Strepsils Intensive Spray

Indications

• Pain and inflammation in musculoskeletal disorders
• Rheumatic diseases
• Dysmenorrhoea
• Postoperative pain
• Mild to moderate pain

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing information

Adults: Refer to the BNF for specific dosing information. Generally, flurbiprofen is administered orally or topically depending on the formulation and condition being treated.

Mechanism of action

Flurbiprofen exerts its anti-inflammatory effects through reversible inhibition of cyclooxygenase (COX) enzymes, which are crucial for the conversion of arachidonic acid to prostaglandins. By inhibiting both COX-1 and COX-2, flurbiprofen decreases the synthesis of prostaglandins involved in the inflammatory response, thereby alleviating pain, swelling, and fever.

Pharmacodynamics

As a nonsteroidal anti-inflammatory agent, flurbiprofen shares structural and pharmacological similarities with other NSAIDs such as ibuprofen and ketoprofen. The drug exhibits significant anti-inflammatory, analgesic, and antipyretic activities. Its therapeutic efficacy is attributed primarily to the S-enantiomer, which demonstrates predominant anti-inflammatory effects, while both enantiomers contribute to its analgesic properties.

Pharmacokinetics

Flurbiprofen is absorbed well from the gastrointestinal tract, with peak plasma concentrations occurring within 1 to 2 hours after oral administration. It is extensively metabolized in the liver, primarily through glucuronidation, and is excreted mainly in the urine. The drug has a half-life of approximately 3 to 6 hours. The pharmacokinetics may vary in individuals with renal impairment, necessitating caution in dosing for this population.

Contra-indications

• Hypersensitivity to flurbiprofen or any of its excipients
• History of gastrointestinal bleeding or ulceration
• Severe renal impairment
• Active peptic ulcer disease
• History of allergic reactions to NSAIDs

Adverse effects

• Gastrointestinal disturbances (nausea, vomiting, diarrhea, constipation)
• Headache
• Dizziness
• Drowsiness
• Rash or allergic reactions
• Renal impairment
• Increased risk of cardiovascular events
• Photosensitivity

Interactions

• Increased risk of gastrointestinal bleeding with anticoagulants
• May reduce the efficacy of antihypertensive medications
• Increased risk of nephrotoxicity with other nephrotoxic agents
• Potentially increased effects of other NSAIDs

Precautions

• Caution in patients with renal impairment, heart failure, or gastrointestinal disorders
• Use with caution in elderly patients due to increased risk of adverse effects
• Monitor for signs of gastrointestinal bleeding
• Consider alternative analgesics in patients with a history of cardiovascular disease

Pregnancy

Flurbiprofen should be avoided, especially in the third trimester due to the risk of fetal cardiovascular effects. Consult healthcare providers for alternatives.

Breast-feeding

Use with caution; flurbiprofen is excreted in breast milk. Monitor infant for any adverse effects.

Storage

Store in a cool, dry place, away from direct sunlight. Keep out of reach of children.

Formulations

• Tablets
• Topical gel
• Eye drops

Mechanism of action

Similar to other NSAIAs, the anti-inflammatory effect of flurbiprofen occurs via reversible inhibition of cyclooxygenase (COX), the enzyme responsible for the conversion of arachidonic acid to prostaglandin G2 (PGG2) and PGG2 to prostaglandin H2 (PGH2) in the prostaglandin synthesis pathway. This effectively decreases the concentration of prostaglandins involved in inflammation, pain, swelling and fever. Flurbiprofen is a non-selective COX inhibitor and inhibits the activity of both COX-1 and -2. It is also one of the most potent NSAIAs in terms of prostaglandin inhibitory activity.

Pharmacodynamics

Flurbiprofen, a nonsteroidal anti-inflammatory agent (NSAIA) of the propionic acid class, is structually and pharmacologically related to fenoprofen, ibuprofen, and ketoprofen, and has similar pharmacological actions to other prototypica NSAIAs. Flurbiprofen exhibits antiinflammatory, analgesic, and antipyretic activities. The commercially available flurbiprofen is a racemic mixture of (+)S- and (-) R-enantiomers. The S-enantiomer appears to possess most of the anti-inflammatory, while both enantiomers may possess analgesic activity.