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 :254.3

%Protein binding :99

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) :0.1

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

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function, but avoid if possible

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

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

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

HD :Unlikely to be dialysed. Dose as in normal renal function.

HDF/high flux :Unknown dialysability. Dose as in normal renal function.

CAV/VVHD :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

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Route

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

Rate of Administration

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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.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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