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Ketoprofen: Drug information

Ketoprofen: Drug information
(For additional information see "Ketoprofen: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Serious cardiovascular thrombotic events:

Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction (MI) and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.

Ketoprofen is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.

Serious gastrointestinal bleeding, ulceration, and perforation:

NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

Brand Names: Canada
  • Anafen [DSC];
  • Ketoprofen-E;
  • PMS-Ketoprofen [DSC];
  • PMS-Ketoprofen-E [DSC]
Pharmacologic Category
  • Analgesic, Nonopioid;
  • Nonsteroidal Anti-inflammatory Drug (NSAID), Oral
Dosing: Adult

Note: The enteric coated tablet and ER formulations are not recommended for the treatment of acute pain. Lower doses should be considered in small or debilitated patients.

Ankylosing spondylitis

Ankylosing spondylitis:

Oral (off-label): 100 mg twice daily (Ref).

Rectal suppository [Canadian product]: Insert one suppository rectally in the morning and evening (twice daily) or at bedtime (once daily). May supplement with divided oral dosing up to a combined rectal/oral maximum of 200 mg daily; for severe rheumatic activity or an inadequate response to lower dosages, a combined rectal/oral dose up to 300 mg daily may be considered.

Dysmenorrhea, pain

Dysmenorrhea, pain: Oral: Immediate release: 25 to 50 mg every 6 to 8 hours up to a maximum of 300 mg/day.

Osteoarthritis, rheumatoid arthritis

Osteoarthritis, rheumatoid arthritis:

Oral:

Immediate release: 50 mg 4 times daily or 75 mg 3 times daily; maximum: 300 mg/day.

Enteric coated [Canadian product]: Usual dose: 50 mg 3 or 4 times daily; up to 200 mg daily; twice daily regimen (eg, 100 mg twice daily) may be considered after maintenance dose is established; maximum: 300 mg/day.

Extended release: 200 mg once daily; maximum: 200 mg/day.

Rectal suppository [Canadian product]: Insert one suppository rectally in the morning and evening (twice daily) or at bedtime (once daily). May supplement with divided oral dosing up to a combined rectal/oral maximum of 200 mg daily; for severe rheumatic activity or an inadequate response to lower dosages, a combined rectal/oral dose up to 300 mg daily may be considered.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

In general, nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended for use in patients with advanced renal disease.

Manufacturer's labeling:

Canadian label: Contraindicated in severe renal impairment (CrCl <30 mL/minute).

GFR ≥25 mL/minute/1.73 m2: There are no specific dosage adjustments provided in the manufacturer's labeling. In patients with mild impairment, the manufacturer's labeling recommends a maximum dose of 150 mg/day.

GFR <25 mL/minute/1.73 m2: There are no specific dosage adjustments provided in the manufacturer's labeling. Maximum dose: 100 mg/day

KDIGO 2012 guidelines provide the following recommendations for NSAIDs:

eGFR 30 to <60 mL/minute/1.73 m2: Temporarily discontinue in patients with intercurrent disease that increases risk of acute kidney injury. Prolonged therapy is not recommended.

eGFR <30 mL/minute/1.73 m2: Avoid use.

Dosing: Hepatic Impairment: Adult

Hepatic impairment and serum albumin <3.5 g/dL: Maximum initial dose: 100 mg/day; use with caution to avoid adverse effects and discontinue if hepatic function worsens.

Dosing: Older Adult

Note: Unless alternative agents are ineffective and a gastroprotective agent can be administered, avoid short-term scheduled use in combination with corticosteroids, anticoagulants, or antiplatelet agents or chronic use with or without medications that increase risk for bleeding (Ref).

Oral: An initial dose reduction of 33% to 50% has been recommended (Ketoprofen Canadian product labeling 2011).

