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phenylbutazone

M02AA01

Forms & Strengths

Oral tablets: 100 mg
Topical gel/cream: 5-10%

Adult Dosing

Rheumatoid arthritis/osteoarthritis: 100-200 mg orally 3 times daily with food
Short-term acute musculoskeletal inflammation: Initial 400 mg/day divided, maintenance 100-200 mg/day, maximum duration 1 week

Pediatric Dosing

Safety and efficacy not established in children; use generally avoided due to high toxicity profile

Indications

Short-term treatment of severe acute inflammatory conditions of the musculoskeletal system
Ankylosing spondylitis (when other agents have failed)
Acute gouty arthritis

Mechanism of Action

Nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2), reducing prostaglandin synthesis

Contraindications

Hypersensitivity to phenylbutazone or other NSAIDs
History of peptic ulcer disease or active GI bleeding
Severe hepatic or renal impairment
History of blood dyscrasias or bone marrow depression
Cardiovascular disease, severe heart failure, or uncontrolled hypertension
Third trimester of pregnancy

Adverse Reactions

Agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia
Peptic ulceration, gastrointestinal bleeding, perforation, nausea, dyspepsia
Hepatotoxicity, elevated liver enzymes
Fluid retention, edema, renal failure, hypertension
Skin rashes, Stevens-Johnson syndrome, toxic epidermal necrolysis

Drug Interactions

Oral anticoagulants (warfarin): Increased risk of severe bleeding
Antidiabetic agents (sulfonylureas): Enhanced hypoglycemic effect
Lithium and methotrexate: Decreased renal clearance leading to toxicity
Other NSAIDs or corticosteroids: Increased risk of GI ulceration and bleeding
ACE inhibitors and diuretics: Decreased antihypertensive efficacy and increased nephrotoxicity risk

Curated Content: Needs Vetting Before Put to Clinical Use