Flurbiprofen

Also indexed as: Ansaid®

Flurbiprofen is used to treat pain caused by rheumatoid arthritis and osteoarthritis, and is in a family of medications known as non-steroidal anti-inflammatory drugs (NSAIDs).

Summary of Interactions with Vitamins, Herbs, and Foods
(for details about the summarized interactions, read the full article)

Beneficial May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.

Calcium*

Vitamin D*
Beneficial May be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.

N-acetyl cysteine
Avoid Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.

Food
Avoid Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

Lithium*

White willow*
Supportive interaction

None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Calcium and Vitamin D
Elevated calcium and vitamin D blood levels are commonly found in people with sarcoidosis. In one individual with sarcoidosis, taking flubiprofen lowered elevated blood calcium levels, but did not alter the concentration of vitamin D.1 One controlled study showed that flurbiprofen reduced blood levels of vitamin D in people with frequent calcium kidney stones.2 Further research is needed to determine whether flurbiprofen reduces blood calcium and vitamin D levels in healthy people.

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.3 Since major changes in lithium blood levels can produce unwanted side effects or interfere with its efficacy, NSAIDs should be used with caution, and only under medical supervision, in people taking lithium supplements.

N-acetyl cysteine (NAC)
Nonsteroidal anti-inflammatory drugs commonly cause damage to stomach and intestinal tissue. Though the mechanism by which NSAIDs cause this side effect is unknown, some researchers believe that free-radical damage is involved. A test tube study showed that flurbiprofen increases free-radical activity in stomach cells, which is blocked by the antioxidant N-acetyl cysteine.4 Additional research is needed to determine whether people taking flurbiprofen together with N-acetyl cysteine might experience fewer gastrointestinal side effects.

Interactions with Herbs

White willow bark (Salix alba)
White willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of salicylates like aspirin to individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs.5 Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.

Interactions with Foods and Other Compounds

Food
Taking NSAIDs with food may reduce stomach and intestinal side effects.6 Although taking flurbiprofen with food reduces the rate at which the drug is absorbed, it does not reduce the total amount that is absorbed.7 Therefore, to avoid possible side effects, people on long-term flurbiprofen therapy should take the drug with meals.

References

1. Brown RC, Heyburn PJ, Littlewood TJ, Beck P. Prostaglandin synthetase inhibition in hypercalcaemia with sarcoidosis. Lancet 1984;2:37.

2. Brown RC, Heyburn PJ, Littlewood TJ, Beck P. Prostaglandin synthetase inhibition in hypercalcaemia with sarcoidosis. Lancet 1984;2:37.

3. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

4. Kusuhara H, Komatsu H, Sumichika H, Sugahara K. Reactive oxygen species are involved in the apoptosis induced by nonsteroidal anti-inflammatory drugs in cultured gastric cells. Eur J Pharmacol 1999;383:331–7.

5. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

6. Olin BR, et. Central Nervous System Drugs, Analgesics and Anti-inflammatory Agents, Nonsteroidal Anti-inflammatory Agents. In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

7. Dressman JB, Berardi RR, Elta GH, et al. Absorption of flurbiprofen in the fed and fasted states. Pharm Res 1992;9:901–7.