Indications And Dose
Pain and inflammation in rheumatic disease and other musculoskeletal disorders ▶BY MOUTH ▶Adult: 300 mg twice daily
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Drug reference
Pain and inflammation in rheumatic disease and other musculoskeletal disorders ▶BY MOUTH ▶Adult: 300 mg twice daily
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Active bladder disease (or symptoms). active gastro-intestinal bleeding. active gastro-intestinal ulceration. active prostate disease (or symptoms). history of gastro-intestinal bleeding related to previous NSAID therapy. history of gastro-intestinal perforation related to previous NSAID therapy. history of recurrent gastro-intestinal haemorrhage (two or more distinct episodes). history of recurrent gastro-intestinal ulceration (two or more distinct episodes). history of recurrent urinary-tract disorders (if urinary symptoms develop discontinue immediately and perform urine tests and culture). severe heart failure
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Allergic disorders. cardiac impairment (NSAIDs may impair renal function). cerebrovascular disease. coagulation defects. connective-tissue disorders. dehydration (risk of renal impairment). elderly (risk of serious side-effects and fatalities). heart failure. history of gastro-intestinal disorders (e.g. ulcerative colitis, Crohn’s disease). ischaemic heart disease. peripheral arterial disease. risk factors for cardiovascular events. uncontrolled hypertension Musculoskeletal system
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Contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID—which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID.
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CSM ADVICE Following reports of severe cystitis the CSM has recommended that tiaprofenic acid should not be given to patients with urinary-tract disorders and should be stopped if urinary symptoms develop. Patients should be advised to stop taking tiaprofenic acid and to report to their doctor promptly if they develop urinary-tract symptoms (such as increased frequency, nocturia, urgency, pain on urinating, or blood in urine).
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→Appendix 1: NSAIDs
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Agranulocytosis. alopecia. anaemia. angioedema. aplastic anaemia. appetite decreased. asthma. bladder pain. bronchospasm. confusion. constipation. Crohn’s disease aggravated. cystitis. depression. diarrhoea. dizziness. drowsiness. dyspnoea. fatigue. fertility decreased female. fluid retention. gastrointestinal discomfort. gastrointestinal disorders. haemolytic anaemia. haemorrhage. hallucination. headache. heart failure. hepatic disorders. hypersensitivity. hypertension. increased risk of arterial thromboembolism. malaise. meningitis aseptic (patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible). nausea. nephritis tubulointerstitial. nephropathy. neutropenia. oedema. optic neuritis. oral ulceration. pancreatitis. paraesthesia. photosensitivity reaction. renal failure (more common in patients with pre-existing renal impairment). severe cutaneous adverse reactions (SCARs) . skin reactions. sodium retention. thrombocytopenia. tinnitus. urinary disorders. urinary tract inflammation. vertigo. visual impairment. vomiting SIDE-EFFECTS, FURTHER INFORMATION For information about cardiovascular and gastrointestinal side-effects, and a possible exacerbation of symptoms in asthma, see Non- steroidal anti-inflammatory drugs. p. 1193
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Caution—long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment.
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Avoid unless the potential benefit outweighs the risk. Avoid during the third trimester (risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn); onset of labour may be delayed and duration may be increased.
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Use with caution during breast-feeding. Amount too small to be harmful.
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Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment. Dose adjustments In elderly patients, manufacturer advises dose reduction to 200 mg twice daily in mild to moderate impairment.
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Avoid if possible or use with caution. Avoid in severe impairment. Dose adjustments Reduce dose in mild or moderate impairment. The lowest effective dose should be used for the shortest possible duration. Monitoring In renal impairment monitor renal function; sodium and water retention may occur and renal function may deteriorate, possibly leading to renal failure.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 21 ▶Surgam (Sanofi) Tiaprofenic acid 300 mg Surgam 300mg tablets | 56 tablet P £14.95 DT = £14.95 Soft tissue and joint disorders 5.1 Local inflammation of joints and soft tissue Musculoskeletal system CORTICOSTEROIDS Corticosteroids, inflammatory disorders Systemic corticosteroids Short-term treatment with corticosteroids can help to rapidly decrease inflammatory symptoms of rheumatoid arthritis. g Long-term treatment in patients with established rheumatoid arthritis should only be continued after evaluating the risks and all other treatments have been considered h, see Rheumatoid arthritis p. 1152. Polymyalgia rheumatica and giant cell (temporal) arteritis are always treated with corticosteroids. Relapse is common if therapy is stopped prematurely. Many patients require treatment for at least 2 years and in some patients it may be necessary to continue long-term low-dose corticosteroid treatment. Polyarteritis nodosa and polymyositis are usually treated with corticosteroids. Systemic lupus erythematosus is treated with corticosteroids when necessary using a similar dosage regimen to that for polyarteritis nodosa and polymyositis. Patients with pleurisy, pericarditis, or other systemic manifestations will respond to corticosteroids. It may then be possible to reduce the dosage; alternate-day treatment is sometimes adequate, and the drug may be gradually withdrawn. In some mild cases corticosteroid treatment may be stopped after a few months. Many mild cases of systemic lupus erythematosus do not require corticosteroid treatment. Alternative treatment with anti-inflammatory analgesics, and possibly chloroquine p. 651 or hydroxychloroquine sulfate p. 1156, should be considered. Ankylosing spondylitis should not be treated with long-term corticosteroids; rarely, pulse doses may be needed and may be useful in extremely active disease that does not respond to conventional treatment. Local corticosteroid injections Corticosteroids are injected locally for an anti-inflammatory effect. In inflammatory conditions of the joints, particularly in rheumatoid arthritis, they are given by intra-articular injection to relieve pain, increase mobility, and reduce deformity in one or a few joints; they can also provide symptomatic relief while waiting for disease-modifying antirheumatic drugs (DMARDs) to take effect. Full aseptic precautions are essential; infected areas should be avoided. Occasionally an acute inflammatory reaction develops after an intra-articular or soft-tissue injection of a corticosteroid. This may be a reaction to the microcrystalline suspension of the corticosteroid used, but must be distinguished from sepsis introduced into the injection site. Smaller amounts of corticosteroids may also be injected directly into soft tissues for the relief of inflammation in conditions such as tennis or golfer’s elbow or compression neuropathies. In tendinitis, injections should be made into the tendon sheath and not directly into the tendon (due to the absence of a true tendon sheath and a high risk of rupture, the Achilles tendon should not be injected). Hydrocortisone acetate below or one of the synthetic analogues is generally used for local injection. Intra-articular corticosteroid injections can cause flushing and may affect the hyaline cartilage. Each joint should not usually be treated more than 4 times in one year. Corticosteroid injections are also injected into soft tissues for the treatment of skin lesions. eiiii F 709
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300 mg twice daily
First-line fragment. Read the complete Indications and Dose section above.
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