Patients should be informed of the following information before initiating therapy with an NSAID and periodically during the course of ongoing therapy. Patients should also be encouraged to read the NSAID Medication Guide that accompanies each prescription dispensed.

1. Orudis or Oruvail, like other NSAIDs, may cause serious CV side effects, such as MI or stroke, which may result in hospitalization and even death. Although serious CV events can occur without warning symptoms, patients should be alert for the signs and symptoms of chest pain, shortness of breath, weakness, slurring of speech, and should ask for medical advice when observing any indicative sign or symptoms. Patients should be apprised of the importance of this follow-up (see WARNINGS - Cardiovascular Effects).

2. Orudis and Oruvail, like other NSAIDs, can cause GI discomfort and, rarely, serious GI side effects, such as ulcers and bleeding, which may result in hospitalization and even death. Although serious GI tract ulcerations and bleeding can occur without warning symptoms, patients should be alert for the signs and symptoms of ulcerations and bleeding, and should ask for medical advice when observing any indicative sign or symptoms including epigastric pain, dyspepsia, melena, and hematemesis. Patients should be apprised of the importance of this follow-up (see ²WARNINGS - Gastrointestinal Effects: Risk of Ulceration, Bleeding, and Perforation-).

3. Orudis and Oruvail, like other NSAIDs, can cause serious skin side effects such as exfoliative dermatitis, SJS, and TEN, which may result in hospitalizations and even death. Although serious skin reactions may occur without warning, patients should be alert for the signs and symptoms of skin rash and blisters, fever, or other signs of hypersensitivity such as itching, and should ask for medical advice when observing any indicative signs or symptoms. Patients should be advised to stop the drug immediately if they develop any type of rash and contact their physicians as soon as possible.

4. Patients should promptly report signs or symptoms of unexplained weight gain or edema to their physicians.

5. Patients should be informed of the warning signs and symptoms of hepatotoxicity (e.g., nausea, fatigue, lethargy, pruritus, jaundice, right upper quadrant tenderness, and 'flu-like' symptoms). If these occur, patients should be instructed to stop therapy and seek immediate medical therapy.

6. Patients should be informed of the signs of an anaphylactoid reaction (e.g. difficulty breathing, swelling of the face or throat). If these occur, patients should be instructed to seek immediate emergency help (see WARNINGS).

7. In late pregnancy, as with other NSAIDs, Orudis and Oruvail should be avoided because it may cause premature closure of the ductus arteriosus.

NSAIDs are often essential agents in the management of arthritis and have a major role in the treatment of pain, but they also may be commonly employed for conditions which are less serious. Physicians may wish to discuss with their patients the potential risks (see WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS sections) and likely benefits of NSAID treatment, particularly when the drugs are used for less serious conditions where treatment without NSAIDs may represent an acceptable alternative to both the patient and physician.

Because aspirin causes an increase in the level of unbound ketoprofen, patients should be advised not to take aspirin while taking ketoprofen (see DRUG INTERACTIONS ). It is possible that minor adverse symptoms of gastric intolerance may be prevented by administering Orudis with antacids, food or milk. Oruvail has not been studied with antacids. Because food and milk do affect the rate but not the extent of absorption (see CLINICAL PHARMACOLOGY), physicians may want to make specific recommendations to patients about when they should take ketoprofen in relation to food and/or what patients should do if they experience minor GI symptoms associated with ketoprofen therapy.

Medication Guide
for
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

(See the end of this Medication Guide for a list of prescription NSAID medicines.)

NSAID medicines may increase the chance of a heart attack or stroke that can lead to death. This chance increases:

· with longer use of NSAID medicines
· in people who have heart disease

· can happen without warning symptoms
· may cause death

The chance of a person getting an ulcer or bleeding increases with:

· taking medicines called corticosteroids and anticoagulants
· longer use
· smoking
· drinking alcohol
· older age
· having poor health

· exactly as prescribed
· at the lowest dose possible for your treatment
· for the shortest time needed

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as:

· different types of arthritis
· menstrual cramps and other types of short-term pain

· if you had an asthma attack, hives, or other allergic reaction with aspirin or any other NSAID medicine
· for pain right before or after heart bypass surgery

· about all your medical conditions.
· about all of the medicines you take. NSAIDs and some other medicines can interact with each other and cause serious side effects. Keep a list of your medicines to show to your healthcare provider and pharmacist.
· if you are pregnant. NSAID medicines should not be used by pregnant women late in their pregnancy.
· if you are breastfeeding. Talk to your doctor.

Get emergency help right away if you have any of the following symptoms:

· shortness of breath or trouble breathing
· chest pain
· weakness in one part or side of your body
· slurred speech  
· swelling of the face or throat

· nausea  
· more tired or weaker than usual  
· itching
· your skin or eyes look yellow
· stomach pain
· flu-like symptoms
· vomit blood
· there is blood in your bowel movement or it is black and sticky like tar
· unusual weight gain
· skin rash or blisters with fever
· swelling of the arms and legs, hands and feet

These are not all the side effects with NSAID medicines. Talk to your healthcare provider or pharmacist for more information about NSAID medicines.

· Aspirin is an NSAID medicine but it does not increase the chance of a heart attack. Aspirin can cause bleeding in the brain, stomach, and intestines. Aspirin can also cause ulcers in the stomach and intestines.

· Some of these NSAID medicines are sold in lower doses without a prescription (over-the-counter). Talk to your healthcare provider before using over-the-counter NSAIDs for more than 10 days.

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