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Ketoprofen

Class
Nonsteroidal anti-inflammatory drugs
Subclass
Propionates
Generic name
Ketoprofen
Brand names
Orudis®
Common formulations
Capsule, Tablet
See also
Ketoprofen ER (Oruvail®)
Dosage and administration
Adults patients
Treatment
Dysmenorrhea
•
Maintenance: 25-50 mg PO q6-8h
•
Maximum: 300 mg per day
Osteoarthritis
•
Maintenance: 50-75 mg PO q6-8h
•
Maximum: 300 mg per day
Rheumatoid arthritis
•
Maintenance: 50-75 mg PO q6-8h
•
Maximum: 300 mg per day
Symptomatic relief
Symptomatic relief of pain • Mild-to-moderate
•
Maintenance: 25-50 mg PO q6-8h
•
Maximum: 300 mg per day
Other off-label uses
•
Treatment of axial spondyloarthritis
•
Treatment of gouty arthritis (acute)
•
Treatment of migraine in females with menstruation
•
Prevention of migraine attacks
Indications for use
Labeled indications
Adults
•
Treatment of dysmenorrhea
•
Treatment of osteoarthritis
•
Treatment of rheumatoid arthritis
•
Symptomatic relief of pain (mild-to-moderate)
Off-label indications
Adults
•
Treatment of axial spondyloarthritis
•
Treatment of gouty arthritis (acute)
•
Treatment of migraine in females with menstruation
•
Prevention of migraine attacks
Safety risks
Boxed warnings
Cardiovascular thrombotic events
Gastrointestinal bleeding, peptic ulcer disease, gastric perforation
•
Use extreme caution in elderly patients and patients with a history of peptic ulcer disease and/or gastrointestinal bleeding.
Contraindications
Hypersensitivity to ketoprofen or any of its components or other NSAIDs
Aspirin-exacerbated respiratory disease
Post-myocardial infarction period
Warnings and precautions
Abnormal LFTs
•
Use caution with hepatic disease.
Anemia
•
Use caution in patients taking the drug for a prolonged period.
Edema, myocardial infarction, cardiovascular mortality
•
Use extreme caution in patients with HF.
Exacerbation of hematologic disorder
•
Use extreme caution in patients with pre-existing hematological disease (e.g., coagulopathy or hemophilia) or thrombocytopenia.
Exacerbation of hypertension
•
Use caution in patients with hypertension.
Exacerbation of thromboembolism
•
Use caution in patients with hypertension and congestive HF.
Renal papillary necrosis, AKI
•
Use caution in elderly patients or patients with impaired renal function, HF, liver dysfunction, or taking diuretics or ACEis.
Severe cutaneous adverse reactions
•
Maintain a high level of suspicion, as ketoprofen has been associated with an increased risk of severe cutaneous adverse reactions, including exfoliative dermatitis, Stevens-Johnson Syndrome, toxic epidermal necrolysis, and DRESS syndrome.
Specific populations
Renal impairment
CrCl > 60 mL/min
•
Use with caution. Maximal dose of 150 mg daily. Monitor for reduction in intrarenal autocoid synthesis, hyperkalemia and sodium retention.
CrCl 25-60 mL/min
•
Use with caution. Monitor for reduction in intrarenal autocoid synthesis, hyperkalemia and sodium retention.
CrCl < 25 mL/min
•
Avoid use as much as possible. Maximal dose of 100 mg daily. Monitor for reduction in intrarenal autocoid synthesis, hyperkalemia and sodium retention.
Renal replacement therapy
Continuous renal replacement
•
Avoid use as much as possible. Monitor for hyperkalemia.
Intermittent hemodialysis
•
Avoid use as much as possible. Monitor for hyperkalemia.
Peritoneal dialysis
•
Avoid use as much as possible. Monitor for hyperkalemia.
Hepatic impairment
Any severity
•
Use with caution. Monitor serum concentrations.
Pregnancy and breastfeeding
Pregnancy
< 20 weeks of gestation • Australia Category: C
•
Use only if benefits outweigh potential risks.
20-30 weeks of gestation • Australia Category: C
•
Use only if benefits outweigh potential risks. Monitor for oligohydramnios. Discontinue if oligohydramnios occurs.
> 30 weeks of gestation • Australia Category: C
•
Avoid use. Systemic and intranasal ketorolac is contraindicated in labor and obstetric delivery because it may adversely affect fetal circulation and uterine contractions.
•
Avoid ketorolac use during the third trimester of pregnancy (starting at 30 weeks of gestation) due to the risk of premature closure of the fetal ductus arteriosus and persistent pulmonary hypertension in the neonate.
Breastfeeding
Consider alternative agents that may be safer.
Unknown drug levels in breastfed infants.
May potentially cause adverse effects in breastfed infants.
Adverse reactions
Very common > 10%
•
Dyspepsia
Common 1-10%
•
Acute cystitis, acute pancreatitis, agranulocytosis, alopecia, anemia, angioedema, aseptic meningitis, bronchospasm, cholestasis, conjunctivitis, ↓ platelet count, ↓ serum sodium, diabetes mellitus, diaphoresis, dysgeusia, dysphonia, erythema multiforme, exacerbation of arrhythmia, exfoliative dermatitis, gastritis, gastrointestinal bleeding, gastrointestinal perforation, gynecomastia, heart failure, hepatic steatosis, hepatitis, hypertension, interstitial nephritis, jaundice, laryngeal edema, migraine, myocardial infarction, nephrotic syndrome, onycholysis, peptic ulcer disease, peripheral edema, peripheral vasodilation, pharyngitis, photosensitivity of skin, purpura, renal failure, abdominal pain, amnesia, chills, confusion, constipation, ↓ libido, depression, diarrhea, dizziness, dry mouth, dyspnea, erectile dysfunction, eye pain, flatulence, generalized pruritus, hallucinations, headache, hearing loss, hematemesis, hematuria, hypersalivation, ↑ appetite, ↑ libido, insomnia, loss of appetite, malaise, melena, myalgia, nausea, nightmares, nosebleed, palpitations, paresthesia, skin rash, somnolence, tinnitus, vertigo, visual disturbances, vomiting, weight gain, weight loss, retinal hemorrhage, retinal pathology, rhinitis, sinus tachycardia, skin discoloration, Stevens-Johnson syndrome, stomatitis, toxic epidermal necrolysis, urticaria
Unknown frequency
•
Acute liver failure, DRESS syndrome, ↓ urine output, esophageal stricture, esophagitis/esophageal ulcer, hepatic necrosis, ↑ BUN, ↑ liver enzymes, ↑ serum potassium, ↑ urine protein, medication overuse headache, platelet dysfunction, renal papillary necrosis, dysphagia, dysuria, heartburn, nocturia, odynophagia, polyuria, stroke, thromboembolism
Interactions
Drug(s)
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