Fenoprofen

Oral
Ankylosing spondylitis, Osteoarthritis, Rheumatoid arthritis

Oral
Mild to moderate pain

Severe: Contraindicated.

Should be taken with food.

Hypersensitivity to fenoprofen; history of asthma, urticaria, or allergic-type reaction to aspirin or other NSAIDs; active, or history of peptic ulcer/haemorrhage (2 or more distinct episodes of proven ulceration or bleeding); history of gastrointestinal bleeding or perforation related to previous NSAIDs therapy; in the setting of CABG surgery. Severe renal impairment. Pregnancy (3rd trimester).

Patient with known CV disease or risk factors for CV disease, uncontrolled hypertension, CHF, established ischaemic heart disease, peripheral arterial disease; history of upper gastrointestinal disease (e.g. ulcerative colitis, Crohn’s disease). Hepatic and mild to moderate renal impairment. Elderly. Pregnancy (1st and 2nd trimester) and lactation.

Significant: Anaphylactoid reactions, CNS effects (e.g. drowsiness, dizziness), visual disturbances (e.g. blurred vision), haematological effects (e.g. decreased platelet adhesion and aggregation, anaemia), increased transaminase, increased risk of hyperkalaemia; dysuria, cystitis, haematuria, interstitial nephritis, nephrotic syndrome.
Cardiac disorders: Palpitation.
Ear and labyrinth disorders: Tinnitus.
Gastrointestinal disorders: Dyspepsia, nausea, abdominal pain, diarrhoea, vomiting, constipation.
General disorders and administration site conditions: Asthenia.
Metabolism and nutrition disorders: Peripheral oedema.
Nervous system disorders: Headache, somnolence.
Psychiatric disorders: Nervousness.
Skin and subcutaneous tissue disorders: Increased sweating, pruritus, rash.
Potentially Fatal: Serious CV thrombotic events (e.g. MI, stroke), drug reaction with eosinophilia and systemic symptoms (DRESS); gastrointestinal inflammation, ulceration, bleeding, and perforation. Rarely, severe hepatic reactions (e.g. fulminant hepatitis, hepatic necrosis, hepatic failure), serious skin reactions (e.g. exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis).

PO: Z (NSAIDs caused foetal ductus arteriosus premature closure, foetal renal impairment and persistent pulmonary hypertension. Avoid near term, else use lowest dose for shortest time.)

This drug may cause drowsiness, dizziness, fatigue, or visual disturbances, if affected, do not drive or operate machinery.

Obtain LFT, renal function (e.g. urine output, BUN, creatinine); CBC and chemistry profile periodically during long-term therapy. Monitor blood pressure at initiation and during therapy; signs and symptoms of bleeding, fluid retention, hepatotoxicity, or ototoxicity.

Symptoms: Lethargy, drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding. Rarely, hypertension, acute renal failure, respiratory depression, coma. Management: Supportive and symptomatic treatment. Consider emesis, activated charcoal, and/or osmotic catharsis within 4 hours of ingestion or in case of large overdosage.

Increased risk of adverse effects (e.g. gastrointestinal toxicity, bleeding) with other NSAIDs, anticoagulants (e.g. warfarin), antiplatelets (e.g. aspirin), SSRIs, and corticosteroids. May reduce antihypertensive effects of ACE inhibitors, angiotensin II receptor antagonists, and β blockers (e.g. propranolol). May reduce the natriuretic effects of loop and thiazide diuretics. May increase plasma concentration and toxicity of digoxin. May increase toxicity of lithium and methotrexate. May increase nephrotoxic effect of ciclosporin. May increase the risk of pemetrexed-associated myelosuppression, renal and gastrointestinal toxicity. Decreased plasma half-life with phenobarbital. May increase the risk of convulsions with quinolone antibiotics. Increased risk of haematological toxicity with zidovudine.

Rate and extent of absorption may be reduced when taken with food or milk. Increased risk of gastrointestinal bleeding with alcohol.

May interfere with Amerlex-M kit assay values and may give false elevations in both free and total serum triiodothyronine. May lead to false positive aldosterone/renin ratio.

Description:
Mechanism of Action: Fenoprofen is a propionic acid derivative which reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes resulting in decreased formation of prostaglandin precursors. It also has antipyretic, analgesic, and anti-inflammatory actions.
Onset: Full effect: Up to 2-3 weeks.
Pharmacokinetics:
Absorption: Rapidly and almost completely absorbed from the gastrointestinal tract. Food and milk may reduce the rate and extent of absorption. Bioavailability: Approx 85%. Time to peak plasma concentration: 1-2 hours.
Distribution: Enters breast milk. Plasma protein binding: 99%.
Metabolism: Extensively metabolised in the liver.
Excretion: Via urine (approx 90% as metabolite). Elimination half-life: Approx 3 hours.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 3342, Fenoprofen. https://pubchem.ncbi.nlm.nih.gov/compound/Fenoprofen. Accessed Sept. 27, 2022.

Store between 20-25°C.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

M01AE04 - fenoprofen ; Belongs to the class of propionic acid derivatives of non-steroidal antiinflammatory and antirheumatic products.

Anon. Fenoprofen. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 12/09/2022.

Anon. Fenoprofen. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 12/07/2022.

Buckingham R (ed). Fenoprofen Calcium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 12/07/2022.

Fenoprofen 300 (Typharm Ltd). MHRA. https://products.mhra.gov.uk. Accessed 12/07/2022.

Nalfon Capsule (Xspire Pharma). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/07/2022.