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Generic name: Fenoprofen calcium.

Proprietary name: Nalfon.

Primary use

This non-steroidal anti-inflammatory agent is used in the management­ of rheumatoid arthritis.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Diplopia

3. Eyelids or conjunctiva

a.Erythema

b.Conjunctivitis – non-specific

c.Angioneurotic edema

d.Urticaria

Possible

1. Optic neuritis

2. Visual field defects

a.Scotomas – centrocecal or paracentral

b.Enlarged blind spot

c.Constriction

3. Subconjunctival or retinal hemorrhages secondary to drug-induced anemia

4. Eyelids or conjunctiva

a.Erythema multiforme

b.Stevens-Johnson syndrome

c.Exfoliative dermatitis

d.Toxic epidermal necrolysis

Clinical significance

Ocular side effects are seldom of clinical significance with fenoprofen. The most common adverse events are transient blurred vision and diplopia. Many of the adverse events associated with the other non-steroidal anti-inflammatories have been reported to the National Registry with fenoprofen, however, the numbers are small. Any skin lesion associated with the use of this drug requires stopping the drug and obtaining dermatologic consultation since a small number go on to severe systemic disease. Again, as with others in this group of drugs, there appears to be a rare idio­ syncratic optic nerve response that may be associated with the use of this drug. There have been cases reported to the National Registry where there was a unilateral or bilateral decrease in visual acuity ranging from 20/80 to 20/200 after 6 months of therapy. Visual fields may show various types of scotoma. If the medication is stopped, the visual acuity usually returns to normal in 1 to 3 months. It has, however, taken over 8 months for color vision to return. It is not possible to state a positive cause-and-effect relationship between optic neuritis and this drug. It is prudent, however, to stop the medication if optic neuritis occurs. There are no reports in the literature or in the National Registry of this agent causing intracranial hypertension.

References and Further Reading

Bigby M, Stern R. Cutaneous reactions to nonsteroidal anti-inflammatory drugs. A review. J Am Acad Dermatol 12: 866, 1985.

McEvov GK (ed). American Hospital Formulary Service Drug Information 87, American Society for Hospital Pharmacists, Bethesda, pp 914–917, 1987.

Sweetman SC (ed). Martindale: The Complete Drug Reference. 34th edn. Pharmaceutical Press, London, p 39, 2004.

Treusch PJ, et al. Agranulocytosis associated with fenoprofen. JAMA 241: 2700, 1979.

Generic name: Flurbiprofen.

Proprietary names: Ansaid, Ocufen.

Primary use

Systemic

This non-steroidal anti-inflammatory agent is used in the treatment of rheumatoid arthritis.

Ophthalmic

Flurbiprofen is used for the inhibition of intraoperative miosis.

Ocular side effects

Systemic administration

Possible

1. Decreased vision

2. Eyelids or conjunctiva

a.Erythema

b.Conjunctivitis – non-specific

c.Urticaria

3. Diplopia

4. Subconjunctival or retinal hemorrhages secondary to drug-induced anemia

Local ophthalmic use or exposure

Certain

1. Irritation

a.Hyperemia

b.Burning sensation 2. Cornea

a.Punctate keratitis

b.Delayed wound healing

Probable

1. May aggravate herpes infections

2. Increased ocular or periocular bleeding

Clinical significance

Ocular side effects secondary to systemic administration are infrequent. While side effects reported with other non-steroidal anti-inflammatory agents must be looked for, to date no cases of optic neuritis or intracranial hypertension have been reported to the National Registry.

Generally, short-term therapy with ophthalmic flurbiprofen has been well tolerated; the most frequent adverse reactions have been mild transient stinging and burning on instillation. Flurbiprofen has been shown to inhibit corneal scleral wound healing, decrease leukocytes in tears and increase complications of herpetic keratitis. Flurbiprofen is one of the more potent nonsteroidal anti-inflammatory drugs, which can interfere with thrombocyte aggregation. This may cause intraoperative bleeding as a rare event. This is more common if the patient is already on anticoagulants.