Rectal suppository [Canadian product]: There are no specific dosing adjustments provided in the manufacturer's labeling however an initial dose reduction is recommended.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Gastrointestinal: Dyspepsia (11%)

Hepatic: Abnormal hepatic function tests (≤15%)

1% to 10%:

Dermatologic: Skin rash (>1%)

Gastrointestinal: Abdominal pain (3% to 9%), anorexia (>1%), constipation (3% to 9%), diarrhea (3% to 9%), flatulence (3% to 9%), nausea (3% to 9%), stomatitis (>1%), vomiting (>1%)

Genitourinary: Urinary tract irritation (>1%)

Nervous system: Abnormal dreams, depression, dizziness (>1%), drowsiness, headache (3% to 9%), insomnia, malaise, nervousness

Ophthalmic: Visual disturbance (>1%)

Otic: Tinnitus (>1%)

Renal: Renal insufficiency (3% to 9%; including increased blood urea nitrogen)

<1%:

Cardiovascular: Acute myocardial infarction, cardiac arrhythmia, cardiac failure, edema, facial edema, hypertension, palpitations, peripheral vascular disease, shock, tachycardia, vasodilation

Dermatologic: Alopecia, bullous rash, diaphoresis, eczema, erythema multiforme, exfoliative dermatitis, onycholysis, pruritus, skin discoloration, skin photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

Endocrine & metabolic: Change in libido, exacerbation of diabetes mellitus, gynecomastia, hyponatremia, increased thirst, microvesicular steatosis, weight gain, weight loss

Gastrointestinal: Buccal necrosis, dysgeusia, eructation, gastritis, gastrointestinal hemorrhage, gastrointestinal perforation, gastrointestinal ulcer, hematemesis, increased appetite, melena, occult blood in stools, pancreatitis, peptic ulcer, salivation, ulcerative colitis, xerostomia

Genitourinary: Hematuria, impotence, nephrotic syndrome, uterine hemorrhage

Hematologic & oncologic: Agranulocytosis, anemia, disorder of hemostatic components of blood, hemolysis, purpuric disease, purpuric rash, rectal hemorrhage, thrombocytopenia

Hepatitis: Cholestatic hepatitis, hepatitis, jaundice

Hypersensitivity: Anaphylaxis, hypersensitivity reaction

Infection: Infection, septicemia

Nervous system: Amnesia, aseptic meningitis, chills, confusion, dysphoria, hallucination, migraine, nightmares, paresthesia, personality disorder, vertigo

Neuromuscular & skeletal: Myalgia

Ophthalmic: Conjunctivitis, dry eye syndrome, eye pain, retinal hemorrhage, retinal pigment changes

Otic: Auditory impairment

Renal: Acute renal tubular disease, interstitial nephritis, renal failure syndrome

Respiratory: Bronchospasm, dyspnea, epistaxis, hemoptysis, laryngeal edema, pharyngitis, rhinitis

Frequency not defined:

Cardiovascular: Cerebrovascular accident, coronary thrombosis

Gastrointestinal: Gastrointestinal inflammation

Postmarketing:

Hepatic: Hepatotoxicity (idiosyncratic) (Chalasani 2014)

Immunologic: Drug rash with eosinophilia and systemic symptoms

Contraindications

Hypersensitivity to ketoprofen or any component of the formulation; history of asthma, urticaria, or allergic-type reactions after taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs); use in the setting of CABG surgery.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to other NSAIDs; active duodenal, gastric, or peptic ulcer; active GI bleeding; inflammatory bowel disease; inflammatory lesions or recent bleeding of the rectum or anus (suppository only); cerebrovascular bleeding or other bleeding disorders; heart failure; severe liver impairment or active liver disease; severe renal impairment (CrCl <30 mL/minute) or deteriorating renal disease; known hyperkalemia; pregnancy (third trimester); breastfeeding; pediatric patients <12 years of age.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactoid reactions: Even in patients without prior exposure anaphylactoid reactions may occur; patients with "aspirin triad" (bronchial asthma, aspirin intolerance, rhinitis) may be at increased risk. Contraindicated in patients who experience bronchospasm, asthma, rhinitis, or urticaria with nonsteroidal anti-inflammatory drug (NSAID) or aspirin therapy.

