulsion (Fish Oil Based)	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Felbinac	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Glucosamine	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Haloperidol	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Haloperidol. Specifically including drowsiness and confusion.
HydrALAZINE	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of HydrALAZINE.
Ibritumomab Tiuxetan	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding.
Ibrutinib	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Inotersen	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Limaprost	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Multivitamins/Fluoride (with ADE)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Multivitamins/Minerals (with ADEK, Folate, Iron)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Multivitamins/Minerals (with AE, No Iron)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Naftazone	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents.
Obinutuzumab	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased.
Omega-3 Fatty Acids	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Pentosan Polysulfate Sodium	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents.
Pentoxifylline	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Porfimer	Photosensitizing Agents may enhance the photosensitizing effect of Porfimer.
Potassium-Sparing Diuretics	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics.
PRALAtrexate	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Closely monitor for increased pralatrexate serum levels and/or toxicity if used concomitantly with an NSAID. Monitor for decreased pralatrexate serum levels with NSAID discontinuation.
Probenecid	May increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents.
Prostacyclin Analogues	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Prostaglandins (Ophthalmic)	Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic).
Quinolones	Nonsteroidal Anti-Inflammatory Agents may enhance the neuroexcitatory and/or seizure-potentiating effect of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Quinolones.
Salicylates	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.
Serotonin/Norepinephrine Reuptake Inhibitors	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective).
Tacrolimus (Systemic)	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tacrolimus (Systemic).
Thiazide and Thiazide-Like Diuretics	May enhance the nephrotoxic effect of Nonsteroidal AntiInflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics.
Thrombolytic Agents	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents.
Tipranavir	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Tolperisone	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may enhance the therapeutic effect of Nonsteroidal Anti-Inflammatory Agents.
Tricyclic Antidepressants (Tertiary Amine)	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective).
Vancomycin	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Vancomycin.
Verteporfin	Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin.
Vitamin E (Systemic)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Risk Factor D (Consider therapy modification)
Apixaban	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Apixaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of apixaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Bile Acid Sequestrants	May decrease the absorption of Nonsteroidal Anti-Inflammatory Agents.
CycloSPORINE (Systemic)	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of CycloSPORINE (Systemic). Management: Consider alternatives to nonsteroidal anti-inflammatory agents (NSAIDs). Monitor for evidence of nephrotoxicity, as well as increased serum cyclosporine concentrations and systemic effects (eg, hypertension) during concomitant therapy with NSAIDs.
Dabigatran Etexilate	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of dabigatran and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Diclofenac (Systemic)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Seek alternatives to the combined use of diclofenac with other nonsteroidal anti-inflammatory agents (NSAIDs). Avoid the use of diclofenac/misoprostol with other NSAIDs.
Edoxaban	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of edoxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Bleeding may occur. Management: Concomitant treatment with these agents should generally be avoided. If used concomitantly, increased diligence in monitoring for adverse effects (eg, bleeding, bruising, altered mental status due to CNS bleeds) must be employed.
Lithium	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Lithium.
Loop Diuretics	Nonsteroidal Anti-Inflammatory Agents may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended.
Methotrexate	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Methotrexate. Management: Alternative anti-inflammatory therapy should be considered whenever possible, especially if the patient is receiving higher, antineoplastic doses of methotrexate.
Rivaroxaban	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of rivaroxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Salicylates	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Salicylates. An increased risk of bleeding may be associated with use of this combination. Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the cardioprotective effect of Salicylates. Salicylates may decrease the serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Exceptions: Choline Magnesium Trisalicylate.
Selective Serotonin Reuptake Inhibitors	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider using alternative analgesics, when appropriate, and/or addition of a gastroprotective agent. Monitor patients closely for signs/symptoms of bleeding, and for evidence of diminished SSRI effectiveness with concurrent use.
Sincalide	Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction.
Sodium Phosphates	May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with NSAIDs, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely.
Tenofovir Products	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose.
Vitamin K Antagonists (eg, warfarin)	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the anticoagulant effect of Vitamin K Antagonists.
Risk Factor X (Avoid combination)
Acemetacin	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Aminolevulinic Acid (Systemic)	Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic).
Dexibuprofen	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Dexibuprofen.
Dexketoprofen	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Floctafenine	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Ketorolac (Nasal)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Ketorolac (Systemic)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Macimorelin	Nonsteroidal Anti-Inflammatory Agents may diminish the diagnostic effect of Macimorelin.
Mifamurtide	Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Mifamurtide.
Morniflumate	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective).
Omacetaxine	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Management: Avoid concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs) with omacetaxine in patients with a platelet count of less than 50,000/uL.
Pelubiprofen	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Phenylbutazone	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Talniflumate	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Tenoxicam	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Urokinase	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase.
Zaltoprofen	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Monitoring parameters:

