Diflunisal Uses, Dosage, Side Effects

Diflunisal

(dye-floo′ni-sal)

Classifications: ANALGESIC, NONSTEROIDAL ANTI-INFLAMMATORY DRUG (NSAID)

Therapeutic: ANALGESIC, NSAID; ANTI-RHEUMATIC

Prototype: Ibuprofen

Pregnancy Category: C; D third trimester

AVAILABILITY

Tablet

ACTION & THERAPEUTIC EFFECT

A long-acting nonsteroidal anti-inflammatory drug (NSAID) is a nonnarcotic analgesic agent. This NSAID has peripheral analgesic properties due to interfering with prostaglandin synthesis by inhibiting cyclooxygenase (COX) isoenzymes, COX-1 and COX-2. Has analgesic and anti-inflammatory properties.

USES

Treatment of osteoarthritis and rheumatoid arthritis; mild to moderate pain.

CONTRAINDICATIONS

Patients in whom aspirin or other NSAIDs precipitate an acute asthmatic attack (bronchospasm), urticaria, angioedema, severe rhinitis, or shock; active peptic ulcer, GI bleeding; severe salicylate hypersensitivity; treatment of perioperative pain in CABG care; pregnancy (category D third trimester).

CAUTIOUS USE

History of upper GI disease; preexisting renal disease; impaired renal or hepatic function; alcoholics; compromised cardiac function, and other conditions associated with fluid retention; bone marrow suppression; geriatric patients; hypertension; patients who may be adversely affected by prolonged bleeding time; elderly; pregnancy (category C first and second trimester), lactation. Safe use in children younger than 12 y not established.

ROUTE & DOSAGE

Arthritis/Pain Conditions

Adult: PO 250–500 b.i.d. (max: 1500 mg/day)

ADMINISTRATION

Oral

• Give with water, milk, or food to reduce GI irritation. Food causes slight reduction in absorption rate, but does not affect total amount absorbed.
• Store at 15°–30° C (59°–86° F) in tightly closed containers unless otherwise directed.

Diflunisal Uses, Dosage, Side Effects

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ADVERSE EFFECTS (≥1%)

Body as a Whole: Hypersensitivity syndrome (fever, chills, rash, eosinophilia, changes in renal and hepatic function, anaphylactic reactions with bronchospasm). CNS: Headache, drowsiness, insomnia, dizziness, vertigo, light-headedness, fatigue, weakness, nervousness, confusion, disorientation. CV: Palpitation, tachycardia, peripheral edema. Special Senses: Tinnitus, hearing loss; blurred vision, reduced visual acuity, changes in color vision, scotomas, corneal deposits, retinal disturbances. GI: Nausea, GI pain, flatulence, GI bleeding, peptic ulcer, anorexia, eructation, cholestatic jaundice. Urogenital: Hematuria, proteinuria, interstitial nephritis, renal failure. Hematologic: Prolonged PT, anemia, decreased serum uric acid, transient elevations of liver function tests. Skin: Rash, toxic epidermal necrolysis, exfoliative dermatitis, urticaria. Other: Weight gain, hyperventilation, dyspnea, photosensitivity.

DIAGNOSTIC TEST INTERFERENCE

False elevation of serum salicylate levels.

INTERACTIONS

Drug: ANTACIDS decrease diflunisal absorption; aspirin and other NSAIDS increase risk of GI bleeding; increases risk of warfarin-induced hypoprothrombinemia; increases methotrexate levels and toxicity.

PHARMACOKINETICS

Absorption: Readily from GI tract. Onset: 1 h. Peak: 2–3 h. Duration: 12 h. Distribution: Probably crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 8–12h.

NURSING IMPLICATIONS

Black Box Warning

Diflunisal has been associated with increased risk of serious, potentially fatal, CV thrombotic events (i.e., MI and stroke). Risk may increase with duration of use and may be greater in those with risk factors for CV disease.

Assessment & Drug Effects

• Monitor for and report promptly S&S of CV thrombotic events (i.e., angina, MI, TIA, or stroke).
• Note: Although the antipyretic effect is mild, chronic or high doses may mask fever in some patients.
• Monitor lab tests: With prolonged use, periodic Hgb and Hct, PT/ INR, and renal function tests.

Patient & Family Education

• Seek immediate medical attention if you experience S&S of adverse cardiovascular effects, such as chest pain, shortness of breath, weakness, or slurring of speech.
• Report to prescriber onset of visual or auditory problems.
• Check for and report peripheral edema and unusual weight gain.
• Report immediately to prescriber S&S of serious GI irritation, such as stomach pain, frequent indigestion, tarry stools, or vomiting blood.
• Be alert for S&S of adverse skin reactions. Report promptly development of rash, blisters, or other skin reactions.
• Do not drive or engage in other potentially hazardous activities until reaction to drug is known.
• Do not take aspirin or other OTC analgesics without permission of the prescriber.

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Ditulis oleh Unknown pada tanggal Monday, October 5, 2015