Flexion

# Flexion ## Overview - **Classification**: Non-Steroidal Anti-inflammatory Drug (NSAID) - **Mechanism**: Reversibly inhibits cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes, reducing prostaglandin synthesis. This leads to anti-inflammatory, analgesic, and antipyretic effects. ## Primary Indications 1. **Mild to Moderate Pain**: Acute pain relief, e.g., musculoskeletal pain, dysmenorrhea. 2. **Inflammation**: Management of inflammatory conditions, e.g., osteoarthritis, rheumatoid arthritis. 3. **Fever Reduction**: Symptomatic treatment of fever. ## Adult Dosing ### Standard Dosing **Acute Pain / Inflammation** - **Dose**: **200 mg** to **400 mg** - **Frequency**: Every 4-6 hours as needed - **Route**: Oral (PO) - **Maximum Dose**: **1200 mg/day** for OTC use; **2400 mg/day** for Rx use **Fever Reduction** - **Dose**: **200 mg** to **400 mg** - **Frequency**: Every 4-6 hours as needed - **Route**: Oral (PO) - **Maximum Dose**: **1200 mg/day** ### Dose Adjustments - **Renal Impairment**: - **CrCl 30-60 mL/min**: Use lowest effective dose; monitor renal function closely. - **CrCl <30 mL/min**: Avoid use due to high risk of worsening renal function. - **Hepatic Impairment**: - **Mild to Moderate**: Use lowest effective dose; monitor LFTs. - **Severe**: Contraindicated due to risk of exacerbating liver disease. - **Elderly Patients**: Start with lower end of dosing range (**200 mg**); increased risk of GI, renal, and CV adverse effects. ## Pediatric Dosing ### Neonates (0-28 days) - **Not Recommended**: Generally avoided in neonates due to potential for serious renal and GI adverse effects. - **Special Notes**: Use only if specifically indicated (e.g., PDA closure) under strict medical supervision. ### Infants (1-12 months) - **Indication**: Pain or Fever - **Dose**: **5 mg/kg** to **10 mg/kg** per dose - **Frequency**: Every 6-8 hours as needed - **Maximum**: **40 mg/kg/day** - **Formulation**: Use liquid suspension for accurate dosing. ### Children (1-12 years) - **Indication**: Pain or Fever - **Dose**: **5 mg/kg** to **10 mg/kg** per dose - **Frequency**: Every 6-8 hours as needed - **Maximum**: **40 mg/kg/day** (not to exceed **600 mg** per dose or adult maximum daily dose of **2400 mg**) - **Formulation**: Liquid suspension, chewable tablets, or regular tablets based on age/ability. ### Adolescents (13-18 years) - **Indication**: Pain, Inflammation, Fever - **Dose**: Approach adult dosing. Start with **200 mg** to **400 mg** per dose. - **Frequency**: Every 4-6 hours as needed. - **Maximum**: **1200 mg/day** (OTC) to **2400 mg/day** (prescription). - **Special Notes**: Caution in those with risk factors for GI or renal issues. ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to Flexion, aspirin, or other NSAIDs. - **Absolute**: History of aspirin-exacerbated respiratory disease (AERD) or asthma. - **Absolute**: Active gastrointestinal bleeding or peptic ulcer disease. - **Absolute**: Severe renal (CrCl <30 mL/min) or hepatic impairment. - **Absolute**: Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. - **Relative**: Advanced heart failure (NYHA Class III/IV), uncontrolled hypertension. ### Common Adverse Effects - **Very Common (>10%)**: Nausea, dyspepsia, abdominal pain, headache. - **Common (1-10%)**: Diarrhea, constipation, dizziness, rash, fluid retention. - **Serious but Rare**: GI ulceration/bleeding, acute renal failure, cardiovascular thrombotic events (MI, stroke), severe skin reactions (SJS/TEN), anaphylaxis. ### Key Drug Interactions - **Anticoagulants (e.g., Warfarin)**: Increased risk of bleeding. Monitor INR; consider alternative. - **Corticosteroids**: Increased risk of GI ulceration and bleeding. Co-prescribe PPI. - **Diuretics (e.g., Furosemide)**: Decreased diuretic and antihypertensive effect. Monitor BP, renal function. - **ACE Inhibitors/ARBs**: Increased risk of renal dysfunction and hyperkalemia. Avoid in high-risk patients. - **Lithium**: Increased lithium levels, leading to toxicity. Monitor lithium levels closely. - **Methotrexate**: Increased methotrexate levels, leading to toxicity. Avoid high-dose concomitant use. ## Monitoring & Follow-up - **Before Treatment**: Baseline renal function (SCr, CrCl), liver function tests (ALT, AST), complete blood count (CBC). - **During Treatment**: - **Long-term use**: Monitor SCr/CrCl and LFTs every 6-12 months or as clinically indicated. - **High-risk patients**: More frequent monitoring of renal function and BP. - Monitor for signs of GI bleeding (dark stools, severe abdominal pain). - **Clinical Signs**: Watch for edema, unexplained weight gain, rash, signs of bleeding (bruising, melena), or severe stomach pain. ## Clinical Pearls - 💡 **Administration**: Take with food or milk to minimize GI upset. - 💡 **Hydration**: Ensure adequate hydration, especially in children and elderly, to protect renal function. - 💡 **Cardiovascular Risk**: Use lowest effective dose for shortest duration to minimize cardiovascular thrombotic risks. - 💡 **GI Protection**: Consider a proton pump inhibitor (PPI) or H2-blocker in patients at high risk for GI complications. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.