Contents
What is fenoprofen
Fenoprofen or fenoprofen calcium is a nonsteroidal antiinflammatory drug (NSAID) used in the treatment of acute pain and chronic arthritis. Current indications include chronic joint pain due to osteoarthritis and rheumatoid arthritis, as well as mild-to-moderate acute pain. Fenoprofen works by reducing hormones that cause inflammation and pain in the body.
Fenoprofen belongs to the propionic derivative class of nonsteroidal antiinflammatory drugs (NSAID)s similar to naproxen, ketoprofen, flurbiprofen and ibuprofen. Like other NSAIDs, fenoprofen is a cyclo-oxygenase (Cox-1 and -2) inhibitor that blocks the formation of prostaglandins that are important in pain and inflammatory pathways. Fenoprofen has analgesic as well as antipyretic and antiinflammatory activities. Fenoprofen was approved in the United States in 1976 and is still in clinical use.
Fenoprofen comes as a capsule and a tablet to take by mouth. It is usually taken with a full glass of water three or four times a day for arthritis or every 4 to 6 hours as needed for pain. Fenoprofen can be taken with meals or milk to reduce stomach upset. Your doctor may also recommend that you take fenoprofen with an antacid to reduce stomach upset. If you take fenoprofen regularly, take it at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take fenoprofen exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
If you are taking fenoprofen to relieve the symptoms of arthritis, your symptoms may begin to improve within a few days. It may take 2-3 weeks or longer for you to feel the full benefit of fenoprofen.
People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as fenoprofen may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. This risk may be higher for people who take NSAIDs for a long time. Do not take an NSAID such as fenoprofen if you have recently had a heart attack, unless directed to do so by your doctor. Tell your doctor if you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke, if you smoke,and if you have or have ever had high cholesterol, high blood pressure, or diabetes. Get emergency medical help right away if you experience any of the following symptoms: chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech.
If you will be undergoing a coronary artery bypass graft (CABG; a type of heart surgery), you should not take fenoprofen right before or right after the surgery.
NSAIDs such as fenoprofen may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, are older in age, have poor health, or drink large amounts of alcohol while taking fenoprofen. Tell your doctor if you take any of the following medications: anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven); aspirin; other NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); or serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR). Also tell your doctor if you have or have ever had ulcers, bleeding in your stomach or intestines, or other bleeding disorders. If you experience any of the following symptoms, stop taking fenoprofen and call your doctor: stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools.
Keep all appointments with your doctor and the laboratory. Your doctor will monitor your symptoms carefully and will probably order certain tests to check your body’s response to fenoprofen. Be sure to tell your doctor how you are feeling so that your doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects.
Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with fenoprofen and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (https://www.fda.gov/Drugs/default.htm) or the manufacturer’s website to obtain the Medication Guide.
Fenoprofen vs Ibuprofen
Ibuprofen is one of a group of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) that is available over the counter without a prescription.
Ibuprofen can be used to:
- ease mild to moderate pain – such as toothache, migraine and period pain
- control a high temperature (fever) – for example, when someone has the flu (influenza)
- ease pain and inflammation (redness and swelling) caused by conditions that affect the joints, bones and muscles – such as rheumatoid arthritis and osteoarthritis
- ease pain and swelling caused by sprains and strains – such as sports injuries
Types of ibuprofen
You can buy most types of ibuprofen from supermarkets, general retail outlets or pharmacies. Some types and pack sizes are only available from pharmacy counters, and some only on prescription.
Ibuprofen is available in many forms, including:
- tablets
- capsules
- liquids
- gels or creams
- sprays
In some products ibuprofen is combined with other ingredients. For example, it’s sometimes combined with medicine for a blocked nose (a decongestant) and sold as a cold and flu remedy.
Make sure you use ibuprofen as directed on the label or leaflet, or as instructed by a health professional.
How much you can take depends on your age, the type of ibuprofen you’re taking and how strong it is.
For example:
- adults – can usually take one or two 200mg tablets every four to six hours, but shouldn’t take more than 1,200mg (six 200mg) tablets in the space of 24 hours
- children under 16 – may need to take a lower dose depending on their age; check the packet or leaflet, or ask a pharmacist or doctor for advice
The painkilling effect of ibuprofen begins soon after a dose is taken, but the anti-inflammatory effect can sometimes take up to three weeks to get the best results.
