Flurbiprofen

CLINICAL USE

NSAID and analgesic

DOSE IN NORMAL RENAL FUNCTION

150–200 mg daily in divided doses, increased in acute conditions to 300 mg dailyDysmenorrhoea: 50–100 mg every 4–6 hours; maximum 300 mg daily

PHARMACOKINETICS

Molecular weight :244.3

%Protein binding :99

%Excreted unchanged in urine : <3

Volume of distribution (L/kg) :0.1–0.2

half-life – normal/ESRD (hrs) :3–6/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function, but avoid if possible

10 to 20 : Dose as in normal renal function, but avoid if possible

<10 : Dose as in normal renal function, but only if on dialysis

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Removal very unlikely. Dose as in GFR <10 mL/min.

HD :Removal very unlikely. Dose as in GFR <10 mL/min.

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min.

CAV/VVHD :Removal very unlikely. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

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

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 (risk of lithium toxicity)

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

OTHER INFORMATION

NSAIDs have been reported to cause nephrotoxicity in various forms; interstitial nephritis, nephrotic syndrome and renal failure. In patients with renal, cardiac or hepatic impairment, caution is required since the use of NSAIDs may result in deterioration of renal functionInhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease – avoid if possible; if not, check serum creatinine 48–72 hours after starting NSAID – if creatinine has increased, discontinue therapyUse normal doses in patients with ERF on dialysis if they do not pass any urineUse with caution in renal transplant recipients – can reduce intrarenal autocoid synthesis.

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