• Cardiovascular events: [US Boxed Warning]: NSAIDs cause an increased risk of serious (and potentially fatal) adverse cardiovascular thrombotic events, including MI and stroke. Risk may occur early during treatment and may increase with duration of use. Relative risk appears to be similar in those with and without known cardiovascular disease or risk factors for cardiovascular disease; however, absolute incidence of serious cardiovascular thrombotic events (which may occur early during treatment) was higher in patients with known cardiovascular disease or risk factors and in those receiving higher doses. New onset hypertension or exacerbation of hypertension may occur (NSAIDs may also impair response to ACE inhibitors, thiazide diuretics, or loop diuretics); may contribute to cardiovascular events; monitor blood pressure; use with caution in patients with hypertension. May cause sodium and fluid retention, use with caution in patients with edema. Avoid use in heart failure (FDA 2015). Avoid use in patients with a recent MI unless benefits outweigh risk of cardiovascular thrombotic events. Use the lowest effective dose for the shortest duration of time, consistent with individual patient goals, to reduce risk of cardiovascular events; alternate therapies should be considered for patients at high risk.

• CNS effects: May cause drowsiness, dizziness, blurred vision, and other neurologic effects which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

• Drug reaction with eosinophilia and systemic symptoms: Potentially serious, sometimes fatal, drug reaction with eosinophilia and systemic symptoms (DRESS), also known as multiorgan hypersensitivity reactions, has been reported with NSAIDs. Monitor for signs and symptoms (eg, fever, rash, lymphadenopathy, eosinophilia) in association with other organ system involvement (eg, hepatitis, nephritis, hematological abnormalities, myocarditis, myositis). Early symptoms of hypersensitivity reaction (eg, lymphadenopathy, fever) may occur without rash; discontinue therapy and further evaluate if DRESS is suspected.

• GI events: [US Boxed Warning]: NSAIDs cause increased risk of serious GI inflammation, ulceration, bleeding, and perforation (may be fatal); elderly patients and patients with history of peptic ulcer disease and/or GI bleeding are at greater risk of serious GI events. These events may occur at any time during therapy and without warning. Avoid use in patients with active GI bleeding. In patients with a history of acute lower GI bleeding, avoid use of non-aspirin NSAIDs, especially if due to angioectasia or diverticulosis (Strate 2016). Use caution with a history of GI ulcers, concurrent therapy known to increase the risk of GI bleeding (eg, aspirin, anticoagulants and/or corticosteroids, selective serotonin reuptake inhibitors), advanced hepatic disease, coagulopathy, smoking, use of alcohol, or in elderly or debilitated patients. Use the lowest effective dose for the shortest duration of time, consistent with individual patient goals, to reduce risk of GI adverse events; alternate therapies should be considered for patients at high risk. When used concomitantly with aspirin, a substantial increase in the risk of GI complications (eg, ulcer) occurs; concomitant gastroprotective therapy (eg, proton pump inhibitors) is recommended (Bhatt 2008).

• Hematologic effects: Platelet adhesion and aggregation may be decreased; may prolong bleeding time; patients with coagulation disorders or who are receiving anticoagulants should be monitored closely. Anemia may occur; patients on long-term NSAID therapy should be monitored for anemia. Rarely, NSAID use has been associated with potentially severe blood dyscrasias (eg, agranulocytosis, thrombocytopenia, aplastic anemia).

• Hepatic effects: Transaminase elevations have been reported with use; closely monitor patients with any abnormal LFT. Rare (sometimes fatal) severe hepatic reactions (eg, fulminant hepatitis, hepatic necrosis, hepatic failure) have occurred with NSAID use; discontinue immediately if signs or symptoms of hepatic disease develop or if systemic manifestations occur.

• Hyperkalemia: NSAID use may increase the risk of hyperkalemia, particularly in the elderly, diabetics, renal disease, and with concomitant use of other agents capable of inducing hyperkalemia (eg, ACE-inhibitors). Monitor potassium closely.

• Ophthalmic events: Blurred/diminished vision has been reported; discontinue therapy and refer for ophthalmologic evaluation if symptoms occur. Periodic ophthalmic exams may be necessary with prolonged use.

• Renal effects: NSAID use may compromise existing renal function; dose-dependent decreases in prostaglandin synthesis may result from NSAID use, reducing renal blood flow which may cause renal decompensation (usually reversible). Patients with impaired renal function, dehydration, hypovolemia, heart failure, hepatic impairment, those taking diuretics, and ACE inhibitors, and the elderly are at greater risk of renal toxicity. Rehydrate patient before starting therapy; monitor renal function closely. Long-term NSAID use may result in renal papillary necrosis and other renal injury.

• Skin reactions: NSAIDs may cause potentially fatal serious skin adverse events including exfoliative dermatitis, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN); may occur without warning; discontinue use at first sign of skin rash (or any other hypersensitivity).