Ibuprofen shouldn’t be used to treat conditions that are mainly related to inflammation.
Don’t take more than the recommended dose if it isn’t relieving your symptoms.
Adults can take paracetamol at the same time as ibuprofen if necessary, but this isn’t recommended for children.
As ibuprofen is a type of NSAID, you shouldn’t take more than one of these at a time or you’ll have an increased risk of side effects.
NSAIDs can also interact with many other medicines, including:
- some types of antidepressants – used to treat depression
- beta-blockers – used to treat high blood pressure (hypertension)
- diuretics – which reduce the amount of fluid in your body
Ibuprofen can also interact with ginkgo biloba, a controversial dietary supplement some people claim can treat memory problems and dementia.
There are no known problems caused by taking ibuprofen with any specific foods or by drinking a moderate amount of alcohol.
Taking high doses of ibuprofen over long periods of time can increase your risk of:
- stroke – when the blood supply to the brain is disturbed
- heart attacks – when the blood supply to the heart is blocked
In women, long-term use of ibuprofen might be associated with reduced fertility. This is usually reversible when you stop taking ibuprofen.
Who can take ibuprofen
Some people should avoid using ibuprofen and others should use it with caution. If you have any queries about using ibuprofen or any other medicines, speak to your doctor or pharmacist.
You shouldn’t take ibuprofen if you:
- have a history of a strong, unpleasant reaction (hypersensitivity) to aspirin or other NSAIDs
- currently have or recently had a stomach ulcer, or you have had one in the past
- have severe heart failure
- have severe liver disease
- are taking low-dose aspirin for the prevention of cardiovascular disease
You should use ibuprofen with caution if you’re aged 65 or over, breastfeeding, or have:
- asthma
- kidney or liver problems
- lupus
- Crohn’s disease or ulcerative colitis
- previously had any bleeding in your stomach
- high blood pressure (hypertension)
- narrowing of the arteries (peripheral arterial disease)
- any problems with your heart, such as angina, heart attacks, or mild or moderate heart failure
- had a stroke
Ibuprofen and pregnancy
Ideally, pregnant women shouldn’t take ibuprofen unless a doctor recommends and prescribes it.
It’s best to tell your doctor or pharmacist about any medicines you’re taking.
Paracetamol is recommended as an alternative to ease short-term pain or reduce a high temperature.
Ibuprofen and breastfeeding
Ibuprofen appears in breast milk in small amounts, so it’s unlikely to cause any harm to your baby while you’re breastfeeding.
Ibuprofen and children
Ibuprofen may be given to children aged three months or over who weigh at least 5kg (11lbs) to relieve pain, inflammation or fever.
Your doctor or another healthcare professional may recommend ibuprofen for younger children in certain cases – for example, this may be to control a fever after a vaccination if paracetamol is unsuitable.
If your baby or child has a high temperature that doesn’t get better or they continue to experience pain, speak to your doctor.
Ibuprofen side effects
Ibuprofen can cause a number of side effects. You should take the lowest possible dose for the shortest possible time needed to control your symptoms.
See the patient information leaflet that comes with your medicine for a full list of side effects.
Common side effects of ibuprofen include:
- nausea or vomiting
- constipation or diarrhoea
- indigestion (dyspepsia) or abdominal pain
Less common side effects include:
- headache or dizziness
- bloating (fluid retention)
- raised blood pressure
- inflammation of the stomach (gastritis)
- a stomach ulcer
- allergic reactions – such as a rash
- worsening of asthma symptoms by causing narrowing of the airways (bronchospasm)
- kidney failure
- black stools and blood in your vomit – this can indicate bleeding in your stomach
If you feel unwell after taking ibuprofen or have concerns, speak to your doctor or pharmacist.
Fenoprofen uses
Fenoprofen is used to relieve mild to moderate pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints) and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints). Fenoprofen is also used to relieve mild to moderate pain from other causes. Fenoprofen is in a class of medications called NSAIDs. It works by stopping the body’s production of a substance that causes pain, fever, and inflammation.
Fenoprofen is also used to treat ankylosing spondylitis (arthritis that mainly affects the spine) and gouty arthritis (attacks of severe joint pain and swelling caused by a build-up of certain substances in the joints). It is also sometimes used to reduce fever. Talk to your doctor about the risks of using this medication to treat your condition.
