Ketoprofen

1. Introduction

Ketoprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain, inflammation, and fever. It works by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing the production of prostaglandins, which are mediators of inflammation, pain, and fever.

2. Indications

  • Approved Indications:
    • Pain relief (mild to moderate).
    • Rheumatoid arthritis.
    • Osteoarthritis.
    • Ankylosing spondylitis.
    • Dysmenorrhoea (menstrual pain).
    • Postoperative pain or injury-related pain.
  • Off-Label Uses:
    • Gout (acute flares).
    • Bursitis and tendinitis.

3. Dosage

  • Oral (Capsules or Tablets):
    • Adults:
      • Pain and inflammation: 50–75 mg 2–3 times daily.
      • Maximum dose: 300 mg/day.
    • Elderly:
      • Start with the lowest effective dose, usually 50 mg twice daily.
  • Topical (Gel or Cream):
    • Apply a thin layer to the affected area 2–4 times daily.
  • Injectable:
    • 50–100 mg intramuscularly or intravenously every 6–8 hours as needed.
    • Maximum daily dose: 300 mg.

4. Administration

  • Oral: Take with food or milk to reduce gastrointestinal irritation.
  • Topical: Apply to clean, dry skin; avoid open wounds or mucous membranes.
  • Injection: Administer under medical supervision.

5. Forms Available

  • Oral: Capsules (50 mg, 100 mg), tablets (200 mg extended-release).
  • Topical: Gel (2.5%, 5%).
  • Injectable: Ampoules (50 mg/mL, 100 mg/mL).

6. Side Effects

6.1. Common Side Effects

  • Nausea.
  • Indigestion or heartburn.
  • Dizziness.
  • Headache.

6.2. Less Common Side Effects

  • Diarrhoea or constipation.
  • Rash or skin irritation (with topical use).

6.3. Rare but Serious Side Effects

  • Gastrointestinal bleeding or ulcers.
  • Kidney dysfunction.
  • Cardiovascular events (e.g., heart attack, stroke).
  • Severe allergic reactions (e.g., anaphylaxis).

7. Warnings

  • Gastrointestinal Risks: Prolonged use may increase the risk of stomach ulcers, bleeding, or perforation.
  • Cardiovascular Risks: Increased risk of thrombotic events such as heart attack or stroke with long-term use.
  • Renal Impairment: Use cautiously in patients with kidney disease or dehydration.

8. Precautions

  • Avoid in patients with:
    • History of peptic ulcers or gastrointestinal bleeding.
    • Severe heart failure or cardiovascular disease.
    • Severe kidney or liver impairment.
  • Use cautiously in asthma patients, as NSAIDs may exacerbate symptoms.

9. Interactions

  • Drug-Drug Interactions:
    • Anticoagulants (e.g., warfarin): Increased risk of bleeding.
    • Diuretics and ACE inhibitors: Reduced effectiveness and increased risk of kidney damage.
    • Corticosteroids: Increased risk of gastrointestinal side effects.
    • Aspirin or other NSAIDs: Increased risk of side effects without additional benefit.
  • Drug-Food Interactions:
    • Take with food to reduce stomach irritation.

10. Monitoring Parameters

  • Signs of gastrointestinal bleeding (e.g., black stools, vomiting blood).
  • Kidney function (e.g., creatinine, eGFR) during prolonged use.
  • Liver function tests (LFTs) if used long-term.
  • Blood pressure in hypertensive patients.

11. Use in Children

  • Not typically recommended in children under 12 years. Consult a paediatric specialist for appropriate dosing in older children.

12. Use in Pregnancy

  • Category C (1st and 2nd Trimester): Use only if necessary.
  • Category D (3rd Trimester): Contraindicated due to risks of premature closure of the ductus arteriosus and delayed labour.

13. Use in Elderly

  • Use cautiously due to increased risk of gastrointestinal bleeding, kidney dysfunction, and cardiovascular events. Start with the lowest effective dose.

14. Use in Kidney Disease

  • Use cautiously in mild to moderate renal impairment. Avoid in severe kidney disease.

15. Use in Liver Disease

  • Use cautiously in liver impairment; monitor liver function during prolonged therapy.

16. Patient Counselling Points

  • Take oral ketoprofen with food or milk to minimise stomach upset.
  • Avoid prolonged use unless prescribed by a doctor to reduce the risk of side effects.
  • For topical use, apply sparingly and avoid exposure to sunlight on treated areas to prevent photosensitivity.
  • Report any signs of stomach bleeding (e.g., black stools, persistent stomach pain) or unusual symptoms to your doctor.
  • Avoid alcohol while taking ketoprofen, as it increases the risk of gastrointestinal bleeding.
  • Do not use alongside other NSAIDs without medical advice.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
Orudis (capsules)Sanofi$15–25 (30 capsules, 50 mg)
Oruvail (extended-release)Sanofi$25–40 (30 tablets, 200 mg)
Ketoprofen GelVarious manufacturers$5–10 (50 g, 2.5%)
Generic KetoprofenVarious manufacturers$5–15 (30 capsules, 50 mg)

18. FAQs (15 Questions)

  1. What is ketoprofen used for?
    Ketoprofen is used to treat pain, inflammation, and fever associated with arthritis, injuries, and other conditions.
  2. How does ketoprofen work?
    It reduces inflammation and pain by inhibiting prostaglandin production.
  3. How long does it take for ketoprofen to work?
    Pain relief usually begins within 30 minutes to 1 hour after taking an oral dose.
  4. Can ketoprofen cause side effects?
    Yes, common side effects include nausea, indigestion, and dizziness. Serious effects like gastrointestinal bleeding and kidney problems are rare but possible.
  5. Is ketoprofen safe during pregnancy?
    It should be avoided during the third trimester and used cautiously during the first two trimesters under medical supervision.
  6. Can ketoprofen be used for gout?
    Yes, it may be used to relieve pain and inflammation during acute gout flares.
  7. Can I take ketoprofen with paracetamol?
    Yes, they can be taken together as they have different mechanisms of action.
  8. What should I do if I miss a dose?
    Take it as soon as you remember, unless it’s close to the next dose. Do not double up.
  9. How should ketoprofen gel be applied?
    Apply a thin layer to the affected area and rub gently. Avoid exposure to sunlight on the treated area.
  10. Can ketoprofen cause photosensitivity?
    Yes, especially with topical use. Avoid prolonged sun exposure on treated areas.
  11. Can ketoprofen be taken with alcohol?
    Avoid alcohol, as it increases the risk of gastrointestinal bleeding.
  12. Is ketoprofen safe for elderly patients?
    Yes, but start with lower doses and monitor for side effects like gastrointestinal bleeding.
  13. Can I use ketoprofen for menstrual pain?
    Yes, it is effective for managing dysmenorrhoea.
  14. Does ketoprofen interact with other medications?
    Yes, it interacts with anticoagulants, diuretics, and other NSAIDs.
  15. How should ketoprofen be stored?
    Store at room temperature, away from moisture and heat.