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Fenoprofen

Drug Reference 9 min 402

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Created On: 23/01/2020

Fenoprofen is a nonsteroidal anti-inflammatory drug (NSAID).

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Introduction

Fenoprofen is a nonsteroidal anti-inflammatory drug (NSAID). It may block certain substances in the body that are linked to inflammation. It is used for treating various inflammatory conditions like rheumatoid arthritis, osteoarthritis and also used for treating mild to moderate pain.

Pharmacological class: NSAID

Indications

Osteoarthritis
Rheumatoid arthritis
Mild to moderate pain

Pharmachologic action

Fenoprofen, a propionic acid derivative, reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes resulting in decreased formation of prostaglandin precursors.

Dosage

Osteoarthritis, Rheumatoid arthritis

Adult: 300-600 mg, 3-4 times daily. Max: 3.2 g/day.

Mild to moderate pain

Adult: 200 mg 4-6 hourly as needed. Max: 3.2 g/ day.

Pharmacokinetics

Fenoprofen is rapidly and almost completely absorbed from the GI tract and shows 85% bioavailability. It takes 1-2 hours to achieve peak plasma concentration. It exhibits plasma protein binding of 99%. Fenoprofen undergoes hepatic metabolism to 4'-hydroxyfenoprofen and is excreted via urine as glucuronide and glucuronide of hydroxylated fenoprofen and feces. Plasma half-life is approximately 3 hours.

Contraindications

Contraindicated in patients with hypersensitivity to aspirin or other NSAIDs
Contraindicated in patients receiving treatment of perioperative pain in the setting of CABG surgery
Contraindicated in patients with severe renal impairment
Contraindicated in 3rd trimester of pregnancy

Drug interaction

Increased risk of GI bleeding with anticoagulants, bisphosphonates, clopidogrel, oral corticosteroids, dabigatran, rivaroxaban, salicylates and SSRIs
May reduce antihypertensive effect of ACE inhibitors
Increased nephrotoxicity with ciclosporin
Decrease in plasma half-life with phenobarbital
May reduce the natriuretic effects of loop and thiazide diuretics
May increase toxicity of lithium and methotrexate. Increased risk of CNS stimulation and seizures with quinolones

Side effects

Common (affecting between 1 in 10 to 1 in 100):

Headache
Abdominal Pain
Blurred vision

Uncommon (affecting 1 in 100 to 1 in 1000):

Difficult breathing
Hearing loss
Itching on skin
Rapid weight gain
Rash
Shortness of breath
Tightness in chest
Tingling of hands or feet
Unusual weight gain or loss
Wheezing

Very rare (affecting less than 1 in 10,000):

Back, leg, or stomach pains
Black or red, tarry stools
Bloody stools
Burning feel in chest or stomach
Coughing up blood
Dark urine
Dry mouth
Fever with or without chills
Hoarseness
Increased blood pressure
Nosebleeds
Redness of skin
Swelling of hands, legs, and feet
Swollen or painful glands
Yellow eyes or skin

Precautions

Avoid in patients with known CV disease or risk factors for CV disease
Avoid in patients with history of upper GI disease
Avoid in patients with renal or hepatic impairment

Clinical evidence

In a double-blind crossover study involving the treatment of soft-tissue rheumatism in 50 patients, fenoprofen calcium 600 mg, four times daily, and ibuprofen 400 mg, four times daily, were compared. After 7 days, there was no significant difference between the efficacy of the two drugs with respect to 'pain at rest', 'pain on movement', 'tenderness' or 'sleep disturbance' but fenoprofen was significantly better when considering 'limitation of movement' and 'the physician's assessment of the severity of the condition'. Combining data from weeks 1 and 2 of treatment, 14 days fenoprofen treatment brought about significant improvements in all of the above parameters. Ibuprofen did not significantly improve 'pain at rest', but did improve the other parameters^.1