Disease-related concerns:

• Aseptic meningitis: May increase the risk of aseptic meningitis, especially in patients with systemic lupus erythematosus (SLE) and mixed connective tissue disorders.

• Asthma: Contraindicated in patients with aspirin-sensitive asthma; severe and potentially fatal bronchospasm may occur. Use caution in patients with other forms of asthma.

• Bariatric surgery: Gastric ulceration: Avoid chronic use of oral nonselective NSAIDs after bariatric surgery; development of anastomotic ulcerations/perforations may occur (Bhangu 2014; Mechanick 2020). Short-term use of celecoxib or IV ketorolac are recommended as part of a multimodal pain management strategy for postoperative pain (Chou 2016; Horsley 2019; Thorell 2016).

• Coronary artery bypass graft surgery: [US Boxed Warning]: Use is contraindicated in the setting of coronary artery bypass graft (CABG) surgery. Risk of MI and stroke may be increased with use following CABG surgery.

• Hepatic impairment: Use with caution in patients with hepatic impairment; patients with advanced hepatic disease are at an increased risk of GI bleeding and kidney failure with NSAIDs (AASLD [Biggins 2021]; AASLD [Runyon 2013]). Systemic exposure may be increased in patients with chronic disease and/or hypoalbuminemia. Closely monitor patients with any abnormal LFT.

• Renal impairment: Avoid use in patients with advanced renal disease; discontinue use with persistent or worsening abnormal renal function tests.

Special populations:

• Older adult: Older adult patients are at greater risk for serious GI, cardiovascular, and/or renal adverse events; use with caution.

Other warnings/precautions:

• Surgical/dental procedures: Withhold for at least 4 to 6 half-lives prior to surgical or dental procedures.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Generic: 25 mg, 50 mg, 75 mg [DSC]

Capsule Extended Release 24 Hour, Oral:

Generic: 200 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsule ER 24 Hour Therapy Pack (Ketoprofen ER Oral)

200 mg (per each): $10.82

Capsules (Ketoprofen Oral)

25 mg (per each): $14.96

50 mg (per each): $25.28

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Generic: 50 mg [DSC]

Solution, Injection:

Anafen: 10 mg/mL ([DSC])

Suppository, Rectal:

Generic: 50 mg ([DSC]); 100 mg ([DSC])

Tablet, Oral:

Anafen: 5 mg [DSC], 20 mg [DSC]

Tablet Delayed Release, Oral:

Generic: 50 mg, 100 mg

Tablet Extended Release 24 Hour, Oral:

Generic: 200 mg

Administration: Adult

Oral: Administer with food to reduce GI upset. Do not crush or break ER capsules.

Bariatric surgery: Capsule, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Nonsteroidal anti-inflammatory drugs are not recommended for routine use after bariatric surgery. Where possible, cyclooxygenase-2 selective therapy should be used.

Rectal suppository [Canadian product]: Insert suppository rectally.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at http://www.fda.gov/downloads/Drugs/DrugSafety/UCM387559.pdf, must be dispensed with this medication.

Use: Labeled Indications

Osteoarthritis: Management of the signs and symptoms of osteoarthritis

Pain (immediate release only): Management of pain

Primary dysmenorrhea (immediate release only): Treatment of primary dysmenorrhea

Rheumatoid arthritis: Management of the signs and symptoms of rheumatoid arthritis

Use: Off-Label: Adult

Ankylosing spondylitis

Medication Safety Issues
Sound-alike/look-alike issues:

Ketoprofen may be confused with ketotifen

Older Adult: High-Risk Medication:

Beers Criteria: Ketoprofen is identified in the Beers Criteria as a potentially inappropriate medication to be avoided for chronic use in patients 65 years and older (unless alternative agents ineffective and patient can receive concomitant gastroprotective agent) due to increased risk of GI bleeding and peptic ulcer disease in older adults in high risk category (eg, older than 75 years of age or receiving concomitant oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents). In addition, avoid for short-term scheduled use in combination with oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents unless alternatives are ineffective and patient can receive concomitant gastroprotective agent (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

Substrate of OAT1/3; Inhibits OAT1/3

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of 5-Aminosalicylic Acid Derivatives. Risk C: Monitor therapy

