Classifications: ANALGESIC, NONSTEROIDAL ANTI-INFLAMMATORY DRUG (NSAID); COX-1 AND COX-2 INHIBITOR; ANTIPYRETIC
Therapeutic: ANALGESIC, NSAID
Pregnancy Category: B first or second trimester; D third trimester
ACTION & THERAPEUTIC EFFECT
Inhibits prostaglandin synthesis including in the conjunctiva and uvea by inhibiting the COX-1 or COX-2 enzymes. Ocular flurbiprofen reduces miosis, permitting maintenance of drug-induced mydriasis during surgical procedures. An antiinflammatory, nonsteroidal analgesic. Additionally, it inhibits migration of leukocytes into inflamed tissues, depresses monocyte function, and may inhibit platelet aggregation. Reduces miosis intraoperatively.
Inhibition of intraoperative miosis; arthritis and other inflammatory diseases; mild to moderate pain.
Management of postoperative ocular inflammation, prevention of postcystoid macular edema.
Hypersensitivity to NSAIDs, or salicylates; epithelial herpes simplex; keratitis; perioperative pain from CABG; pregnancy (category D third trimester), lactation.
Patient who may be adversely affected by prolonged bleeding time; patient in whom asthma, rhinitis, or urticaria is precipitated by aspirin or other NSAIDs; pregnancy (category B first and second trimester). Safe use in children not established.
Adult: PO 200–300 mg/day in 2–4 divided doses (max: 300 mg/day)
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/affected eye
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| Flurbiprofen Sodium (Ocufen) Uses, Dosage, Side Effects |
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- 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.
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.
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.
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.
Black Box Warning
Flurbiprofen has been associated with increased risk of serious, potentially fatal GI bleeding and cardiovascular events (e.g., MI & CVA); risk may increase with duration of use and may be greater in the older adult and those with risk factors for CV disease.
Assessment & Drug Effects
- Observe patients with history of cardiac decompensation closely for evidence of fluid retention and edema.
- Monitor for and report promptly S&S of CV thrombotic events (i.e., angina, MI, TIA, or stroke).
- Lab tests: Baseline and periodic evaluations of Hgb, renal function tests, LFTs.
- Auditory and ophthalmologic examinations are recommended with prolonged or high-dose therapy.
- Monitor for GI distress and S&S of GI bleeding.
Patient & Family Education
- Report ocular irritation that persists after flurbiprofen use during surgery (tearing, dry eye sensation, dull eye pain, photophobia) to prescriber.
- Be alert for bleeding tendency and report unexplained bleeding, prolongation of bleeding time, or bruises.
- Notify prescriber 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.
- Monitor for and report promptly S&S of CV thrombotic events (i.e., angina, MI, TIA, or stroke).
- Do not drive or engage in potentially hazardous activities until response to the drug is known.
- Avoid alcohol. Concurrent use may increase risk of GI ulceration and bleeding tendencies.
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