Side Effects of Ansaid (flurbiprofen)

Ansaid (flurbiprofen) is a nonsteroidal anti-inflammatory drug (NSAID) effective in treating fever, and inflammation and pain caused by rheumatoid arthritis or osteoarthritis, as well as soft tissue injuries, such as tendinitis and bursitis. 

As a group, NSAIDs are non-narcotic relievers of mild to moderate pain of many causes, including injury, menstrual cramps, arthritis, and other musculoskeletal conditions. They work by reducing the levels of prostaglandins, chemicals that are responsible for pain, fever, and inflammation. 

Ansaid blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower concentrations of prostaglandins. As a consequence, inflammation, pain and fever are reduced. The brand name Ansaid has been discontinued; generic versions are available. 

Common side effects of Ansaid include

• stomach ulcerations,
• abdominal burning,
• pain,
• cramping,
• indigestion,
• constipation,
• headache,
• nervousness,
• drowsiness,
• water retention,
• sensitivity to sunlight,
• nausea, and
• gastritis.

Serious side effects of Ansaid include

• serious gastrointestinal bleeding,
• liver toxicity,
• rash,
• ringing in the ears,
• lightheadedness,
• rare but severe allergic reactions,
• aggravation of peptic ulcer disease or poor kidney function,
• heart attack,
• stroke,
• accumulation of fluid,
• worsening heart failure, and
• causing or worsening high blood pressure (hypertension) and kidney failure.

Drug interactions of Ansaid include blood thinners such as warfarin, because of the increased risk of bleeding.

• Patients taking lithium can develop toxic blood levels of lithium because Ansaid may inhibit the elimination of lithium from the body by the kidney.
• Side effects from methotrexate and cyclosporine also may be increased by Ansaid.
• Ansaid may reduce the effectiveness of medications that are used to treat high blood pressure because it causes or worsens high blood pressure.
• NSAIDs may diminish the blood pressure-lowering effects of angiotensin converting enzyme (ACE) inhibitors.
• Combining NSAIDs with angiotensin receptor blockers (for example, valsartan, losartan, irbesartan) or angiotensin converting enzyme inhibitors (for example, enalapril, captopril) in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure.
• Persons who have more than three alcoholic beverages per day are at increased risk of developing stomach ulcers when taking Ansaid or other NSAIDs. 

Ansaid is generally avoided during pregnancy. Ansaid is excreted in breast milk. To avoid adverse effects in the infant, nursing mothers should decide whether to stop breastfeeding or stop Ansaid.

Most patients benefit from flurbiprofen and other NSAIDs with few side effects. However, serious side effects can occur, and generally tend to be dose related. Therefore, it is often desirable to use the lowest effective dose to minimize side effects. The most common side effects of flurbiprofen involve the gastrointestinal system. These are:

• Ulcerations
• Abdominal burning
• Pain
• Cramping
• Indigestion
• Constipation
• Headache
• Nervousness
• Drowsiness
• Water retention
• Sensitivity to sunlight
• Nausea
• Gastritis
• Serious gastrointestinal bleeding
• Liver toxicity

Sometimes, stomach ulceration and bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of internal bleeding.

Other important side effects include:

• Rash
• Kidney impairment
• Liver impairment
• Allergic reactions
• Ringing in the ears
• Lightheadedness

Flurbiprofen should be avoided by patients with a history of asthma attacks, hives, or other allergic reactions to aspirin or other NSAIDs. Rare but severe allergic reactions have been reported in such individuals.

It also should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions.

Like other NSAIDS flurbiprofen may cause heart attacks and strokes; accumulation of fluid and worsen heart failure; cause or worsen hypertension and kidney failure.

TABLE 2: Reported adverse events in patients receiving ANSAID (flurbiprofen) or other nonsteroidal anti-inflammatory drugs

ACE-inhibitors

• Reports suggest that nonsteroidal anti-inflammatory drugs may diminish the antihypertensive effect of ACE-inhibitors.
• This interaction should be given consideration in patients taking nonsteroidal antiinflammatory drugs concomitantly with ACE-inhibitors.

Anticoagulants

• The effects of warfarin and NSAIDs on GI bleeding are synergistic, such that users of both drugs together have a risk of serious GI bleeding higher than users of either drug alone.
• The physician should be cautious when administering ANSAID (flurbiprofen) to patients taking warfarin or other anticoagulants.

Aspirin

• Concurrent administration of aspirin lowers serum flurbiprofen concentrations.
• The clinical significance of this interaction is not known; however, as with other NSAIDs, concomitant administration of flurbiprofen and aspirin is not generally recommended because of the potential for increased adverse effects.

Beta-adrenergic blocking agents

• Flurbiprofen attenuated the hypotensive effect of propranolol but not atenolol.
• The mechanism underlying this interference is unknown.
• Patients taking both flurbiprofen and a beta-blocker should be monitored to ensure that a satisfactory hypotensive effect is achieved.

Diuretics

• Clinical studies, as well as post marketing observations, have shown that ANSAID (flurbiprofen) can reduce the natriuretic effect of furosemide and thiazides in some patients.
• This response has been attributed to inhibition of renal prostaglandin synthesis.
• During concomitant therapy with NSAIDs, the patient should be observed closely for signs of renal failure, as well as diuretic efficacy.

Lithium

• NSAIDs have produced an elevation of plasma lithium levels and a reduction in renal lithium clearance.
• The mean minimum lithium concentration increased 15% and the renal clearance was decreased by approximately 20%.
• These effects have been attributed to inhibition of renal prostaglandin synthesis by the nonsteroidal anti-inflammatory drug.
• Thus, when nonsteroidal anti-inflammatory drugs and lithium are administered concurrently, subjects should be observed carefully for signs of lithium toxicity.

Methotrexate

• Nonsteroidal anti-inflammatory drugs have been reported to competitively inhibit methotrexate accumulation in rabbit kidney slices.
• This may indicate that they could enhance the toxicity of methotrexate.
• Caution should be used when nonsteroidal anti-inflammatory drugs are administered concomitantly with methotrexate.