Abrocitinib: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the antiplatelet effect of Abrocitinib. Risk X: Avoid combination

Acalabrutinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Acemetacin: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid combination

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): May enhance the antiplatelet effect of other Agents with Antiplatelet Properties. Risk C: Monitor therapy

Alcohol (Ethyl): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. Risk C: Monitor therapy

Aliskiren: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Risk C: Monitor therapy

Aminoglycosides: Nonsteroidal Anti-Inflammatory Agents may decrease the excretion of Aminoglycosides. Data only in premature infants. Risk C: Monitor therapy

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Anagrelide: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Angiotensin II Receptor Blockers: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Anticoagulants: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Risk C: Monitor therapy

Apixaban: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Apixaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of apixaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Bemiparin: Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin and nonsteroidal anti-inflammatory agents (NSAIDs) due to the increased risk of bleeding. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Bemiparin: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Beta-Blockers: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Beta-Blockers. Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Bisphosphonate Derivatives: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern. Risk C: Monitor therapy

Caplacizumab: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Caplacizumab. Specifically, the risk of bleeding may be increased. Management: Avoid coadministration of caplacizumab with antiplatelets if possible. If coadministration is required, monitor closely for signs and symptoms of bleeding. Interrupt use of caplacizumab if clinically significant bleeding occurs. Risk D: Consider therapy modification

Cephalothin: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased. Risk C: Monitor therapy

Clofarabine: OAT1/3 Inhibitors may increase the serum concentration of Clofarabine. Risk C: Monitor therapy

Collagenase (Systemic): Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and or bleeding may be increased. Risk C: Monitor therapy

Corticosteroids (Systemic): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor therapy

CycloSPORINE (Systemic): Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. Management: Consider alternatives to nonsteroidal anti-inflammatory agents (NSAIDs). Monitor for evidence of nephrotoxicity, as well as increased serum cyclosporine concentrations and systemic effects (eg, hypertension) during concomitant therapy with NSAIDs. Risk D: Consider therapy modification

Dabigatran Etexilate: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of dabigatran and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Dasatinib: May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Deferasirox: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy

Deoxycholic Acid: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased. Risk C: Monitor therapy

Desmopressin: Nonsteroidal Anti-Inflammatory Agents may enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

Dichlorphenamide: OAT1/3 Inhibitors may increase the serum concentration of Dichlorphenamide. Risk C: Monitor therapy

Digoxin: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Digoxin. Risk C: Monitor therapy

Drospirenone-Containing Products: May enhance the hyperkalemic effect of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Edoxaban: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of edoxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Enoxaparin: Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue nonsteroidal anti-inflammatory agents (NSAIDs) prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Enoxaparin: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Eplerenone: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone. Risk C: Monitor therapy

Fexinidazole: May increase the serum concentration of OAT1/3 Substrates (Clinically Relevant). Management: Avoid use of fexinidazole with OAT1/3 substrates when possible. If combined, monitor for increased OAT1/3 substrate toxicities. Risk D: Consider therapy modification

Heparin: Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or nonsteroidal anti-inflammatory agents (NSAIDs) if coadministration is required. Risk D: Consider therapy modification

Heparin: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required. Risk D: Consider therapy modification

Herbal Products with Anticoagulant/Antiplatelet Effects (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Risk C: Monitor therapy

Herbal Products with Anticoagulant/Antiplatelet Effects (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Bleeding may occur. Risk C: Monitor therapy

HydrALAZINE: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of HydrALAZINE. Risk C: Monitor therapy

Ibritumomab Tiuxetan: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding. Risk C: Monitor therapy

Ibrutinib: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Icosapent Ethyl: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Inotersen: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Ketorolac (Nasal): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid combination

Ketorolac (Systemic): Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Ketorolac (Systemic). Risk X: Avoid combination

Lecanemab: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of hemorrhage may be increased. Risk C: Monitor therapy

Leflunomide: May increase the serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor therapy

Limaprost: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Lipid Emulsion (Fish Oil Based): May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Lithium: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Lithium. Management: Consider reducing the lithium dose when initiating a NSAID. Monitor for increased lithium therapeutic/toxic effects if a NSAID is initiated/dose increased, or decreased effects if a NSAID is discontinued/dose decreased. Risk D: Consider therapy modification

