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Flurbiprofen

Flurbiprofen: A Comprehensive Guide to the NSAID You Should Know

Introduction

Flurbiprofen is a nonsteroidal anti-inflammatory drug (NSAID) commonly used for the treatment of pain, inflammation, and fever. Though not as universally recognized as ibuprofen or naproxen, flurbiprofen is an effective option for chronic conditions such as arthritis, post-operative pain, and sore throat relief (in lozenge form). It belongs to the arylpropionic acid class of NSAIDs and is known for its potent anti-inflammatory and analgesic properties.

1. Overview and Chemical Profile

Flurbiprofen

Flurbiprofen is a nonselective COX inhibitor, meaning it inhibits both COX-1 and COX-2 enzymes, which are responsible for the synthesis of prostaglandins—chemicals involved in inflammation, pain, and fever.

  • Chemical Name: 2-(2-fluoro-4-biphenyl)propionic acid

  • Drug Class: NSAID

  • Forms: Oral tablets, ophthalmic solutions, and lozenges

  • Trade Names: Ansaid (U.S.), Froben (Europe and India), Strefen (lozenge)

2. Mechanism of Action

Like all NSAIDs, flurbiprofen works by inhibiting cyclooxygenase enzymes (COX-1 and COX-2). These enzymes play a key role in the conversion of arachidonic acid into prostaglandins, which:

  • Promote inflammation

  • Sensitize nerve endings to pain

  • Induce fever in the hypothalamus

By blocking COX enzymes, flurbiprofen reduces:

  • Inflammatory response

  • Pain perception

  • Fever

However, inhibition of COX-1 can also lead to side effects such as gastrointestinal irritation and reduced platelet aggregation.

3. Formulations and Administration

Flurbiprofen is available in several formulations:

1. Oral Tablets

  • Common dosages: 50 mg, 100 mg

  • Used for: Osteoarthritis, rheumatoid arthritis, musculoskeletal pain, dysmenorrhea

2. Lozenges

  • Typically 8.75 mg per lozenge

  • Marketed for sore throat relief (e.g., Strefen)

  • Available over the counter in many countries

3. Ophthalmic Drops

  • Used to prevent intraoperative miosis and reduce post-operative inflammation in eye surgeries

  • Also indicated in cystoid macular edema

4. Medical Uses

1. Rheumatoid Arthritis and Osteoarthritis

Flurbiprofen is highly effective in reducing the pain, swelling, and stiffness associated with arthritis. It is often prescribed for long-term management of these chronic inflammatory diseases.

2. Musculoskeletal Pain

It is prescribed for sprains, strains, lower back pain, and sports injuries due to its strong anti-inflammatory action.

3. Dysmenorrhea

NSAIDs like flurbiprofen are commonly used for menstrual pain, as they reduce uterine contractions by decreasing prostaglandin levels.

4. Post-Surgical Pain and Inflammation

In ophthalmic form, flurbiprofen is used to manage inflammation after cataract surgery or lens replacement procedures.

5. Sore Throat Relief (Lozenges)

Flurbiprofen lozenges provide targeted relief for sore throats, particularly those associated with inflammation, and are popular due to their local anesthetic and anti-inflammatory action.

5. Dosage and Duration

Oral Tablets

  • Adults: 50–100 mg two to four times daily

  • Maximum: 300–400 mg/day

  • Take with food or milk to minimize stomach upset

Lozenges

  • Up to 5 lozenges in 24 hours

  • Space doses at least 3 hours apart

  • Suitable for short-term use (≤3 days)

Ophthalmic Use

  • 1 drop four times daily

  • Start before surgery and continue postoperatively for up to 14 days

Always consult a healthcare provider before using flurbiprofen in any form.

6. Pharmacokinetics

  • Absorption: Rapid and complete from the gastrointestinal tract

  • Bioavailability: ~90%

  • Peak plasma levels: 1.5–2 hours after oral administration

  • Half-life: Approximately 3–6 hours

  • Metabolism: Hepatic (liver)

  • Excretion: Primarily through urine

Flurbiprofen has a relatively short half-life, requiring multiple daily doses for sustained relief.

7. Benefits and Advantages

✅ Effective Pain Relief

Particularly useful in inflammatory conditions where swelling and pain are both present.

✅ Local Action in Lozenges

Unlike systemic NSAIDs, lozenges provide targeted relief in the throat without affecting the rest of the body.

