• Arthritis/rheumatic disorders

Flurbiprofen Generic Name & Formulations

General Description

Flurbiprofen 100mg; tabs.

Pharmacological Class

NSAID (phenylalkanoic acid deriv.).

How Supplied

Contact supplier


Store at 20° to 25°C (68° to 77°F).


Flurbiprofen Indications


Rheumatoid arthritis. Osteoarthritis.

Flurbiprofen Dosage and Administration

Prior to Treatment Evaluations

Correct volume status in dehydrated or hypovolemic patients.


Use lowest effective dose for shortest duration. 200–300mg/day in 2–4 divided doses; max single dose 100mg. Reduce dosage for renal impairment.


Not established.

Flurbiprofen Contraindications


Aspirin allergy. Coronary artery bypass graft surgery.

Flurbiprofen Boxed Warnings

Boxed Warning

Risk of serious cardiovascular and gastrointestinal events.

Flurbiprofen Warnings/Precautions


Increased risk of serious cardiovascular events (including MI, stroke). Avoid in recent MI, severe heart failure; if necessary, monitor. Increased risk of serious GI adverse events (including inflammation, bleeding, ulceration, perforation). History of ulcer disease and/or GI bleeding. Hypertension; monitor BP closely. Hepatic or renal impairment. Discontinue if signs/symptoms of liver disease develop, or if abnormal LFTs persist or worsen. Dehydration. Hypovolemia. Advanced renal disease: not recommended. Hyperkalemia. Coagulation disorders. Monitor CBCs, blood chemistry, hepatic, renal, and ocular function in long-term therapy. Pre-existing asthma. May mask signs of infection or fever. Discontinue at 1st sign of rash or any other hypersensitivity. Elderly. Debilitated. Labor & delivery. Pregnancy (≥30 weeks gestation; avoid). Nursing mothers.


Cardiovascular Thrombotic Events

Clinical trials of several COX-2 selective and nonselective NSAIDs of up to 3 years duration have shown an increased risk of serious cardiovascular thrombotic events, including myocardial infarction (MI) and stroke.

  • Incidence of serious cardiovascular thrombotic events greater in patients with known cardiovascular disease or risk factors.
  • Increased risk has been observed as early as the first weeks of treatment (based on observational studies).
  • Higher doses have been linked to increased cardiovascular thrombotic risk.
  • To minimize risk, use the lowest effective dose for the shortest time possible.
  • Evidence regarding use of aspirin to mitigate risk has not been consistent; aspirin coadministered with flurbiprofen may increase the risk of serious GI adverse events.

NSAIDs are contraindicated in the setting of coronary artery bypass graft (CABG) surgery. Based on findings from 2 large studies evaluating a COX-2 selective NSAID, use in the first 10-14 days after CABG resulted in an increased incidence of MI and stroke. 

Among patients treated with NSAIDs in the post-MI period, there was an increase in the risk of reinfarction, cardiovascular-related death, and all-cause mortality beginning in the first week of treatment, according to observational studies. 

  • Incidence of death in the first year in the NSAID cohort: 20 per 100 person years
  • Incidence of death in the first year in the non-NSAID cohort: 12 per 100 person years
  • The relative risk of death in NSAID users persisted over at least the next 4 years of follow up.

Avoid the use of flurbiprofen in patients with recent MI unless the benefits are expected to outweigh the risk of recurrent cardiovascular thrombotic events. Monitor for signs of cardiac ischemia if used in patients with recent MI.


  • NSAIDs can lead to new onset hypertension or worsening of pre-existing hypertension.
  • Impaired responses to thiazides and loop diuretics possible when taken with NSAIDs.
  • Use with caution in patients with hypertension; monitor BP.

