ketoprofen

Absorption: Well absorbed from the GI tract.

Distribution: Unknown.

Protein Binding: 99%.

Metabolism/Excretion: Mostly (60%) metabolized by the liver; some renal excretion.

Half-Life: 2–4 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO (analgesic)	within 60 min	1 hr	4–6 hr
PO (anti-inflammatory)	few days–1 wk	unknown	up to 24 hr (SR products)

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Cross-sensitivity may exist with other NSAIDs, including aspirin;
Active GI bleeding;
Ulcer disease;
Some products contain tartrazine and should be avoided in patients with known intolerance;
Perioperative pain from coronary artery bypass graft surgery;
OB: Avoid use after 30 wk gestation;
Lactation: Lactation.

Use Cautiously in:

Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, MI, and stroke, especially with prolonged use or use of higher doses);
Severe hepatic impairment;
History of ulcer disease;
Renal impairment (dose ↓ suggested);
Chronic alcohol use/abuse;
OB: Use at or after 20 wk gestation may cause fetal or neonatal renal impairment; if treatment is necessary between 20 wk and 30 wk gestation, limit use to the lowest effective dose and shortest duration possible;
Pedi: Safety and effectiveness not established in children;
Geri: Extended-release product should not be used in older adults, patients of small stature, or patients with renal impairment; risk of bleeding.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema, HF, hypertension, MI

Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), EXFOLIATIVE DERMATITIS, photosensitivity, rash, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS

EENT: blurred vision, tinnitus

Endo: gynecomastia

GI: constipation, diarrhea, dyspepsia, nausea, vomiting, anorexia, discomfort, flatulence, GI BLEEDING, HEPATITIS

GU: cystitis, hematuria, renal failure

Hemat: blood dyscrasias, prolonged bleeding time

MS: myalgia

Neuro: drowsiness, headache, dizziness., STROKE, drowsiness, headache, dizziness.

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Aspirin alters distribution, metabolism, and excretion of ketoprofen (concurrent use not recommended).
↑adverse GI effects with other NSAIDs, corticosteroids, or alcohol.
Chronic use with acetaminophen may ↑ risk of adverse renal reactions.
May ↓ effectiveness of diuretics or antihypertensives.
May ↑ hypoglycemic effects of insulin or sulfonylurea oral hypoglycemic agents.
May ↑ serum lithium levels and risk of toxicity.
↑risk of toxicity from methotrexate.
Probenecid↑ risk of toxicity from ketoprofen (concurrent use not recommended).
↑risk of bleeding with cefotetan, valproic acid, thrombolytic agents, clopidogrel, eptifibatide, tirofiban, or anticoagulants.
↑risk of adverse hematologic reactions with antineoplastics or radiation therapy.
↑risk of nephrotoxicity with cyclosporine.

Drug-Natural Products:

↑bleeding risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, and Panax ginseng.

Route/Dosage ⬆ ⬇

PO (Adults ): Anti-inflammatory: 150–300 mg/day in 3–4 divided doses or 200 mg once daily as extended-release product; Analgesic: 25–50 mg every 6–8 hr.

Availability ⬆ ⬇

(Generic available)

Capsules: 25 mg; 50 mg; 75 mg
Extended-release capsules: 200 mg

Assessment ⬆ ⬇

Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, wheezing, and urticaria.
Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome or toxic epidermal necrolysis. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia.
Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, facial swelling) periodically during therapy. Discontinue therapy if symptoms occur.
Arthritis: Assess pain and range of motion prior to and 1 hr following administration.
Pain: Assess pain (note type, location, and intensity) prior to and 1 hr following administration.
Fever: Monitor temperature; note signs associated with fever (diaphoresis, tachycardia, malaise).

Lab Test Considerations:

Evaluate BUN, serum creatinine, CBC, and liver function tests periodically in patients receiving prolonged therapy.
- Serum potassium, BUN, serum creatinine, alkaline phosphatase, LDH, AST, and ALT tests may show ↑ levels. Blood glucose, hemoglobin and hematocrit concentrations, leukocyte and platelet counts, and CCr may be ↓.
- May prolong bleeding time by 3–4 min.
- May alter results of urine albumin, bilirubin, 17-ketosteroid, and 17-hydroxycorticosteroid determinations.

Implementation ⬆ ⬇

Administration in higher-than-recommended doses does not provide increased effectiveness but may cause increased side effects. Use lowest effective dose for shortest period of time.
- Coadministration with opioid analgesics may have additive analgesic effects and may permit lower opioid doses.
- Analgesic is more effective if given before pain becomes severe.
PO: For rapid initial effect, administer 30 min before or 2 hr after meals. Capsules may be administered with food, milk, or antacids containing aluminum hydroxide and magnesium hydroxide to decrease GI irritation.
- DNC: Swallow extended-release capsules whole; do not open or chew.
Dysmenorrhea: Administer as soon as possible after the onset of menses.

Patient/Family Teaching ⬆ ⬇

Advise patient to take this medication with a full glass of water and to remain in an upright position for 15–30 min after administration.
Instruct patient to take medication exactly as directed. Take missed doses as soon as remembered but not if almost time for the next dose. Do not double doses.
May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, or other OTC medications without consulting health care professional.
Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
Caution patient to wear sunscreen and protective clothing to prevent photosensitivity reactions.
Caution patient that use of ketoprofen with 3 or more glasses of alcohol may increase risk of GI bleeding.
Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise women to avoid ketoprofen in the 3rd trimester of pregnancy (after 29 wk), may cause premature closure of the fetal ductus arteriosus. Use of ketoprofen after 20 wk may cause fetal renal dysfunction leading to oligohydramnios. May cause reversible infertility in women attempting to conceive; may consider discontinuing ketoprofen.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