BP
CBC
LFTs
RFTs (urine output, serum BUN and creatinine)
chemistry profile
signs or symptoms of GI bleeding
Occult blood loss
periodic ophthalmologic exam with chronic use

How to administer Flurbiprofen (Froben)?

It can be given orally with food, milk, or antacids.
Canadian labeling recommends taking immediately after a meal or with food or milk.

Mechanism of action of Flurbiprofen (Froben):

Flurbiprofen has anti-inflammatory, analgesic and antipyretic properties.
It reduces the formation of prostaglandin precursors through reversible inhibitions of cyclooxygenase-1 (COX-1) and 2 enzymes.
Chemotaxis inhibition, altered lymphocyte activity, lowered proinflammatory cytokine levels, and other hypothesised mechanisms that have not yet been fully explained may also contribute to the anti-inflammatory impact to variable degrees.

Absorption:

Rapid

Protein binding:

>99%, primarily albumin

Metabolism:

Hepatic via CYP2C9; major metabolite is 4-hydroxy-flurbiprofen (inactive)

Bioavailability:

Half-life elimination:

4.7 to 5.7 hours

Time to peak:

~2 hours

Excretion:

Urine (<3% as unchanged; ~70% primarily as metabolites)

International Brands of Flurbiprofen:

NOVO-Flurprofen SR
TEVA-Flurbiprofen
Anflupin
Ansaid
Antadys
Arflur
Bifen Cataplasma
Cebutid
Clinadol Forte
Distex
Eyefen
Flugalin
Flurbi
Flurbic
Flurofen
Flurofen Retard
Flurozin
Froben
Froben SR
Lefenine
Luarprofeno
Majezik
Nibelon
Penostop
Ropion
Strefen
Strepfen
Strepsils
Strepsils Intensiv
Strepsils Intensive
Urbifen

Flurbiprofen Brand Names in Pakistan:

Flurbiprofen Eye Drops 0.03 % w/v
Enflam	Tg Pharma
Eyeflox	P.D.H. Pharmaceuticals (Pvt) Ltd.
Feny	Kobec Pharmacals
Ocufen	Barrett Hodgson Pakistan (Pvt) Ltd.
Optiprofen	P.D.H. Pharmaceuticals (Pvt) Ltd.
Optofen	Sante (Pvt) Limited

Flurbiprofen Gel 5 % w/w
Fenpro	Safina Pharma (Pvt) Ltd
Froben	Abbott Laboratories (Pakistan) Limited.
Froben	Abbott Laboratories (Pakistan) Limited.
Parofen	Syntex Pharmaceuticals
Pro-F	Opal Laboratories (Pvt) Ltd.
Relaxofen	Epharm Laboratories