Loop Diuretics: Nonsteroidal Anti-Inflammatory Agents may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. Risk D: Consider therapy modification

Macimorelin: Nonsteroidal Anti-Inflammatory Agents may diminish the diagnostic effect of Macimorelin. Risk X: Avoid combination

MetFORMIN: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of MetFORMIN. Risk C: Monitor therapy

Methotrexate: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Methotrexate. Management: Avoid coadministration of higher dose methotrexate (such as that used for the treatment of oncologic conditions) and NSAIDs. Use caution if coadministering lower dose methotrexate and NSAIDs. Risk D: Consider therapy modification

Methoxsalen (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Methoxsalen (Systemic). Risk C: Monitor therapy

Mifamurtide: Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Mifamurtide. Risk X: Avoid combination

Multivitamins/Fluoride (with ADE): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Multivitamins/Minerals (with AE, No Iron): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Naftazone: May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Nitisinone: May increase the serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May enhance the adverse/toxic effect of other Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk for gastrointestinal toxicity is increased. Risk X: Avoid combination

Nonsteroidal Anti-Inflammatory Agents (Topical): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of gastrointestinal (GI) toxicity is increased. Management: Coadministration of systemic nonsteroidal anti-inflammatory drugs (NSAIDs) and topical NSAIDs is not recommended. If systemic NSAIDs and topical NSAIDs, ensure the benefits outweigh the risks and monitor for increased NSAID toxicities. Risk D: Consider therapy modification

Obinutuzumab: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased. Risk C: Monitor therapy

Omacetaxine: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Risk C: Monitor therapy

Omega-3 Fatty Acids: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Pentosan Polysulfate Sodium: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents. Risk C: Monitor therapy

Pentoxifylline: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Phenylbutazone: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid combination

Pirtobrutinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Potassium Salts: Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy

Potassium-Sparing Diuretics: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

PRALAtrexate: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Avoid coadministration of pralatrexate with nonsteroidal anti-inflammatory drugs (NSAIDs). If coadministration cannot be avoided, closely monitor for increased pralatrexate serum levels or toxicity. Risk D: Consider therapy modification

Pretomanid: May increase the serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor therapy

Probenecid: May increase the serum concentration of Ketoprofen. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Prostaglandins (Ophthalmic): Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic). Risk C: Monitor therapy

Quinolones: Nonsteroidal Anti-Inflammatory Agents may enhance the neuroexcitatory and/or seizure-potentiating effect of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Quinolones. Risk C: Monitor therapy

Rivaroxaban: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of rivaroxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Salicylates: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Salicylates. An increased risk of bleeding may be associated with use of this combination. Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the cardioprotective effect of Salicylates. Salicylates may decrease the serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Management: Nonselective NSAIDs may reduce aspirin's cardioprotective effects. Administer ibuprofen 30-120 minutes after immediate-release aspirin, 2 to 4 hours after extended-release aspirin, or 8 hours before aspirin. Risk D: Consider therapy modification

Selective Serotonin Reuptake Inhibitors: May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk. Risk D: Consider therapy modification

Selumetinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor therapy

Sincalide: Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider therapy modification

Sodium Phosphates: May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor therapy

Tacrolimus (Systemic): Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tacrolimus (Systemic). Risk C: Monitor therapy

Taurursodiol: May increase the serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk X: Avoid combination

Tenofovir Products: Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose due to a potential risk of acute renal failure. Diclofenac appears to confer the most risk. Risk D: Consider therapy modification

Tenoxicam: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid combination

Teriflunomide: May increase the serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor therapy

Thiazide and Thiazide-Like Diuretics: May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Thrombolytic Agents: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents. Risk C: Monitor therapy

Tipranavir: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Tolperisone: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may enhance the therapeutic effect of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Tricyclic Antidepressants: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of major adverse cardiac events (MACE), hemorrhagic stroke, ischemic stroke, and heart failure may be increased. Tricyclic Antidepressants may enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Urokinase: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase. Risk X: Avoid combination

Vaborbactam: May increase the serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor therapy

Vancomycin: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Vancomycin. Risk C: Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Vitamin E (Systemic): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the anticoagulant effect of Vitamin K Antagonists. Management: Consider alternatives to this combination when possible. If the combination must be used, monitor coagulation status closely and advise patients to promptly report any evidence of bleeding or bruising. Risk D: Consider therapy modification

Zanubrutinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Reproductive Considerations

Nonsteroidal anti-inflammatory drugs (NSAIDs) may delay or prevent rupture of ovarian follicles. This may be associated with infertility that is reversible upon discontinuation of the medication. Consider discontinuing use in patients having difficulty conceiving or those undergoing investigation of fertility (Matyas 2015; Micu 2011).