✅ Potent Anti-Inflammatory

Comparable to ibuprofen and diclofenac in strength, making it a solid choice for rheumatic diseases.

✅ Surgical Use in Ophthalmology

The eye drop formulation is a valuable tool for eye surgeons in reducing surgical inflammation.

✅ Well Studied

Flurbiprofen has been used for decades and has a well-established safety profile when used correctly.

8. Side Effects and Risks

Like all NSAIDs, flurbiprofen is associated with certain side effects. These can range from mild gastrointestinal issues to serious cardiovascular events.

Common Side Effects

  • Nausea

  • Indigestion

  • Heartburn

  • Headache

  • Dizziness

Serious Side Effects

  • Gastrointestinal bleeding or ulcers

  • Kidney dysfunction

  • Increased risk of heart attack or stroke (especially with long-term use)

  • Liver toxicity (rare)

  • Bronchospasm (in aspirin-sensitive individuals)

Eye Drop Side Effects

  • Burning or stinging in the eyes

  • Temporary blurred vision

  • Eye irritation

9. Contraindications and Precautions

Flurbiprofen is not recommended in:

  • People with active peptic ulcers

  • Severe liver or kidney impairment

  • History of gastrointestinal bleeding

  • NSAID-induced asthma

  • Third trimester of pregnancy

Use with caution in:

  • Elderly patients (increased risk of GI bleeding)

  • Those with cardiovascular disease

  • Patients on anticoagulants or corticosteroids

10. Interactions with Other Drugs

Flurbiprofen may interact with:

  • Aspirin and other NSAIDs → increased risk of GI bleeding

  • Anticoagulants (e.g., warfarin) → increased bleeding risk

  • SSRIs → enhanced bleeding risk

  • Diuretics or ACE inhibitors → may reduce renal function

  • Lithium → may increase lithium levels to toxic range

  • Methotrexate → increased toxicity

Always inform your doctor about all medications you’re taking.

11. Flurbiprofen vs. Other NSAIDs

Feature Flurbiprofen Ibuprofen Diclofenac Naproxen
Potency Moderate–High Moderate High Moderate
Half-life Short (3–6 hrs) Short (2–4 hrs) Short–medium Long (12–17 hrs)
Dosing 2–4x daily 3–4x daily 2–3x daily 2x daily
GI Risk Moderate Low–Moderate Moderate–High Moderate
Cardiovascular Risk Moderate Low High Low

Flurbiprofen offers a good balance between potency and tolerability but may require more frequent dosing.

12. Use in Special Populations

Pregnancy

  • Avoid in the third trimester (risk of premature closure of the ductus arteriosus)

  • Consult a doctor before using in the first or second trimesters

Breastfeeding

  • Excreted in small amounts in breast milk

  • Use only if clearly needed

Children

  • Oral and lozenge forms are not typically recommended for young children

  • Eye drops may be used under specialist guidance

13. Clinical Trials and Research

Several studies have demonstrated the efficacy of flurbiprofen in treating:

  • Post-operative dental pain

  • Sore throat due to upper respiratory infections

  • Rheumatoid arthritis and osteoarthritis

Lozenges have been shown to reduce throat pain within 15 minutes, with effects lasting up to 3 hours—making them ideal for symptomatic relief.

14. Practical Tips for Patients

  • Take tablets with food to reduce stomach upset

  • Do not exceed the recommended dose

  • Do not use for more than 3 days without medical advice (especially lozenges)

  • Be cautious with other painkillers—avoid combining multiple NSAIDs

  • Report any signs of bleeding, black stools, or severe abdominal pain immediately

15. Environmental and Legal Aspects

  • Flurbiprofen is prescription-only in some countries (especially oral tablets), while OTC lozenges are widely available

  • Environmental impact of NSAIDs has led to calls for responsible disposal and limiting unnecessary use

Conclusion

Flurbiprofen may not be the most widely used NSAID, but it offers distinct advantages in certain scenarios, particularly for:

  • Inflammatory arthritis

  • Postoperative inflammation (eyes)

  • Localized sore throat relief

Its diverse formulations—oral, lozenge, and ophthalmic—make it a versatile drug that addresses various types of pain and inflammation effectively. Like all NSAIDs, it must be used with caution, especially in people with a history of gastrointestinal or cardiovascular disease. When used appropriately, flurbiprofen can be a highly effective part of the pain management toolkit.