Flurbiprofen 50 mg Tablets
Biprofin	Martin Dow Pharmaceuticals (Pak) Ltd.
Biprotec	Jafson Pharmaceuticals (Pvt) Ltd.
Endol	Paramount Pharmaceuticals
Fbi	Medicraft Pharmaceuticals (Pvt) Ltd.
Flamtab	Semos Pharmaceuticals (Pvt) Ltd.
Flasic	Roomi Enterprises (Pvt) Ltd
Floriwel	Welmark Pharmaceuticals
Flurbin	Mass Pharma (Private) Limited
Flurbizan	Medizan Labs (Pvt) Ltd
Flurip	Askari Pharmaceuticals.
Flurofen	Polyfine Chempharma (Pvt) Ltd.
Flurwin	Wns Field Pharmaceuticals
Froben	Abbott Laboratories (Pakistan) Limited.
Lubifen	Pharmacare Laboratories (Pvt) Ltd.
Rangafen	Hygeia Pharmaceuticals
Rumagesic	Euro Pharma International
Urbofen	Valor Pharmaceuticals

Flurbiprofen 100 mg Tablets
Adwin	Bloom Pharmaceuticals (Pvt) Ltd.
Anaf	Vega Pharmaceuticals Ltd.
Anorcid	Adamjee Pharmaceuticals (Pvt) Ltd.
Ansaid	Pfizer Laboratories Ltd.
Arbiprofen	Arsons Pharmaceuticals Industries (Pvt) Ltd
Arthrofen	Nabiqasim Industries (Pvt) Ltd.
Askosaid	Ideal Pharmaceutical Industries
Balp	Isis Pharmaceutical
Benprofen	Benson Pharamceuticals.
Biake	Evergreen Pharmaceuticals Pvt Limited
Biprofin	Martin Dow Pharmaceuticals (Pak) Ltd.
Biprogesic	Zinta Pharmaceuticals Industries
Bro-Z	Z-Jans Pharmaceutical (Pvt) Ltd.
Brufoz	Fozan Pharmaceuticals Industriers (Pvt) Ltd
Dansaid	Danas Pharmaceuticals (Pvt) Ltd
Dentifen	Macter International (Pvt) Ltd.
Dol	Wilshire Laboratories (Pvt) Ltd.
Dolorid	Maple Pharmaceuticals (Pvt) Ltd
Dulpro	Global Pharmaceuticals
Edge	W & Ali Sons Pharmaceuticals
Elient	Gray`S Pharmaceuticals
Endol	Paramount Pharmaceuticals
Exflam	Tg Pharma
F-100	English Pharmaceuticals Industries
Fabofen	Bloom Pharmaceuticals (Pvt) Ltd.
Fabrul	Focus & Rulz Pharmaceuticals
Fb-Said	Alkemy Pharmaceutical Laboratories (Private) Ltd.
Fbi	Medicraft Pharmaceuticals (Pvt) Ltd.
Febagyl	Noa Hemis Pharmaceuticals
Fen-100	Nenza Pharmaceuticals (Pvt) Limited
Fenpro	Safina Pharma (Pvt) Ltd
Ferryfen	Florence Farmaceuticals (Pvt) Ltd
Flamtab	Semos Pharmaceuticals (Pvt) Ltd.
Flasic	Roomi Enterprises (Pvt) Ltd
Flip	Zephyr Pharmatec (Pvt) Ltd.
Flog	Rogen Pharmaceuticals
Florip	Goodman Laboratories
Floriwel	Welmark Pharmaceuticals
Flubi	Al-Habib Pharmaceuticals.
Fluoral	Alson Pharmaceuticals
Flur	Epoch Pharmaceutical
Flurant	Amarant Pharmaceuticals (Pvt)
Flurbiadvan	Advanced Pharmaceuticals
Flurbimak	Makson Pharmaceuticals
Flurbin	Mass Pharma (Private) Limited
Flurbizan	Medizan Labs (Pvt) Ltd
Flurfin	Nova Med Pharmaceuticals
Flurgem	Delux Chemical Industries
Fluridol	Envoy Pharma
Flurip	Askari Pharmaceuticals.
Fluritab	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Fluritab-100	Nova Med Pharmaceuticals
Flurle	Leads Pharma (Pvt) Ltd
Flurofen	Medisure Laboratories Pakistan (Pvt.) Ltd.
Flursaid	Friends Pharma (Pvt) Ltd