Heart Failure and Edema

  • Meta-analysis of randomized controlled trials showed ~2-fold increase in hospitalizations for heart failure in patients treated with COX-2 selective and nonselective NSAIDs compared with placebo.
  • NSAID use was also associated with increased risk of MI, hospitalization for heart failure and death in a Danish National Registry study of patients with heart failure.
  • Fluid retention and edema have been observed in some patients treated with NSAIDs.
  • Flurbiprofen may blunt the cardiovascular effects of diuretics, ACE inhibitors, ARBs.
  • Avoid use in patients with severe heart failure unless benefits outweigh risk of worsening heart failure.
  • Monitor for signs of worsening heart failure if flurbiprofen is used in patients with severe heart failure.

Gastrointestinal (GI) Effects

  • NSAIDs can cause serious GI adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine.
  • These can occur at any time, with or without warning symptoms (only 1 in 5 patients who develop a serious upper GI adverse event on NSAIDs is symptomatic).
  • Incidence of upper GI ulcers, gross bleeding, or perforation with NSAIDs: ~1% of patients treated for 3-6 months and 2-4% of patients treated for 1 year.
  • Prior history of ulcer disease or GI bleeding: Prescribe with caution; these patients have a >10-fold increased risk for developing GI bleed vs those without these risk factors.
  • Other factors that increase risk of GI bleed in patients treated with NSAIDs: Concomitant oral corticosteroids, anticoagulants, aspirin, SSRIs; longer duration of NSAID use; smoking; alcohol; older age; and poor general health status.
  • Patients with advanced liver disease and/or coagulopathy are at an increased risk for GI bleeding.
  • Use the lowest effective dose for the shortest possible duration to minimize the potential for GI adverse events.
  • If a serious GI adverse event occurs, discontinue NSAID therapy.
  • Alternative therapies should be explored for patients considered at high risk for GI effects.

Hepatic Effects

  • Borderline elevations of 1 or more liver tests without any other signs and symptoms may occur in up to 15% of patients taking NSAIDs.
  • For patients with symptoms/signs suggesting liver dysfunction, or in whom abnormal liver test has occurred: evaluate for more severe hepatic reaction.
  • Discontinue flurbiprofen if abnormal liver tests persist or worsen, if clinical signs/symptoms of liver disease develop, or if systemic manifestations (eg, eosinophilia, rash) occur.

Renal Effects

  • Long-term NSAID use has been associated with renal papillary necrosis and other renal injury.
  • Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion; in these patients administration of NSAIDs may cause a dose-dependent reduction in prostaglandin formation and, secondarily in renal blood flow, which may result in overt renal decompensation.
  • Patients with impaired renal function, heart failure, liver dysfunction, on diuretics, ACE inhibitors, or ARBs, those who are volume-depleted and the elderly are at greatest risk of this reaction; monitor renal function.
  • Discontinuing NSAID therapy usually leads to recovery.
  • Flurbiprofen is not recommended in patients with advanced renal disease; if treatment must be initiated, close monitoring of renal function is advised.


  • Increases in serum potassium concentration have been reported with NSAIDs.

Anaphylactic/Anaphylactoid Reactions

  • Flurbiprofen should not be given to patients with the aspirin triad.
  • This symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs.
  • Use with caution in patients with preexisting asthma.

Skin Reactions

  • NSAIDs can cause serious skin adverse events including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
  • Discontinue treatment at the first appearance of skin rash or any other sign of hypersensitivity.
  • DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) has been reported in patients taking NSAIDs.
  • Symptoms of DRESS: Fever, rash, lymphadenopathy, and/or facial swelling; may resemble acute viral infection.
  • Other clinical manifestations of DRESS: Hepatitis, nephritis, hematological abnormalities, myocarditis, myositis.
  • Discontinue treatment if signs/symptoms of DRESS develop.

Hematological Effects

  • Anemia is sometimes seen in patients receiving NSAIDs.
  • Check hemoglobin/hematocrit if patients exhibit signs/symptoms of anemia.

Masking of Inflammation and Fever

  • Flurbiprofen reduces inflammation, and may reduce fever, thereby diminishing the utility of diagnostic signs in detecting infections.