Fenoprofen is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Fenoprofen special precautions
Fenoprofen can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use fenoprofen just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
Fenoprofen may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using fenoprofen, especially in older adults.
Before taking fenoprofen:
- tell your doctor and pharmacist if you are allergic to fenoprofen, aspirin or other NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), any other medications, or any of the inactive ingredients in fenoprofen capsules or tablets. Ask your pharmacist for a list of the inactive ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin, in Lotrel), captopril, enalapril (Vasotec, in Vaseretic), fosinopril, lisinopril (in Zestoretic), moexipril (Univasc), perindopril (Aceon, in Prestalia), quinapril (Accupril, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi, in Edarbyclor), candesartan (Atacand, in Atacand HCT), eprosartan (Teveten), irbesartan (Avapro, in Avalide), losartan (Cozaar, in Hyzaar), olmesartan (Benicar, in Azor, in Benicar HCT, in Tribenzor), telmisartan (Micardis, in Micardis HCT, in Twynsta), and valsartan (in Exforge HCT); beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol (Trandate), metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), and propranolol (Hemangeol, Inderal, Innopran); diuretics (‘water pills’); lithium (Lithobid); oral medications for diabetes; methotrexate (Otrexup, Rasuvo, Trexall); phenobarbital; phenytoin (Dilantin, Phenytek); and sulfa antibiotics such as sulfisoxazole and sulfamethoxazole (in Bactrim, in Septra). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had the conditions mentioned in the IMPORTANT WARNING section or asthma, especially if you also have frequent stuffed or runny nose or nasal polyps (swelling of the lining of the nose); heart failure; swelling of the hands, feet, ankles, or lower legs; a hearing impairment; anemia (blood cells do not bring enough oxygen to all parts of the body); or liver or kidney disease.
- tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, you plan to become pregnant, or you are breast-feeding. If you become pregnant while taking fenoprofen, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking fenoprofen.
- you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
- remember that alcohol can add to the drowsiness caused by this drug. Do not drink alcohol while taking this medication.
Fenoprofen may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using fenoprofen, especially in older adults.
You should not use fenoprofen if you are allergic to it, or if you have:
- severe kidney disease; or
- a history of asthma attack or severe allergic reaction after taking aspirin or an NSAID.
To make sure fenoprofen is safe for you, tell your doctor if you have:
- heart disease, high blood pressure, high cholesterol, diabetes, or if you smoke;
- a history of heart attack, stroke, or blood clot;
- a history of stomach ulcers or bleeding;
- asthma;
- liver or kidney disease; or
- fluid retention.
Taking fenoprofen during the last 3 months of pregnancy may harm the unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using fenoprofen.
It is not known whether fenoprofen passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Fenoprofen is not approved for use by anyone younger than 18 years old.
Fenoprofen dosage
The recommended fenoprofen dose in adults with pain is 200 mg every 4 to 6 hours. Higher doses are used for chronic arthritis, in the range of 400 to 600 mg 3 or 4 times per day, with a maximum dose of 3,200 mg daily. Fenoprofen is available by prescription only in the form of capsules or tablets of 200, 300, 400 and 600 mg in both generic and trade formulations (Nalfon). As with other NSAIDs, fenoprofen is generally well tolerated, but side effects can include headache, dizziness, somnolence, gastrointestinal upset, nausea, abdominal discomfort, diarrhea, peripheral edema and hypersensitivity reactions.
Adult dose for osteoarthritis
Use: For the relief of signs and symptoms of osteoarthritis and rheumatoid arthritis
- 400 mg to 600 mg orally 3 or 4 times a day
- Maximum dose: 3200 mg/day
Comments:
- Dose adjustments should be made following initiation of therapy or during exacerbations of the disease.
- Patients with rheumatoid arthritis usually require larger doses than those with osteoarthritis; the lowest effective dose that yields acceptable control for either condition should be employed.
Adult dose for rheumatoid arthritis
Use: For the relief of signs and symptoms of osteoarthritis and rheumatoid arthritis
- 400 mg to 600 mg orally 3 or 4 times a day
- Maximum dose: 3200 mg/day
Comments:
- Dose adjustments should be made following initiation of therapy or during exacerbations of the disease.
- Patients with rheumatoid arthritis usually require larger doses than those with osteoarthritis; the lowest effective dose that yields acceptable control for either condition should be employed.
