Ketoprofen

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Introduction

Generic Name: Ketoprofen Brand Names: Orudis®, Oruvail®, Fastum® Chemical Formula: C16H14O3

Ketoprofen is a potent nonsteroidal anti-inflammatory drug (NSAID) used primarily for its analgesic, anti-inflammatory, and antipyretic properties. It is generally prescribed to treat various pain and inflammatory conditions, including arthritis and other musculoskeletal disorders. Ketoprofen acts by inhibiting the cyclooxygenase (COX) enzymes, which reduces the production of prostaglandins, which are the molecules responsible for generating pain, inflammation, and fever in the body.

In addition to its oral formulations such as tablet, capsules, ketoprofen is also available in topical and injectable forms, making it helpful in both clinical and over-the-counter use.

Uses

  1. Rheumatoid Arthritis
    Ketoprofen is widely prescribed to decrease the pain, swelling, and stiffness associated with rheumatoid arthritis, an autoimmune disease which causes chronic inflammation in the joints.
  2. Osteoarthritis
    For individuals suffering from osteoarthritis, this drug provides relief from joint pain and inflammation, improving mobility.
  3. Menstrual Pain (Dysmenorrhea)
    This drug is often used to provide relief from painful menstrual cramps. Its anti-inflammatory action helps alleviate the pain associated with uterine contractions, making it an effective option for women with moderate to severe dysmenorrhea.
  4. Muscle Injuries and Sprains
    Due to its anti-inflammatory properties, this drug is often used to treat sports-related injuries, including sprains, strains, and tendonitis. Its topical form is useful for localized relief of pain and inflammation.
  5. Postoperative Pain
    Ketoprofen is sometimes prescribed after minor surgeries to decrease the postoperative pain and swelling.
  6. Gout
    This drug is also sometimes prescribed to manage gout by reducing pain and inflammation in the affected joints

Dosage

  • Oral Dosage (Adults): 50-100 mg every 6 to 8 hours, depending on the severity of the pain or inflammation. The maximum daily dosage usually does not exceed 300 mg unless specifically instructed by a healthcare provider.
  • Extended-release capsules: 200 mg once daily for managing chronic conditions like arthritis.
  • Topical Gel: To be applied in the affected area as directed, typically 2-3 times a day.
  • Injection: Ketoprofen can be administered via intramuscular or intravenous injection under medical supervision, mostly for short term pain management.

For elderly patients or those with renal impairment, a lower starting dose is recommended to avoid health complications and toxicity

Side Effects

Common Side Effects:

  • Nausea, vomiting
  • Dizziness
  • Diarrhea
  • Headache
  • Heartburn
  • Constipation

Serious Side Effects:

  • Gastrointestinal Issues: Indigestion, stomach pain/irritation are some of the common gastrointestinal side effects. Prolonged use can result in gastrointestinal ulcers.
  • Cardiovascular Effects: Long-term use of ketoprofen may lead to an elevated risk of heart attack or stroke, particularly in patients having cardiovascular diseases or disorders​.
  • Liver and Kidney Function: Regular monitoring of liver enzymes and kidney function is advised while undergoing prolonged ketoprofen therapy as it carries a risk of hepatotoxicity or renal impairment.
  • Allergic Effects: Severe allergic reactions, although rare, may include difficulty breathing, swelling, or severe skin rash​.

Contraindications

Ketoprofen is contraindicated in patients with:

  • History of peptic ulcers or gastrointestinal bleeding .
  • Severe renal or hepatic impairment.
  • Documented or known hypersensitivity to ketoprofen or other NSAIDs.
  • Asthma: Certain individuals having asthma may experience severe bronchospasms when taking NSAIDs.
  • Heart conditions: Due to its cardiovascular risks, this drug should be used cautiously in patients with existing heart disease, hypertension or related diseases.

Drug Interactions

Ketoprofen may interact with other medications, leading to increased risk of adverse effects or reduced therapeutic efficacy. Some notable interactions include:

  • Warfarin and other anticoagulants: Concomitant administration increases the risk of bleeding.
  • Diuretics: This drug may reduce the efficacy of diuretics and elevate the risk of renal damage.
  • ACE Inhibitors and Angiotensin II Receptor Blockers: Combined use may worsen kidney function or induce renal impairment.
  • Lithium: Ketoprofen can increase lithium levels, raising the risk of toxicity of Lithium.

Warnings and Precautions

1. Gastrointestinal Risks
Long-term use of ketoprofen, especially at high doses, is related to an increased risk of severe gastrointestinal complications, which includes ulcers, bleeding, and perforation of the stomach or the intestines. Patients with a history of gastrointestinal disease should use ketoprofen cautiously and strictly under medical supervision.

2. Cardiovascular Risks
Like other NSAIDs, ketoprofen has been linked to an elevated risk of cardiovascular events, particularly in individuals with history or existing cardiovascular diseases. Its use should be limited and under medical supervision in patients with heart disease or hypertension.

3. Renal and Hepatic Impairment
Ketoprofen can exacerbate existing kidney or liver conditions, and therefore regular monitoring is essential in these people with these conditions. Patients with severe renal impairment should avoid using this drug unless absolutely necessary and as suggested by healthcare provider.

4. Pregnancy and Lactation
This drug should be avoided during pregnancy, especially in the third trimester, as it may cause the premature closure of the ductus arteriosus in the fetus. Although small amounts may be excreted in breast milk, ketoprofen is usually not recommended for nursing mothers.

Patient Education

  • Administration with Food: To reduce the risk of gastrointestinal side effects, patients should take ketoprofen preferably with food or milk.
  • Signs of GI Bleeding: Should seek immediate medical attention if there are signs of gastrointestinal bleeding, such as black, tarry stools or vomiting of blood.
  • Avoid Alcohol: Alcohol consumption should be limited or avoided while taking ketoprofen, as it may increase the risk of stomach ulcers or bleeding.
  • Hydration: Adequate hydration is important, particularly for patients with kidney or related issues or those taking other medications that may affect the renal function.

Age and Use of Ketoprofen

Elderly Patients:
Older adults may be more sensitive to the adverse effects of ketoprofen, particularly with respect to gastrointestinal and renal function and hence generally not recommended for people above the age of 65 Lower doses and close monitoring are recommended for elderly patients.

Pediatric Use:
Ketoprofen is not recommended for the use in children under the age of 18.

Specialized Uses

1. Topical Use
Topical ketoprofen gel is a good alternative for patients who wish to avoid the gastro-intestinal or other side effects associated with oral formulation of NSAIDs. It is used in treating localized musculoskeletal pain and inflammation.

2. Use in Chronic Pain
For chronic pain conditions like osteoarthritis or rheumatoid arthritis, ketoprofen has been found to be effective over extended periods, but only under strict medical supervision due to the risk of serious side effects.

Ketoprofen is a vital NSAID for managing pain, inflammation, and fever. Its effectiveness in treating conditions like arthritis, postoperative pain, and musculoskeletal injuries makes it an important molecule in both short and long-term pain management. However, due to the potential for serious side effects, including gastrointestinal bleeding and cardiovascular risks, ketoprofen should be used cautiously and under strict medical supervision, particularly in the elderly and in those patients with existing diseases or disorders.

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