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Look Up > Drugs > Fenoprofen
Fenoprofen
Pronunciation
U.S. Brand Names
Generic Available
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Monitoring Parameters
Reference Range
Test Interactions
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(fen oh PROE fen)

U.S. Brand Names
Nalfon®

Generic Available

Yes


Synonyms
Fenoprofen Calcium

Pharmacological Index

Nonsteroidal Anti-Inflammatory Agent (NSAID)


Use

Symptomatic treatment of acute and chronic rheumatoid arthritis and osteoarthritis; relief of mild to moderate pain


Pregnancy Risk Factor

B (D in 3rd trimester or near delivery)


Contraindications

Known hypersensitivity to fenoprofen or other NSAIDs


Warnings/Precautions

Use with caution in patients with congestive heart failure, dehydration, hypertension, decreased renal or hepatic function, history of GI disease, or those receiving anticoagulants


Adverse Reactions

>10%:

Central nervous system: Dizziness

Dermatologic: Rash

Gastrointestinal: Abdominal cramps, heartburn, indigestion, nausea

1% to 10%:

Central nervous system: Headache, nervousness

Dermatologic: Itching

Endocrine & metabolic: Fluid retention

Gastrointestinal: Vomiting

Otic: Tinnitus

<1%: Congestive heart failure, hypertension, arrhythmias, tachycardia, confusion, hallucinations, aseptic meningitis, mental depression, drowsiness, insomnia, urticaria, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome, angioedema, polydipsia, hot flashes, gastritis, GI ulceration, cystitis, polyuria, agranulocytosis, anemia, hemolytic anemia, bone marrow suppression, leukopenia, thrombocytopenia, hepatitis, peripheral neuropathy, toxic amblyopia, blurred vision, conjunctivitis, dry eyes, decreased hearing, acute renal failure, allergic rhinitis, shortness of breath, epistaxis


Overdosage/Toxicology

Symptoms of overdose include acute renal failure, vomiting, drowsiness, leukocytosis

Management of a nonsteroidal anti-inflammatory drug (NSAID) intoxication is primarily supportive and symptomatic. Fluid therapy is commonly effective in managing the hypotension that may occur following an acute NSAID overdose, except when this is due to an acute blood loss.


Drug Interactions

Decreased effect with phenobarbital; ACE-inhibitor effects may be decreased by concurrent therapy with NSAIDs

Increased effect/toxicity of phenytoin, sulfonamides, sulfonylureas

Increased toxicity with salicylates, oral anticoagulants


Mechanism of Action

Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclo-oxygenase, which results in decreased formation of prostaglandin precursors


Pharmacodynamics/Kinetics

Onset of effect: Begins in a few days

Absorption: Rapid (to 80%) from upper GI tract

Distribution: Does not cross the placenta

Protein binding: 99%

Metabolism: Extensively in the liver

Half-life: 2.5-3 hours

Time to peak serum concentration: Within 2 hours

Elimination: In urine 2% to 5% as unchanged drug; small amounts appear in feces


Usual Dosage

Adults: Oral:

Mild to moderate pain: 200 mg every 4-6 hours as needed


Dietary Considerations

May be administered with food to decrease GI distress


Monitoring Parameters

Monitor CBC, liver enzymes; monitor urine output and BUN/serum creatinine in patients receiving diuretics


Reference Range

Therapeutic: 20-65 mg/mL (SI: 82-268 mmol/L)


Test Interactions

chloride (S), sodium (S)


Mental Health: Effects on Mental Status

Dizziness is common; may cause nervousness; rarely may cause insomnia, confusion, depression, or hallucinations


Mental Health: Effects on Psychiatric Treatment

May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may decrease the clearance of lithium resulting in elevated serum levels and potential toxicity; monitor serum lithium levels; use acetaminophen, if possible, for pain


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

NSAID formulations are known to reversibly decrease platelet aggregation via mechanisms different than observed with aspirin. The dentist should be aware of the potential of abnormal coagulation. Caution should also be exercised in the use of NSAIDs in patients already on anticoagulant therapy with drugs such as warfarin (Coumadin®).


