Pronunciation:

(fen oh PROE fen)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Lactation:

Contraindications:

Warnings/Precautions:

Use of NSAIDs can compromise existing renal function especially when Clcr<30 mL/minute. CNS side effects such as confusion, agitation, and hallucination are generally seen in overdose or high-dose situations; however, elderly may demonstrate these adverse effects at lower doses than younger adults. Do not exceed 3200 mg/day. Withhold for at least 4-6 half-lives prior to surgical or dental procedures.

Adverse Reactions:

>10%:

Central nervous system: Dizziness (7% to 15%), somnolence (9% to 15%)

Gastrointestinal: Abdominal cramps (2% to 4%), heartburn, indigestion, nausea (8% to 14%), dyspepsia (10% to 14%), flatulence (14%), anorexia (14%), constipation (7% to 14%), occult blood in stool (14%), vomiting (3% to 14%), diarrhea (2% to 14%)

1% to 10%:

Central nervous system: Headache (9%)

Dermatologic: Itching

Endocrine & metabolic: Fluid retention

<1%: CHF, hypertension, arrhythmia, 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, dyspnea, epistaxis, rash, pruritus

Overdosage/Toxicology:

Drug Interactions:

ACE inhibitors: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure.

Angiotensin II antagonists: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure.

Anticoagulants (warfarin, heparin, LMWHs) in combination with NSAIDs can cause increased risk of bleeding.

Other antiplatelet drugs (ticlopidine, clopidogrel, aspirin, abciximab, dipyridamole, eptifibatide, tirofiban) can cause an increased risk of bleeding.

Cholestyramine and colestipol reduce the bioavailability of diclofenac; separate administration times.

Corticosteroids may increase the risk of GI ulceration; avoid concurrent use.

Cyclosporine: NSAIDs may increase serum creatinine, potassium, blood pressure, and cyclosporine levels; monitor cyclosporine levels and renal function carefully.

Gentamicin and amikacin serum concentrations are increased by indomethacin in premature infants. Results may apply to other aminoglycosides and NSAIDs.

Hydralazine's antihypertensive effect is decreased; avoid concurrent use.

Lithium levels can be increased; avoid concurrent use if possible or monitor lithium levels and adjust dose. Sulindac may have the least effect. When NSAID is stopped, lithium will need adjustment again.

Loop diuretics efficacy (diuretic and antihypertensive effect) is reduced. Indomethacin reduces this efficacy, however, it may be anticipated with any NSAID.

Methotrexate: Severe bone marrow suppression, aplastic anemia, and GI toxicity have been reported with concomitant NSAID therapy. Avoid use during moderate or high-dose methotrexate (increased and prolonged methotrexate levels). NSAID use during low-dose treatment of rheumatoid arthritis has not been fully evaluated; extreme caution is warranted.

Verapamil plasma concentration is decreased by diclofenac; avoid concurrent use.

Warfarin's INRs may be increased by piroxicam. Other NSAIDs may have the same effect depending on dose and duration. Monitor INR closely. Use the lowest dose of NSAIDs possible and for the briefest duration.

Ethanol/Nutrition/Herb Interactions:

Ethanol: Avoid ethanol (may enhance gastric mucosal irritation).

Food: Fenoprofen peak serum levels may be decreased if taken with food.

Herb/Nutraceutical: Avoid cat's claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, red clover, horse chestnut, green tea, ginseng (all have additional antiplatelet activity).

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: A few days

Absorption: Rapid, 80%

Distribution: Does not cross the placenta

Protein binding: 99%

Metabolism: Extensively hepatic

Half-life elimination: 2.5-3 hours

Time to peak, serum: ~2 hours

Excretion: Urine (2% to 5% as unchanged drug); feces (small amounts)

Dosage:

Rheumatoid arthritis: 300-600 mg 3-4 times/day up to 3.2 g/day

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

Monitoring Parameters:

Reference Range:

Test Interactions:

Dietary Considerations:

Patient Education:

Nursing Implications:

Anesthesia and Critical Care Concerns/Other Considerations:

In short-term use, NSAIDs vary considerably in their effect on blood pressure. When NSAIDs are used in patients with hypertension, appropriate monitoring of blood pressure responses should be completed and the duration of therapy, when possible, kept short. The use of NSAIDs in the treatment of patients with congestive heart failure may be associated with an increased risk for fluid accumulation and edema. May precipitate renal failure in dehydrated patients.

Cardiovascular Considerations:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Capsule, as calcium (Nalfon®): 200 mg, 300 mg

Tablet, as calcium: 600 mg

International Brand Names: