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(FEN-oh-PRO-fen KAL-see-uhm)
Nalfon Pulvules
Class: Analgesic/NSAID

 Action Decreases inflammation, pain and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis.

 Indications Symptomatic relief for rheumatoid arthritis, osteoarthritis, mild to moderate pain. unlabeled use(s): Symptomatic relief for juvenile rheumatoid arthritis; migraine prophylaxis and treatment.

 Contraindications Sensitivity to aspirin or other NSAIDs; preexisting renal disease.

 Route/Dosage

Rheumatoid Arthritis/Osteoarthritis

PO 300 to 600 mg tid to qid; do not exceed 3.2 g/day.

Mild/Moderate Pain

PO 200 mg q 4 to 6 h prn.

 Interactions

Anticoagulants: May increase risk of bleeding caused by gastric erosion. Methotrexate: May increase methotrexate levels. Phenobarbital: Phenobarbital, an enzyme inducer, may decrease fenoprofen half-life. Dosage adjustments of fenoprofen may be required if phenobarbital is added or withdrawn.

 Lab Test Interferences False elevation in free and total serum T3 as measured by Amerlex-M kit.

 Adverse Reactions

CV: CHF; hypotension; hypertension; peripheral edema; fluid retention; vasodilation. CNS: Dizziness; drowsiness; headaches; nervousness; anxiety; confusion; somnolence. DERM: Pruritus; erythema; urticaria. EENT: Visual disturbances; tinnitus; dry eyes. GI: Heartburn; dyspepsia; nausea; vomiting; diarrhea; constipation; increased or decreased appetite; indigestion; GI bleeding; ulceration; abdominal distress/cramps/pain; flatulence; occult blood in stool. GU: Hematuria; proteinuria; renal insufficiency; glomerular and interstitial nephritis; acute renal failure with preexisting renal dysfunction. HEMA: Bone marrow depression; neutropenia; leukopenia; hypocoagulability. META: Hyperglycemia; hypoglycemia; hyponatremia. RESP: Bronchospasm; laryngeal edema; hemoptysis; shortness of breath.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly patients: Increased risk of adverse reactions. Hypersensitivity: Use caution in aspirin-sensitive individuals due to possible cross-sensitivity. GI effects: Serious GI toxicity (eg, bleeding, ulceration, perforation) can occur at any time, with or without warning symptoms. GU effects: GU tract problems have occurred (most frequently dysuria, cystitis, hematuria, nephrotic syndrome). This may be preceded by fever, rash, arthralgia, oliguria, and azotemia, and may progress to anuria. Rapid recovery followed early recognition and drug withdrawal. Renal effects: Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia and renal papillary necrosis may occur.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Give with food, milk, or antacids if GI upset occurs.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess baseline renal function, BP, blood glucose levels, PT, and CBC prior to beginning therapy and monitor periodically during therapy.
  • Monitor blood glucose closely in patients with diabetes.
  • Assess for any visual disturbances. Notify physician if any visual changes occur.
  • Assess auditory function during prolonged therapy in patients with impaired hearing.
  • Report any CNS or respiratory disturbances to physician.
  • Monitor PT if patient is concurrently taking anticoagulant.
  • Evaluate for signs and symptoms of ulceration and bleeding if patient is on prolonged therapy.
OVERDOSAGE: SIGNS & SYMPTOMS
  Drowsiness, dizziness, mental confusion, disorientation, lethargy, paresthesias, numbness, vomiting, gastric irritation, nausea, abdominal pain, headache, tinnitus, sweating, convulsions, blurred vision, elevations in serum creatine and BUN, hypotension, tachycardia

 Patient/Family Education

  • Instruct patient to take with food, milk, or antacids if GI symptoms occur (eg, pain, nausea, anorexia). If symptoms persist, report to physician.
  • Advise patient that improvement may occur in 2 to 3 days but 2 to 3 wk may be required.
  • Inform patient taking anticoagulant concurrently to watch for signs and symptoms of bleeding or unusual bruising and report immediately to physician.
  • Instruct patient to call physician if headaches or other CNS disturbances occur. If headaches persist despite dosage reduction, drug may be discontinued.
  • Advise patient to avoid aspirin and alcoholic beverages while taking medication.
  • Instruct patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness, coordination and dexterity.
  • Instruct patient to report to physician any fever, rash, joint pain, or any changes in urinary elimination including those associated with pain, discoloration, or decreased amount.
  • Advise patient to minimize exposure to sun and to use sunscreen or wear protective clothing outdoors until tolerance is determined.

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