Flurun	Qintar Pharmacuticals
Flurwin	Wns Field Pharmaceuticals
Flurwood	W.Woodward Pakistan (Pvt) Ltd.
Flusaid	Alliance Pharmaceuticals (Pvt) Ltd.
Flusid	Batala Pharmaceuticals.
Fluwitt	Lowitt Pharmaceuticals (Pvt) Ltd
Frobafen	Caylex Pharmaceuticals (Pvt) Ltd.
Froben	Abbott Laboratories (Pakistan) Limited.
Frodon	Saydon Pharmaceutical Industries (Pvt) Ltd.
Frogesic	Navegal Laboratories
Frugesic	Mediceena Pharma (Pvt) Ltd.
Fufit	Wise Pharmaceuticals (Pvt) Ltd
Fysid	Fynk Pharmaceuticals
Getnov	Nova Med Pharmaceuticals
Glofen	Webros Pharmaceuticals
Hafsad	Zesion Pharmaceutical (Pvt) Ltd
Harisid	Harrison Pharmaceuticals
Healsed	Heal Pharmaceuticals Pvt Ltd
Ib-Proof	Jinnah Pharmaceuticals
Inflamatix	Continental Chemical Company (Pvt) Ltd.
Inovan	Raazee Theraputics (Pvt) Ltd.
Instagesic	Azron Pharmaceuticals (Pvt) Ltd
Jasic	Libra Pharmaceuticals (Pvt) Ltd
Kolzin	Spirax International
Lorbi	Fedro Pharmaceutical
Magifen	Dr. Raza Pharma (Private) Limited
Marifen	Miracle Pharmaceuticals(Pvt) Ltd
Mobez	Figs Pharmaceuticals
Naplur	Munawar Pharma (Pvt) Ltd.
Nefro	P.D.H. Pharmaceuticals (Pvt) Ltd.
Neo Triad	Helicon Pharmaceutek Pakistan (Pvt) Ltd.
Nu-Flurbrofen	Hamaz Pharmaceutical (Pvt) Ltd.
Olgon	Himont Pharmaceuticals (Pvt) Ltd.
Oragesic	Himont Pharmaceuticals (Pvt) Ltd.
Ostiflur	Medisure Laboratories Pakistan (Pvt.) Ltd.
Paincid	Schazoo Zaka
Pansaid	Pakheim Internanational Pharma
Pansol	Pharmix Laboratories (Private) Limited.
Parad	Silver Oak Corporation.
Parofen	Syntex Pharmaceuticals
Pictor	Max Pharmaceuticals
Pictor	Max Pharmaceuticals
Pro-F	Opal Laboratories (Pvt) Ltd.
Puricap	Rotex Medica Pakistan (Pvt) Ltd
Q-Fur	Epoch Pharmaceutical
Rakaprofen	Rakaposhi Pharmaceutical (Pvt) Ltd.
Rangafen	Hygeia Pharmaceuticals
Rasbid	Rasco Pharma
Relaxofen	Epharm Laboratories
Relaxofen	Epharm Laboratories
Relepan	Lloyds Pharmaceuticals
Riboprofen	Ferroza International Pharmaceuticals (Pvt) Ltd.
Robigesic	Robins Pharmaceutical Industries
Rubinol	Obsons Pharmaceuticals
Rubio	Nimrall Laboratories
Rumagesic	Euro Pharma International
Sanid	Stanley Pharmaceuticals (Pvt) Ltd.
Sapid	Sapient Pharma
Siskat	Tagma Pharma (Pvt) Ltd.
Skel Fen	Pakistan Pharmaceutical Products (Pvt) Ltd.
Strefen	Healers Laboratories
Swaprofen	Swan Pharmaceuticals(Pvt) Ltd
Synalgo	Platinum Pharmaceuticals (Pvt.) Ltd.
Syro	Albro Pharma
Taprofen	Jawa Pharmaceuticals(Pvt) Ltd.
Tencid	Regent Laboratories Ltd.
Tornil	Serene Pharmaceuticals
Ultifen	Hansel Pharmacueutical Pvt (Ltd)
Urben	Zanctok Pharmaceuticals
Urbicid	Flow Pharmaceuticals (Pvt) Ltd.
Urbofen	Valor Pharmaceuticals
Velsaid	Everest Pharmaceuticals
Vio Fen	Venus Pharma
Vio Fen	Venus Pharma
Viosaid	Venus Pharma
Vobifen	Novartis Pharma (Pak) Ltd
Zitis	Excel Healthcare Laboratories (Pvt.) Ltd.