Adult dose for pain
Use: For the relief of mild to moderate pain
- 200 mg orally every 4 to 6 hours as needed
Renal dose adjustments
- Advanced renal disease: Avoid use unless benefit is expected to outweigh risk of worsening renal function
Dialysis
- Data not available
Liver dose adjustments
- If liver disease develops or if systemic manifestations such as eosinophilia or rash occur, this drug should be discontinued.
Dose Adjustments
- Elderly: Elderly patients may require lower doses due to increased risk for adverse effects including cardiovascular, gastrointestinal, hepatic and/or renal adverse reactions.
What happens if I miss a dose?
Since fenoprofen is sometimes used only when needed, you may not be on a dosing schedule. If you are on a schedule, use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
Fenoprofen side effects
Fenoprofen may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- headache
- nervousness
- drowsiness
- sweating
- constipation
- ringing in the ears
Some side effects can be serious. If you experience any of the following symptoms, or those mentioned in the IMPORTANT WARNING section, call your doctor immediately. Do not take any more fenoprofen until you speak to your doctor.
- blurred vision
- shaking of a part of the body that you cannot control
- unexplained weight gain
- shortness of breath or difficulty breathing
- swelling in the abdomen, ankles, feet, or legs
- fever
- blisters
- rash
- itching
- hives
- swelling of the eyes, face, lips, tongue, throat, hands, arms, feet, ankles, or lower legs
- hoarseness
- difficulty breathing or swallowing
- yellowing of the skin or eyes
- excessive tiredness
- unusual bleeding or bruising
- lack of energy
- upset stomach
- loss of appetite
- pain in the upper right part of the stomach
- flu-like symptoms
- pale skin
- fast or pounding heartbeat
- cloudy, discolored, or bloody urine
- back pain
- difficult or painful urination
Fenoprofen may cause other side effects. Call your doctor if you have any unusual problems while taking fenoprofen.
Fenoprofen calcium overdose
In case of fenoprofen overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call your local emergency services number.
Symptoms of fenoprofen overdose may include:
- heartburn
- nausea
- vomiting
- stomach pain
- dizziness
- unsteadiness or difficulty balancing
- headache
- ringing in the ears
- shaking of a part of the body that you cannot control
- drowsiness
- confusion
Below are symptoms of a fenoprofen calcium overdose in different parts of the body.
AIRWAYS AND LUNGS
- Slow and labored breathing
EYES AND EARS
- Blurred vision
- Ringing in the ears
BLADDER AND KIDNEYS
- Little or no urine output
STOMACH AND INTESTINES
- Diarrhea
- Nausea and vomiting (sometimes with blood)
- Stomach pain
HEART AND BLOOD
- Increased heart rate
NERVOUS SYSTEM
- Agitation
- Confusion
- Coma (decreased level of consciousness and lack of responsiveness)
- Seizures
- Dizziness
- Drowsiness
- Delirium (person is not making sense)
- Movement problems
- Numbness and tingling
- Unsteadiness
- Severe headache
SKIN
- Rash
What to expect at the emergency room
Take the container to the hospital with you, if possible.
Your doctor will measure and monitor the person’s vital signs, including temperature, pulse, breathing rate, and blood pressure.
Tests that may done include:
- Activated charcoal
- Blood and urine tests
- Camera down the throat to look for burns in the esophagus and the stomach
- Chest x-ray
- ECG (electrocardiogram or heart tracing)
Treatment may include:
- Fluids through a vein (by IV)
- Medicines to treat symptoms
- Laxative
- Tube through the mouth into the stomach if vomiting contains blood
- Breathing support, including a tube through the mouth into the lungs and connected to a breathing machine (ventilator)
Fenoprofen overdose prognosis
Taking too much fenoprofen does not usually cause serious problems. The person may have some stomach pain and vomiting (possibly with blood). However, these symptoms will likely get better. In rare cases, a blood transfusion may be needed. Passing a tube through the mouth into the stomach (endoscopy) may be required to stop internal bleeding.
In rare cases, there can be ringing in the ears and a bad headache, but these symptoms will likely pass as well.
If kidney damage is severe, dialysis (kidney machine) may be needed until kidney function returns. In some cases, the damage is permanent.
A large fenoprofen overdose can cause serious damage to children and adults. Death may occur.
