FLURBIPROFEN SODIUM
Clinical safety rating: avoid
ACE inhibitors and ARBs may have diminished antihypertensive effect Increases risk of serious cardiovascular thrombotic events and GI bleeding.
Non-selective cyclooxygenase (COX-1 and COX-2) inhibitor, thereby decreasing prostaglandin synthesis, which mediates inflammation, pain, and fever.
| Metabolism | Primarily hepatic via glucuronidation and aromatic hydroxylation; CYP450 involvement is minimal. |
| Excretion | Renal: 70% as conjugates (glucuronide) and unchanged drug (<1%); biliary/fecal: minimal. |
| Half-life | 3-4 hours; in elderly or hepatic impairment may extend to 5-6 hours. |
| Protein binding | >99% bound to albumin. |
| Volume of Distribution | 0.13-0.18 L/kg; low Vd indicates extensive protein binding and limited tissue distribution. |
| Bioavailability | Oral: 92-96%; ophthalmic: negligible systemic absorption. |
| Onset of Action | Ophthalmic: ~1 hour; oral: 30-60 minutes. |
| Duration of Action | Ophthalmic: 4-6 hours; oral: 4-6 hours (analgesic); inflammation suppression persists longer. |
50 mg orally every 4 to 6 hours as needed; maximum 300 mg per day.
| Dosage form | SOLUTION/DROPS |
| Renal impairment | CrCl 30-59 mL/min: reduce dose by 50% and avoid use if CrCl <30 mL/min. |
| Liver impairment | Child-Pugh Class B or C: contraindicated; for mild impairment (Child-Pugh A): use with caution at lowest effective dose. |
| Pediatric use | Not recommended for use in pediatric patients under 18 years of age. |
| Geriatric use | Initiate at lowest effective dose (e.g., 50 mg every 6-8 hours), monitor renal function and GI bleeding risk; avoid long-term use. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
ACE inhibitors and ARBs may have diminished antihypertensive effect Increases risk of serious cardiovascular thrombotic events and GI bleeding.
| FDA category | Positive |
| Breastfeeding | Flurbiprofen is excreted into human milk in low amounts. The milk-to-plasma ratio is approximately 0.03. Due to low levels and short half-life, it is considered compatible with breastfeeding; however, caution is advised in infants with thrombocytopenia or renal impairment. |
| Teratogenic Risk |
■ FDA Black Box Warning
NSAIDs cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. Risk may increase with duration of use. Contraindicated for treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
| Common Effects | inflammation |
| Serious Effects |
["History of hypersensitivity to flurbiprofen or any component of the formulation","History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs","Treatment of perioperative pain in the setting of CABG surgery (absolute)","Active gastrointestinal bleeding","Advanced renal disease","Active peptic ulcer disease"]
| Precautions | ["Cardiovascular risk: Increased risk of serious cardiovascular thrombotic events; use with caution in patients with cardiovascular disease or risk factors.","Gastrointestinal risk: Increased risk of serious GI adverse events including bleeding, ulceration, and perforation; use with caution in patients with history of GI disease.","Renal effects: May cause renal toxicity, especially in patients with preexisting renal impairment, heart failure, liver dysfunction, or elderly.","Ophthalmic use: Caution in patients with active epithelial herpes keratitis; risk of corneal complications (e.g., keratitis, corneal ulcer)."] |
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| First trimester: Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of miscarriage and congenital malformations (especially cardiac defects) based on observational studies. Second trimester: Generally considered lower risk; however, NSAIDs may cause fetal renal dysfunction and oligohydramnios. Third trimester: Risk of premature closure of the ductus arteriosus, fetal nephrotoxicity, oligohydramnios, and pulmonary hypertension. Avoid after 30 weeks gestation. |
| Fetal Monitoring | Monitor maternal blood pressure, renal function, and signs of bleeding. Fetal monitoring includes ultrasound assessment of amniotic fluid volume (oligohydramnios), ductus arteriosus patency (if exposed after 30 weeks), and fetal growth. In late pregnancy, consider non-stress test or biophysical profile if prolonged use. |
| Fertility Effects | NSAIDs may impair female fertility by inhibiting prostaglandin synthesis, affecting ovulation and implantation. Reversible upon discontinuation. In males, no significant adverse effects on fertility reported. |