Ketoprofen

CLINICAL USE


NSAID and analgesic

DOSE IN NORMAL RENAL FUNCTION

Oral: 100–200 mg daily in 2–4 divided dosesDysmenorrhoea: 50 mg every 8 hoursPR: 100 mg at nightIM: 50–100 mg every 4 hours, maximum 200 mg daily

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :254.3
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :99
  • %Excreted unchanged in urine &nbsp &nbsp : <1

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.1

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :1.5–8/5–9

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function, but avoid if possible
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function, but avoid if possible
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function, but only use if on dialysis

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in normal renal function.

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Unlikely to be dialysed. Dose as in normal renal function.
  • HDF/high flux &nbsp :Unknown dialysability. Dose as in normal renal function.
  • CAV/VVHD &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in GFR 10 to 20 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsACE inhibitors and angiotensin-II antagonists: antagonism of hypotensive effect, increased risk of nephrotoxicity and hyperkalaemia
  • Analgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects); avoid with ketorolac (increased risk of side effects and haemorrhage)
  • Antibacterials: possibly increased risk of convulsions with quinolones
  • Anticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarins
  • Antidepressants: increased risk of bleeding with SSRIs and venlafaxineAntidiabetic agents: effects of sulphonylureas enhanced
  • Anti-epileptics: possibly increased phenytoin concentration
  • Antivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavir
  • Ciclosporin: may potentiate nephrotoxicity Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinib
  • Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect, hyperkalaemia with potassium-sparing diuretics
  • Lithium: excretion decreased Pentoxifylline: increased risk of bleeding Probenecid: excretion reduced by probenecid
  • Tacrolimus: increased risk of nephrotoxicity

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral, IM, rectal. The injection must not be given by the IV route

    Rate of Administration

    –

    Comments

    Administer by deep IM injection into the upper, outer quadrant of the buttock

    OTHER INFORMATION

    Combined oral and rectal treatment, maximum total daily dose 200 mgInhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease – avoid if possible; if not, check serum creatinine 48–72 hours after starting NSAID – if raised, discontinue NSAID therapy.KEToProFEn 409Use normal doses in patients with ERF on dialysis if they do not pass any urineUse with caution in renal transplant recipients – can reduce intrarenal autocoid synthesisNSAIDs decrease platelet aggregation Associated with nephrotic syndrome, interstitial nephritis, hyperkalaemia and sodium retention.
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