Laboratory Monitoring

  • Consider periodic CBC, chemistry profile for patients on long-term NSAID therapy.

Ocular Effects

  • Adverse eye reactions have been reported with NSAIDs.
  • For patients who develop eye complaints, ophthalmologic studies are recommended.

Pregnancy Considerations

NSAIDs should be avoided in pregnant women at about 30 weeks gestation and later as they increase the risk of premature closure of the fetal ductus arteriosus.

Use of NSAIDs at about 20 weeks gestation or later may cause fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment. These adverse events are seen, on average, after days or weeks of treatment. Rarely, oligohydramnios has been reported 48 hours after NSAID initiation. Oligohydramnios is often reversible with treatment discontinuation.

If treatment with flurbiprofen is necessary between 20 and 30 weeks gestation, limit treatment to the lowest effective dose for the shortest possible duration.

If flurbiprofen treatment extends beyond 48 hours, consider ultrasound monitoring of amniotic fluid. Discontinue if oligohydramnios occurs.

Nursing Mother Considerations

It is not known whether this drug is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from flurbiprofen tablets, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Considerations

Safety and effectiveness in pediatric patients have not been established.

Geriatric Considerations

Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection and it may be useful to monitor renal function. 

Elderly patients are at greater risk for NSAID-associated serious cardiovascular, gastrointestinal, and/or renal adverse reactions; use the lowest effective dose.

Renal Impairment Considerations

Monitor patients with significantly impaired renal function closely.

Not recommended in patients with advanced renal disease; if needed, close monitoring of the patient’s renal function is advisable.

Hepatic Impairment Considerations

Patients with hepatic disease may require reduced doses of flurbiprofen as hepatic metabolism accounts for >90% of flurbiprofen elimination.

Other Considerations for Specific Populations

NSAIDs may delay or prevent rupture of ovarian follicles, which has been associated with reversible infertility in some women.

Consider withdrawing flurbiprofen in women who have difficulties conceiving or who are undergoing investigation of infertility.

Flurbiprofen Pharmacokinetics


Peak plasma concentrations occur at approximately 2 hours; administration of food or antacids may alter the rate of absorption.


99% bound to plasma proteins.


Hepatic (CYP2C9); UGT2B7 is the predominant UGT isozyme responsible for the glucuronidation.


Predominantly renal elimination. Half-life of R- and S-flurbiprofen are similar, about 4.7 and 5.7 hours, respectively.

Flurbiprofen Interactions


Avoid concomitant aspirin, salicylates (eg, diflunisal, salsalate) or other NSAIDs. Increased risk of GI bleed with anticoagulants, antiplatelets, oral corticosteroids, SSRIs, SNRIs, smoking, alcohol, or prolonged NSAID therapy; monitor. May antagonize, or increase risk of renal failure with diuretics (eg, loop or thiazides), ACE inhibitors, ARBs, or β-blockers; monitor closely. Potentiates digoxin; monitor levels. May potentiate lithium, methotrexate, cyclosporine; monitor for toxicity. Concomitant with pemetrexed may increase risk of pemetrexed-associated myelosuppression, renal, and GI toxicity.


Drugs That Interfere With Hemostasis

  • Flurbiprofen and anticoagulants (eg, warfarin( have a synergistic effect on bleeding.
  • Concomitant use of drugs that interfere with serotonin reuptake and NSAIDs may potentiate bleeding risk (based on case-control and epidemiological studies).
  • Concomitant anticoagulants (eg, warfarin), antiplatelets (eg, aspirin), SSRIs, SNRIs: Monitor for signs of bleeding.


  • Concomitant use of aspirin (analgesic doses) does not produce a greater therapeutic effect and may result in greater GI adverse reactions than NSAIDs alone.
  • Concomitant aspirin lowers flurbiprofen concentrations (clinical significance unknown).
  • Because of the increased risk for bleeding, concomitant aspirin is not recommended.
  • Flurbiprofen is not a substitute for low dose aspirin for cardiovascular protection.