Based on available information, NSAIDs can be continued in males with rheumatic and musculoskeletal diseases who are planning to father a child (ACR [Sammaritano 2020]).

Pregnancy Considerations

Ketoprofen crosses the placenta (Bannwarth 1999).

Birth defects have been observed following in utero nonsteroidal anti-inflammatory drug (NSAID) exposure in some studies; however, data are conflicting (Bloor 2013). Nonteratogenic effects, including prenatal constriction of the ductus arteriosus, persistent pulmonary hypertension of the newborn, oligohydramnios, necrotizing enterocolitis, renal dysfunction or failure, and intracranial hemorrhage, have been observed in the fetus/neonate following in utero NSAID exposure (Bermas 2014; Bloor 2013). Maternal NSAID use may cause fetal renal dysfunction leading to oligohydramnios. Although rare, this may occur as early as 20 weeks' gestation and is more likely to occur with prolonged maternal use. Oligohydramnios may be reversible following discontinuation of the NSAID (Dathe 2019; FDA 2020). In addition, nonclosure of the ductus arteriosus postnatally may occur and be resistant to medical management (Bermas 2014; Bloor 2013).

Maternal use of NSAIDs should be avoided beginning at 20 weeks' gestation. If NSAID use is necessary between 20 and 30 weeks' gestation, limit use to the lowest effective dose and shortest duration possible; consider ultrasound monitoring of amniotic fluid if treatment extends beyond 48 hours, and discontinue the NSAID if oligohydramnios is found (FDA 2020). Because NSAIDs may cause premature closure of the ductus arteriosus, prescribing information for ketoprofen specifically states use should be avoided starting at 30 weeks' gestation.

Based on available information, NSAIDs can be continued during the first 2 trimesters of pregnancy in patients with rheumatic and musculoskeletal diseases; use in the third trimester is not recommended (ACR [Sammaritano 2020]).

NSAIDs may be used as part of a multimodal approach to pain relief following cesarean delivery (ACOG 2019).

Breastfeeding Considerations

Ketoprofen is present in breast milk (Jacqz-Aigrain 2007).

One case each of esophageal ulcer, erosive gastritis, meningeal hemorrhage, and renal insufficiency following ketoprofen exposure via breast milk were spontaneously reported to the French Pharmacoviligance Database between 1984 and 2011 (Soussan 2014).

Nonopioid analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs), are preferred for breastfeeding patients who require pain control peripartum or for surgery outside of the postpartum period (ABM [Martin 2018]; ABM [Reece-Stremtan 2017]). NSAIDs are considered compatible for the treatment of rheumatic and musculoskeletal diseases in lactating patients; agents with a short half-life and established safety data in infants may be preferred (ACR [Sammaritano 2020]).

Breastfeeding is not recommended by the manufacturer. Maternal use of NSAIDs should be avoided if the breastfeeding infant has platelet dysfunction, thrombocytopenia, or a ductal-dependent cardiac lesion (ABM [Martin 2018]; ABM [Reece-Stremtan 2017]; Bloor 2013).

Dietary Considerations

To minimize gastrointestinal effects, administer with food or milk.

Monitoring Parameters

CBC (periodically during long-term therapy or if develop signs/symptoms of anemia); chemistry profile (periodically during long-term therapy); weight gain or edema in patients with predisposing conditions, such as heart failure; signs of bleeding (occult or gross blood loss); periodic liver function tests; renal function (urine output, serum BUN, creatinine); blood pressure; periodic ophthalmic exams in patients receiving prolonged therapy

Mechanism of Action

Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors; has antipyretic, analgesic, and anti-inflammatory properties

