Fenoprofen

CLINICAL USE

NSAID and analgesic

DOSE IN NORMAL RENAL FUNCTION

300–600 mg 3–4 times a day; maximum 3 g daily

PHARMACOKINETICS

Molecular weight :558.6 (as calcium salt)

%Protein binding :>99

%Excreted unchanged in urine : 2–5

Volume of distribution (L/kg) :0.1

half-life – normal/ESRD (hrs) :3/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Start with low dose, but avoid if possible

10 to 20 : Start with low dose, but avoid if possible

<10 : Start with low dose, but only use if on dialysis

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Start with low doses and increase according to response.

HD :Not dialysed. Start with low doses and increase according to response. See ‘Other Information’

HDF/high flux :Not dialysed. Start with low doses and increase according to response. See ‘Other Information’

CAV/VVHD :Not dialysed. Dose as in GFR 10 to 20 mL/min .

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsACE Inhibitors and angiotensin- II antagonists: increased risk of hyperkalaemia and nephrotoxicity; reduced hypotensive effect

Analgesics: avoid concomitant use with other NSAIDs or aspirin; avoid concomitant use with ketorolac (increased side effects and haemorrhage)

Antibacterials: possibly increased risk of convulsions with quinolones

Anticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarins

Antidepressants: increased risk of bleeding with SSRIs or venlafaxineAntidiabetic agents: effects of sulphonylureas enhanced

Anti-epileptics: possibly enhanced effect of phenytoin

Antivirals: concentration possibly increased by ritonavir; increased risk of haematological toxicity with zidovudine

Ciclosporin: may potentiate nephrotoxicity Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinib

Lithium: excretion reduced

Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect; hyperkalaemia with potassium-sparing diureticsPentoxifylline: increased risk of bleeding

Tacrolimus: increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

–.FEnoProFEn 301

OTHER INFORMATION

Contraindicated in patients with history of significantly impaired renal functionInhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease – avoid use if possible; if not, check serum creatinine 48–72 hours after starting NSAID – if it has increased, discontinue therapyPossibility of decreased platelet aggregationCan use normal doses in patients with ERF on dialysisUse with caution in renal transplant recipients – can reduce intrarenal autocoid synthesisAssociated with nephrotic syndrome, interstitial nephritis, hyperkalaemia, sodium retention

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