Dexketoprofen

CLINICAL USE

NSAID and analgesic

DOSE IN NORMAL RENAL FUNCTION

12.5 mg every 4–6 hoursor 25 mg every 8 hours

PHARMACOKINETICS

Molecular weight :254.3

%Protein binding :99

%Excreted unchanged in urine :

<10 :

Volume of distribution (L/kg) :0.24

half-life – normal/ESRD (hrs) :1.65/Increased

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function but use with caution

10 to 20 : Dose as in normal renal function but avoid if possible

<10 : Dose as in normal renal function but only if on dialysis

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Dialysed. Dose as in normal renal function. See ‘Other Information’

HD :Dialysed. Dose as in normal renal function. See ‘Other Information’

HDF/high flux :Dialysed. Dose as in normal renal function. See ‘Other Information’

CAV/VVHD :Dialysed. Dose as for GFR=10–20 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 hyperkalaemiaAnalgesics: 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 quinolonesAnticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarinsAntidepressants: increased risk of bleeding with SSRIs and venlafaxineAntidiabetic agents: effects of sulphonylureas enhancedAnti-epileptics: possibly increased phenytoin concentrationAntivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavirCiclosporin: may potentiate nephrotoxicity Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinibDiuretics: increased risk of nephrotoxicity; antagonism of diuretic effect, hyperkalaemia with potassium-sparing diureticsLithium: excretion decreased Pentoxifylline: increased risk of bleeding Tacrolimus: increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

–

Comments

–

OTHER INFORMATION

Inhibition 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 therapyUse 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 synthesisDexketoprofen should be used with caution in uraemic patients predisposed to gastrointestinal bleeding or uraemic coagulopathies.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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