Fevastin

# Fevastin ## Overview - **Classification**: Nonsteroidal Anti-inflammatory Drug (NSAID) - **Mechanism**: Inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis. This leads to anti-inflammatory, analgesic, and antipyretic effects. ## Primary Indications 1. **Mild to Moderate Pain** - Acute musculoskeletal pain, headache, dental pain. 2. **Fever** - Reduction of elevated body temperature. 3. **Inflammation** - Management of signs and symptoms of osteoarthritis and rheumatoid arthritis. ## Adult Dosing ### Standard Dosing **Mild to Moderate Pain/Fever** - **Dose**: **200 mg** to **400 mg** - **Frequency**: Every 4 to 6 hours as needed - **Route**: Oral - **Maximum Daily Dose**: **1200 mg** (OTC), **3200 mg** (Rx, supervised) **Inflammation (Osteoarthritis/Rheumatoid Arthritis)** - **Dose**: **400 mg** to **800 mg** - **Frequency**: 3 to 4 times daily - **Route**: Oral - **Maximum Daily Dose**: **3200 mg** ### Dose Adjustments - **Renal Impairment**: - CrCl 30-60 mL/min: Use with caution, consider lower doses. - CrCl <30 mL/min: **Contraindicated** due to risk of renal failure. - **Hepatic Impairment**: - Mild to Moderate: Use with caution, monitor liver function. - Severe: Generally **contraindicated** or significantly reduced dose under strict monitoring. - **Elderly Patients**: - Start with lower end of dosing range. - Increased risk of GI adverse effects and renal impairment. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: **Not recommended** for routine use. - **Special Notes**: NSAIDs can close patent ductus arteriosus and increase risk of necrotizing enterocolitis. Use only under strict medical supervision for specific conditions (e.g., PDA closure if indicated). ### Infants (1-12 months) - **Indication**: Fever, mild to moderate pain. - **Dose**: **5 mg/kg** to **10 mg/kg** per dose - **Frequency**: Every 6 to 8 hours as needed - **Maximum**: **40 mg/kg/day** (not to exceed 4 doses/day) - **Formulation**: Oral suspension is preferred for accurate dosing. ### Children (1-12 years) - **Indication**: Fever, mild to moderate pain, juvenile idiopathic arthritis (JIA). - **Dose**: **5 mg/kg** to **10 mg/kg** per dose - **Frequency**: Every 6 to 8 hours as needed - **Maximum**: **40 mg/kg/day** (not to exceed **1200 mg/day**) - **JIA Dose**: **30-50 mg/kg/day** in 3-4 divided doses (Max **2400 mg/day**). ### Adolescents (13-18 years) - **Indication**: Fever, pain, inflammation. - **Dose**: Generally follows **adult dosing** guidelines. - **Maximum**: **1200 mg/day** (OTC), **3200 mg/day** (Rx, supervised). - **Considerations**: Age-appropriate formulations (tablets, capsules) can be used. ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to Fevastin, aspirin, or other NSAIDs. - **Absolute**: Active gastrointestinal bleeding or peptic ulcer disease. - **Absolute**: Severe renal or hepatic impairment. - **Absolute**: Severe uncontrolled heart failure. - **Absolute**: Coronary artery bypass graft (CABG) surgery (peri-operative pain). - **Absolute**: Third trimester of pregnancy (risk of premature ductus arteriosus closure). - **Relative**: History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs. ### Common Adverse Effects - **Very Common (>10%)**: Dyspepsia, nausea, abdominal pain. - **Common (1-10%)**: Headache, dizziness, diarrhea, constipation, heartburn, rash. - **Serious but Rare**: Gastrointestinal ulceration/bleeding, renal failure, cardiovascular thrombotic events (MI, stroke), severe allergic reactions (anaphylaxis, SJS). ### Key Drug Interactions - **Anticoagulants (e.g., Warfarin)**: Increased risk of bleeding. **Monitor INR closely**, consider alternative pain relief. - **Corticosteroids**: Increased risk of GI ulceration and bleeding. **Co-prescribe with caution**, consider GI prophylaxis. - **Diuretics (e.g., Furosemide), ACE Inhibitors, ARBs**: Reduced antihypertensive and diuretic effects; increased risk of renal impairment. **Monitor blood pressure and renal function**. - **Lithium**: Increased lithium levels, leading to toxicity. **Monitor lithium levels**. - **Methotrexate**: Increased methotrexate toxicity. **Avoid concurrent use** or significantly reduce methotrexate dose. ## Monitoring & Follow-up - **Before Treatment**: Baseline complete blood count (CBC), renal function (Cr, BUN), liver function tests (LFTs) if prolonged use or high risk. - **During Treatment**: - **Long-term use**: Periodically monitor CBC, Cr, BUN, and LFTs (e.g., every 6-12 months). - **High-risk patients**: Monitor more frequently for GI symptoms, edema, blood pressure. - **Clinical Signs**: Watch for signs of GI bleeding (black/tarry stools, coffee-ground vomit), unexplained weight gain, edema, decreased urine output, persistent abdominal pain. ## Clinical Pearls - 💡 **Administration**: Take Fevastin with food or milk to minimize GI upset. - 💡 **Hydration**: Ensure adequate hydration, especially in elderly or patients with pre-existing renal conditions, to reduce renal risk. - 💡 **Patient Counseling**: Advise patients to report any signs of GI bleeding, severe abdominal pain, or unusual bruising/bleeding immediately. - 💡 **"Start Low, Go Slow"**: In elderly patients or those with risk factors, begin with the lowest effective dose and titrate cautiously. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.