ACE Inhibitors, ARBs, and Beta-Blockers

  • NSAIDs may diminish the antihypertensive effect of these agents; monitor blood pressure.
  • Deterioration of renal function possible when NSAIDs coadministered with ACE inhibitors or ARBs in patients who are elderly, volume-depleted, or have renal impairment; monitor for signs of worsening renal function.
  • Patients should be adequately hydrated.
  • Assess renal function at the start of concomitant treatment and periodically thereafter.


  • NSAIDs reduce the natriuretic effect of loop diuretics (eg, furosemide) and thiazide diuretics in some patients resulting from renal prostaglandin synthesis inhibition.
  • If concomitant use is needed, observe for worsening renal function and evaluate antihypertensive effects.


  • Flurbiprofen increases serum concentration and prolongs the half-life of digoxin.
  • Monitor serum digoxin levels.


  • NSAIDs may elevate lithium levels (by 15%) and reduce lithium clearance (by 20%) due to inhibition of renal prostaglandin synthesis.
  • Monitor patients for lithium toxicity.


  • Increased risk of methotrexate toxicity (eg, neutropenia, thrombocytopenia, renal dysfunction) with concomitant flurbiprofen.
  • Monitor patients for methotrexate toxicity.


  • Concomitant use may increase cyclosporine-associated nephrotoxicity.
  • Monitor for signs of worsening renal function.

NSAIDs and Salicylates

  • GI toxicity may be increased with concomitant use of flurbiprofen and NSAIDs or salicylates.
  • Concomitant use is not recommended as there is little or no increase in efficacy.


  • Concomitant use may increase risk of pemetrexed-associated myelosuppression, renal and GI toxicity.
  • CrCl 45-79mL/min: monitor for toxicity when flurbiprofen is used with pemetrexed.
  • Avoid NSAIDs with short elimination half-lives (eg, diclofenac, indomethacin) for a period of 2 days before, the day of, and 2 days following administration of pemetrexed.
  • Patients taking NSAIDs with longer half-lives (eg, meloxicam, nabumetone) should interrupt dosing for at least 5 days before, the day of, and 2 days after pemetrexed administration.


  • Concomitant use may increase the risk of GI ulceration and bleeding.
  • Monitor for signs of bleeding.

Flurbiprofen Adverse Reactions

Adverse Reactions

GI upset, abdominal pain, dyspepsia, constipation, headache, edema, UTI; cardiovascular thrombotic events, GI ulcer/bleed, hepatotoxicity, renal toxicity, hypersensitivity reactions, anemia.

Flurbiprofen Clinical Trials

See Literature

Flurbiprofen Note


Formerly known under the brand name Ansaid.

Flurbiprofen Patient Counseling

Patient Counseling

Be alert to the symptoms of cardiovascular thrombotic events, as the use of NSAIDs may increase the risk of these events. 

Be alert to the signs/symptoms of GI tract ulcerations and bleeding (eg, epigastric pain, dyspepsia, melena, and hematemesis)’ follow-up is important if GI effects occur. Risk of GI toxicity is increased with concomitant use of other NSAIDs,including OTC medications that contain NSAIDs.

Be alert to the symptoms of CHF (eg, shortness of breath, unexplained weight gain, or edema).

Be alert to the signs/symptoms of serious skin manifestations; use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity.

Hepatotoxicity is possible; discontinue therapy if symptoms such as nausea, fatigue, lethargy, pruritus, jaundice, right upper quadrant tenderness, and "flu-like" symptoms occur.

Seek immediate emergency help if anaphylactic/anaphylactoid reaction (eg,difficulty breathing, swelling of the face or throat) occurs.

Pregnant patients: Avoid flurbiprofen starting at 30 weeks gestation.

Women of reproductive age: NSAIDs have been associated with a reversible delay in ovulation.