Flurbiprofen 200 mg Tablets
Swaprofen	Swan Pharmaceuticals(Pvt) Ltd

Flurbiprofen SR 200 mg Tablets
Inovan	Raazee Theraputics (Pvt) Ltd.

Flurbiprofen 100 mg Capsules
Florefen	Florence Farmaceuticals (Pvt) Ltd

Flurbiprofen Capsules SR 200 mg
Froben	Abbott Laboratories (Pakistan) Limited.

Disclaimer Notice:

Emedz.net is not an online pharmacy:

We are not affiliated with any pharmaceutical companies:

Flurbiprofen (Froben) 100 mg, 200 mg Tablets, Eye Drops, Gel

Indications of Flurbiprofen (Froben):

Rheumatoid arthritis and osteoarthritis:

Off Label Use of Flurbiprofen in Adults:

Flurbiprofen (Froben) dose in adults:

US labeling:

Flurbiprofen (Froben) dose in the treatment of Rheumatoid arthritis and osteoarthritis:

Canadian labeling:

Flurbiprofen (Froben) dose in the treatment of Ankylosing spondylitis, osteoarthritis, and rheumatoid arthritis:

Flurbiprofen (Froben) dose in Dysmenorrhea:

Flurbiprofen (Froben) dose in mild to moderately severe pain:

Flurbiprofen (Froben) Use in Children:

Pregnancy Risk Category: C (D in the third trimester)

Flurbiprofen use during breastfeeding:

Flurbiprofen (Froben) Dose adjustment in renal disease:

US labeling:

Canadian labeling:

KDIGO 2012 guidelines provide the following recommendations for NSAIDs:

Flurbiprofen (Froben) Dose adjustment in liver disease:

US labeling:

Canadian labeling:

Side Effects of Flurbiprofen (Froben):

Cardiovascular:

Central Nervous System:

Dermatologic:

Endocrine & Metabolic:

Gastrointestinal:

Hepatic:

Neuromuscular & skeletal:

Ophthalmic:

Otic:

Respiratory:

Contraindications to Flurbiprofen (Froben):

Warnings and precautions

Anaphylactoid reactions

Cardiovascular events: [US Boxed Warn]

CNS effects

GI events: [US Boxed Warning]

Genitourinary effects

Hematologic effects

Hepatic effects

Hyperkalemia:

Ophthalmic effects

Effects on the renal system:

Reactions to skin:

Aseptic meningitis

Asthma

Coronary bypass surgery for coronary artery bypass: [US Boxed Warn]

Hepatic impairment

Renal impairment

Monitoring parameters:

How to administer Flurbiprofen (Froben)?

Mechanism of action of Flurbiprofen (Froben):

International Brands of Flurbiprofen:

Flurbiprofen Brand Names in Pakistan:

Flurbiprofen Eye Drops 0.03 % w/v

Flurbiprofen Gel 5 % w/w

Flurbiprofen 50 mg Tablets

Flurbiprofen 100 mg Tablets

Flurbiprofen 200 mg Tablets

Flurbiprofen SR 200 mg Tablets

Flurbiprofen 100 mg Capsules

Flurbiprofen Capsules SR 200 mg

Recent Posts

Related Posts