Professional view

flurbiprofen: prescribing and clinical use

Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.

flurbiprofen: clinical details

Prescribing considerations

Assess gastrointestinal, cardiovascular, renal, hepatic, bleeding and respiratory risk before systemic treatment.
Review prescribed and over-the-counter NSAIDs, aspirin, anticoagulants, antiplatelets, corticosteroids, SSRIs, antihypertensives and nephrotoxic medicines.
Older people and patients who are dehydrated or have renal, cardiac or hepatic impairment are more susceptible to serious NSAID toxicity.
Reassess worsening throat symptoms, new symptoms or possible bacterial tonsillitis; NSAIDs may mask infection-related pain or fever.

Contraindications and cautions

Hypersensitivity to flurbiprofen or a formulation excipient.
Previous asthma, bronchospasm, rhinitis, angioedema or urticaria triggered by aspirin or another NSAID.
Active or recurrent peptic ulceration, gastrointestinal haemorrhage, or previous NSAID-associated gastrointestinal bleeding or perforation.
Severe heart, renal or hepatic failure.
Third trimester of pregnancy.
Product-specific age restrictions: selected lozenges are unsuitable below 12 years and the selected spray below 18 years.

Monitoring

For systemic treatment, consider baseline blood pressure, renal function and full blood count; assess liver function where hepatic impairment is present.
After initiation or a treatment change, consider renal function, full blood count, blood pressure and haemoglobin according to gastrointestinal and patient-specific risk.
During continued treatment, periodically review blood pressure, renal function, blood count, relevant liver function, efficacy, adverse effects and ongoing need.

Clinical pharmacology

A propionic-acid NSAID with analgesic, anti-inflammatory and antipyretic activity through prostaglandin-synthesis inhibition. It is highly protein-bound, mainly metabolised by hydroxylation and eliminated through the kidneys. Oromucosal products produce lower systemic exposure than tablets but are not purely local.

Formulation and product differences

Coated tablets provide systemic treatment and contain lactose, sucrose and glucose.
Lozenges provide local throat delivery for people over 12 and should be moved around the mouth while dissolving.
The selected oromucosal spray is licensed for adults and must not be inhaled during application.
Orange and eucalyptus/manuka lozenges contain isomalt and maltitol, which may have a laxative effect; flavourings and spray preservatives can cause allergic reactions.