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FENOPROFEN CALCIUM (NALFON)



INDICATIONS



Fenoprofen is a non-steroidal anti-inflammatory medication indicated for mild to moderate arthritic pain in patients 18 years of age and older. The drug is available as 200mg and 400mg capsules and produces its pharmacological effect through non –specific prostaglandin synthesis inhibition.

Research has not developed any conclusions as to whether or not Fenoprofen and partial doses of oral corticosteroids produce a significant “steroid sparing effect" as with other medications of the non-steroidal family. Nalfon added to gold salts for combination maintenance therapy in rheumatoid patients has not been proven to provide additional significant benefit. Osteoarthritic patient response to Fenoprofen is monitored by reduced tenderness of affected joints following activity, reduced night pain, swelling, stiffness and pain relief with motion and rest. Good results also express as increased range of motion of the affected joints.

Clinical research indicates the Fenoprofen is comparable to aspirin in similar aspects of relief as in osteoarthritis but has significantly less gastrointestinal reactions such as nausea, dyspepsia, and tinnitus(ringing in the ears)than aspirin. Fenoprofen reduced pain intensity provides excellent analgesic responses which are sustained. The platelet aggregation suppression effect of Fenoprofen is less than aspirin and can be administered with antacid without decreased or prolonged absorption.

Fenoprofen should be avoided in patients with a hypersensitivity to aspirin or the other non-steroidal anti-inflammatory and patients with asthma, those patients who have recently had coronary artery bypass graft surgery (CABG) or with significant reduced kidney function.

SIDE EFFECTS



Fenoprofen, like all the non-steroidal anti-inflammatory drugs, produce an increased risk of cardiovascular side effects, though to a lesser degree, such as thrombosis, myocardial infarction, stroke. This medication also increases or worsens hypertension in pre-existing diagnosed patients or may lead to initial onset of elevated pressure. Patients taking thiazide or loop diuretics may have reduced blood levels of these therapeutics measures when taking Fenoprofen and so blood pressures should be monitored regularly.

Fluid accumulation while on Fenoprofen can produce congestive heart failure (CHF) in some patients with heart failure or compromised cardiac function. Gastrointestinal risks include ulcerations, bleeding and possibly perforation of the stomach, small or large intestine and may be fatal. As with all medication, the smallest possible effective dose should be administered and adjusted to patients need. Untoward effects are increased in patients who consume significant amounts of alcohol over prolonged periods of time; long periods of time of taking the drug, smoking, and in poor health status patients. Prolonged utilization may induce renal capillary necrosis.

Various reactions may occur with Fenoprofen including the integumentary (skin), CNS central nervous system, ocular, and hearing. The skin may present with pruritis(itching), exfoliative dermatitis, Stevens-Johnsons (SJS), toxic epidermal necrolysis (TEN) and so the drug must be discontinued. No ocular abnormalities have been reported while taking Fenoprofen as has been the case with some of the other anti-inflammatories. The drug should be avoided during pregnancy to avoid the possibility of premature closue of the patent ductus arteriosus. Prolonged usage should be closely monitored with blood pressure, eye, blood labs, hearing and vision checks.

Drug interactions with Fenoprofen include the ace-inhibitors with reduced anti-hypertensive effect. Aspirin will reduce the therapeutic half life of the Fenoprofen. The loop, thiamine diuretics may have reduced response. Due to the synergistic effects of warfarin and any of the non specific non steroidal anti-inflammatory, the combination should be avoided. Prolonged use of Phenobarbital by the epileptic may induce hepatic enzymes and reduced the benefit of Fenoprofen.

DOSAGE



Doses of Fenoprofen for analgesia are 200mg every 4-6 hours with food. The arthritic dose , the smallest most effective dose as per above noted, is up to 3200mg daily every 3-4 hours with food. Many patients may require adjustment of doses.

REFERENCES

The Medication Guide, Nalfon (Fenoprofen calcium), Pedinol Pharmaceuticals, July 2009

MPR, Monthly Physician Reference, Pain Management Reference, 2011 Edition

COMMENTS

I have found a place for Fenoprofen (Nalfon) in my practice in the patient requiring analgesia after surgery or injury to bone or soft tissue, or to treat acute arthritic or bursitis especially in those patients with cardiac consideration. When used in short term management of pain along with addressing the etiology of the pain, the results have been good.



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