Patient Information

Take this medication exactly as directed; do not increase dose without consulting prescriber. Do not crush tablets or break capsules. Take with food or milk to reduce GI distress. Maintain adequate fluid intake (2-3 L/day of fluids unless instructed to restrict fluid intake). Do not use alcohol, aspirin, or aspirin-containing medication, and all other anti-inflammatory medications without consulting prescriber. You may experience drowsiness, dizziness, nervousness, or headache (use caution when driving or engaging in tasks requiring alertness until response to drug is known); anorexia, nausea, vomiting, or heartburn (frequent small meals, frequent mouth care, sucking lozenges, or chewing gum may help); fluid retention (weigh yourself weekly and report unusual (3-5 lb/week) weight gain). GI bleeding, ulceration, or perforation can occur with or without pain; discontinue medication and contact prescriber if persistent abdominal pain or cramping, or blood in stool occurs. Report breathlessness, difficulty breathing, or unusual cough; chest pain, rapid heartbeat, palpitations; unusual bruising/bleeding; blood in urine, stool, mouth, or vomitus; swollen extremities; skin rash or itching; acute fatigue; or changes in hearing or ringing in ears. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Breast-feeding is not recommended.


Nursing Implications

Monitor CBC, liver enzymes; monitor urine output and BUN/serum creatinine in patients receiving diuretics


Dosage Forms

Capsule, as calcium: 200 mg, 300 mg

Tablet, as calcium: 600 mg


References

Appleby DH, "Fenoprofen (Nalfon®) Overdose," Drug Intell Clin Pharm, 1981, 15(2):129-30.

Brooks PM and Day RO, "Nonsteroidal Anti-inflammatory Drugs - Differences and Similarities," N Engl J Med, 1991, 324(24):1716-25.

Clinch D, Banerjee AK, Ostick G, "Absence of Abdominal Pain in Elderly Patients With Peptic Ulcer," Age Ageing, 1984, 13:120-3.

Clive DM, Stoff JS, "Renal Syndromes Associated With Nonsteroidal Anti-inflammatory Drugs," N Engl J Med, 1984, 310(9):563-72.

Court H and Volans GN, "Poisoning After Overdose With Nonsteroidal Anti-inflammatory Drugs," Adverse Drug React Acute Poisoning Rev, 1984, 3(1):1-21.

"Drugs for Pain," Med Lett Drugs Ther, 1998, 40(1033):79-84.

Graham DY, "Prevention of Gastroduodenal Injury Induced by Chronic Nonsteroidal Anti-inflammatory Drug Therapy," Gastroenterology, 1989, 96(2 Pt 2 Suppl):675-81.

Gurwitz JH, Avorn J, Ross-Degnan D, et al, "Nonsteroidal Anti-Inflammatory Drug-Associated Azotemia in the Very Old," JAMA, 1990, 264(4):471-5.

Hawkey CJ, Karrasch JA, Szczepanski L, et al, "Omeprazole Compared With Misoprostrol for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs," N Engl J Med, 1998, 338(11):727-34.

Hoppmann RA, Peden JG, and Ober SK, "Central Nervous System Side Effects of Nonsteroidal Anti-inflammatory Drugs. Aseptic Meningitis, Psychosis, and Cognitive Dysfunction," Arch Intern Med, 1991, 151(7):1309-13.

Kolodzik JM, Eilers MA, and Angelos MG, "Nonsteroidal Anti-inflammatory Drugs and Coma: A Case Report of Fenoprofen Overdose," Ann Emerg Med, 1990, 19(4):378-81.

Pounder R, "Silent Peptic Ulceration: Deadly Silence or Golden Silence?" Gastroenterology, 1989, 96(2 Pt 2 Suppl):626-31.

Smolinske SC, Hall AH, Vandenberg SA, et al, "Toxic Effects of Nonsteroid Anti-inflammatory Drugs in Overdose. An Overview of Recent Evidence on Clinical Effects and Dose-Response Relationships," Drug Saf, 1990, 5(4):252-74.

Stotts JS, Fang ML, Dannaker CJ, et al, "Fenoprofen-Induced Toxic Epidermal Necrolysis," J Am Acad Dermatol, 1988, 18(4 Pt 1):755-7.

Vale JA and Meredith TJ, "Acute Poisoning Due to Nonsteroidal Anti-inflammatory Drugs," Med Toxicol, 1986, 1(1):12-31.

Verbeeck RK, "Pharmacokinetic Drug Interactions With Nonsteroidal Anti-inflammatory Drugs," Clin Pharmacokinet, 1990, 19(1):44-66.

Yeomans ND, Tulassay Z, Juhasz L, et al, "A Comparison of Omeprazole With Ranitidine for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs," N Engl J Med, 1998, 338(11):719-26.


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