- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Oral formulations of flurbiprofen
Dysmenorrhoea (adjunctive treatment)
Pain - mild to moderate
Relief of migraine headache
Short term use in musculoskeletal disorders
150 mg to 200 mg daily in two to four divided doses.
The maximum daily dosage may be increased to 300 mg in divided doses.
Initial dose: 100 mg
Followed by 50 mg or 100mg every four to six hours.
The maximum daily dosage should not exceed 300 mg.
(See Dosage; Adult)
Children aged 12 to 18 years
(See Dosage; Adult)
Children under 12 years
Hereditary fructose intolerance
History of gastrointestinal bleeding
History of gastrointestinal perforation
History of peptic ulcer
History of ulcerative colitis
Severe cardiac failure
Severe hepatic impairment
Severe renal impairment
Third trimester of pregnancy
Precautions and Warnings
Females attempting to conceive
Risk factors for cardiovascular disorder
Congestive cardiac failure
Connective tissue disorder
First trimester of pregnancy
Glucose-galactose malabsorption syndrome
History of gastrointestinal disorder
Ischaemic heart disease
Second trimester of pregnancy
Systemic lupus erythematosus
NSAIDs may provoke or exacerbate asthma
Advise ability to drive/operate machinery may be affected by side effects
Consider other first line treatment options in the elderly
Consider the need for combination therapy with gastroprotective agents
Preparation contains sucrose
Advise patient to take with or after food
Discontinue if signs of gastro-intestinal bleeding occur
Elderly - monitor for gastro-intestinal bleeding over initial 4 weeks
May inhibit platelet aggregation - observe for signs of bleeding
Monitor closely patient with a history of congestive cardiac failure
Monitor for gastrointestinal bleeding following discontinuation of therapy
Monitor renal function in patients with cardiac impairment
Monitor renal function in patients with hepatic impairment
Monitor renal function in patients with renal impairment
Advise patients to report lower gastrointestinal bleeding
Avoid concomitant drugs which may increase risk of gastrotoxicity/bleeding
Discontinue if signs of gastro-intestinal ulceration occur
High dose/long term use may increase risk of arterial thrombotic events
May prolong bleeding time
Risk of gastro-intestinal bleeding increased in the elderly
Severe gastro-intestinal side effects may occur without warning
Discontinue if drug-related rash or other hypersensitivity reactions occur
Discontinue if patient is attempting to conceive
Discontinue if severe skin reaction occurs
Dosage must be individualised for each patient, especially children
Maintain treatment at the lowest effective dose
Reduce dose in elderly
Start treatment at lowest recommended dose
Avoid long term use
Maintain treatment for the shortest possible duration
May cause impaired fertility
Pregnancy and Lactation
Flurbiprofen is contraindicated in the third trimester of pregnancy.
At the time of writing there is limited published information regarding the use of flurbiprofen during human pregnancy (Briggs et al, 2015). Studies that have used flurbiprofen on pregnant rats have shown a decrease in foetal survival and prolonged gestation (Briggs et al, 2015). Similar findings to other NSAIDs that have also been associated with spontaneous abortion. However Briggs (2015) also states the risk of flurbiprofen causing defects when used in pregnancy appears to be low. The manufacturer states to avoid the use of flurbiprofen during the first two trimesters of pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Use flurbiprofen with caution in breastfeeding.
At the time of writing there is limited published information regarding the use of flurbiprofen during breastfeeding. The Drugs and Lactation Database (LactMed) states that flurbiprofen has a short half-life and therefore any insignificant amounts of the drug that may be excreted in breast milk is unlikely to cause harm to the infant. Hale (2015) also supports LactMed stating any trace of flurbiprofen excreted into breast milk is likely to be clinically insignificant. Schaefer (2015) states that there has been no toxic affects reported on the use of flurbiprofen in breastfeeding, however the manufacturer still suggests to avoid using flurbiprofen during breastfeeding.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Abnormal liver function
Aggravation of existing asthma
Exacerbation of colitis
Exacerbation of Crohn's disease
Gastro-intestinal ulceration and bleeding
Non-specific allergic reactions
Systemic lupus erythematosus
Toxic epidermal necrolysis
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: February 2017
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Joint Formulary Committee. British National Formulary. 72nd ed. London: BMJ Group and Pharmaceutical Press; 2016.
Paediatric Formulary Committee. BNF for Children 2016-2017. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2016.
Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.
Summary of Product Characteristics: Froben 50 mg Tablets. Mylan Products Limited. Revised September 2016.
Summary of Product Characteristics: Froben 100 mg Tablets. Mylan Products Limited. Revised September 2016.
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Last accessed: 11 January 2017
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.