No

Nonsteroidal Anti-Inflammatory Agent (NSAID)

Dental: Management of postoperative pain

Medical: Inhibition of intraoperative miosis; acute or long-term treatment of signs and symptoms of rheumatoid arthritis and osteoarthritis; prevention and management of postoperative ocular inflammation and postoperative cystoid macular edema remains to be determined

C (D in 3rd trimester)

Dendritic keratitis, hypersensitivity to flurbiprofen or any component

Should be used with caution in patients with a history of herpes simplex, keratitis, and patients who might be affected by inhibition of platelet aggregation; dehydration; slowing of corneal wound healing patients in whom asthma, rhinitis, or urticaria is precipitated by aspirin or other NSAIDs.

Ophthalmic:

>10%: Ocular: Slowing of corneal wound healing, mild ocular stinging, itching and burning eyes, ocular irritation

1% to 10%: Ocular: Eye redness

Oral:

>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, shortness of breath, allergic rhinitis, epistaxis

Symptoms include apnea, metabolic acidosis, coma, and nystagmus; leukocytosis, renal failure

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 NSAIDs overdose, except when this is due to an acute blood loss. Seizures tend to be very short-lived and often do not require drug treatment; although, recurrent seizures should be treated with I.V. diazepam. Since many of the NSAID undergo enterohepatic cycling, multiple doses of charcoal may be needed to reduce the potential for delayed toxicities.

CYP2C9 enzyme substrate; CYP2C9 enzyme inhibitor

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

Onset of effect: Within 1-2 hours

Oral: Rheumatoid arthritis and osteoarthritis: 200-300 mg/day in 2-, 3-, or 4 divided doses

Ophthalmic: Instill 1 drop every 30 minutes, 2 hours prior to surgery (total of 4 drops to each affected eye)

Can be taken with food, milk, or antacid to decrease GI effects; food alters rate of absorption but not amount

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

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

No information available to require special precautions

<1% of patients experience dry mouth; 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®).

Oral: 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; changes in hearing or ringing in ears. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Ophthalmic: Wash hands before instilling. Sit or lie down to instill. Open eye, look at ceiling, and instill prescribed amount of medication. Close eye and roll eye in all directions, and apply gentle pressure to inner corner of eye. Do not let tip of applicator touch eye or contaminate tip of applicator. Use protective dark eyewear until healed; avoid direct sunlight. Temporary stinging or burning may occur. Report persistent pain, burning, redness, vision disturbances, swelling, itching, or worsening of condition.

Care should be taken to avoid contamination of the solution container tip

Solution, ophthalmic, as sodium (Ocufen®): 0.03% (2.5 mL, 5 mL, 10 mL)

Tablet, as sodium (Ansaid®): 50 mg, 100 mg

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