Other proposed mechanisms not fully elucidated (and possibly contributing to the anti-inflammatory effect to varying degrees), include inhibiting chemotaxis, altering lymphocyte activity, inhibiting neutrophil aggregation/activation, and decreasing proinflammatory cytokine levels.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Regular release: <30 minutes

Duration: Regular release: Up to 6 hours

Absorption: Almost complete

Distribution: 0.1 L/kg

Protein binding: >99%, primarily to albumin; Hepatic impairment: Unbound fraction is approximately doubled

Metabolism: Hepatic via glucuronidation; metabolite (inactive) can be converted back to parent compound; may have enterohepatic recirculation

Bioavailability: ~90%

Half-life elimination:

Regular release: 2 to 4 hours; Renal impairment: Mild: 3 hours; moderate to severe: 5 to 9 hours

Enteric coated tablet [Canadian product]: 2 hours

Extended release: ~3 to 7.5 hours

Rectal suppository [Canadian product]: ~2 to 2.5 hours

Time to peak, serum:

Regular release: 0.5 to 2 hours

Enteric coated tablet [Canadian product]: 1 to 2 hours

Extended release capsule: 6 to 7 hours; Extended release tablet [Canadian product]: 5 to 6 hours

Rectal suppository [Canadian product]: ~1 hour

Excretion: Urine (~80%, primarily as glucuronide conjugates)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Clearance is decreased and half-life is prolonged.

Hepatic function impairment: Unbound fraction is approximately doubled, probably due to hypoalbuminemia.

Older adult: Plasma and renal clearance are reduced and the unbound fraction increases.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Alrheumat | Fastum | Kefentech | Ketotop | Orudis | Oruvail | Profenid;
  • (AR) Argentina: Helenil | Orudis;
  • (AT) Austria: Fastum | Keprodol | Profenid;
  • (AU) Australia: Orudis | Oruvail;
  • (BD) Bangladesh: Fastum | Festam | Kefen | Keto-A | Ketofen | Ketonac | Ketonal | Ketron | Ketronil | Kontrol tr | Kop | Kynol | Orket | Oruvail | Profenid | Profenid e | Top | Wakoflex | Xynofen;
  • (BE) Belgium: Fastum | Rofenid;
  • (BF) Burkina Faso: Axen | Ketonal | Ketoprofene ubigen | Ketum | Profemigr | Profenid | Profenid lp;
  • (BG) Bulgaria: Bi profenid | Fastum | Ketoflex | Ketonal | Ketum | Okitask | Profenid | Profenid lp | Topogel;
  • (BR) Brazil: Algie | Algiprofen | Artrinid | Artrosil | Bicerto | Ceftfenpro lp | Ceprofen | Cetofenid | Cetoprofeno | Fenbip | Flamador | Ketop | Profenid | Rhalunid | Triploa;
  • (CH) Switzerland: Fastum | Ketoprofen Bayer | Profenid;
  • (CI) Côte d'Ivoire: Ketoflex | Ketonal | Ketoprof | Ketoprofene | Koten | Profemigr;
  • (CL) Chile: Bonil | Dolofar | Dolostat | Dolostat bi | Fastum | Flogofin | Flogofin TU LCH | Keprodol | Ketoprofeno | Profenid | Relatene | Talflex | Talflex bi;
  • (CN) China: Ao ding ni | Bu shi | Fastum | Oruvail | Profenid | Remason | Ricfen | San si teng | Shu li ang | Wei kang li;
  • (CO) Colombia: Dolomax | Ketoflex | Ketoprofeno | Ketoprofeno Genfar | Ketum | Lyndak | Profenid | Rhonicap;
  • (CZ) Czech Republic: Fastum | Ketobene | Ketonal | Profenid;
  • (DE) Germany: Advel Schmerzgel | Alrheumun | Dolormin mit ketoprofen | Effekton Ketoprofen | Gabrilen | Ketolist | Ketoprofen CT | Orudis | Phardol ketoprofen schmerzgel | Spondylon | Togal mobil-gel ketoprofen;
  • (DK) Denmark: Ketoprofen nm;
  • (DO) Dominican Republic: Artrogel | Biprofenid | Dolofast | Fastum | Kefentech | Kepron | Ketoprofeno Genfar | Noflan | Profenid;
  • (EC) Ecuador: Dolofast | Fastum | Ketoprofeno | Profenid | Talflex;
  • (EE) Estonia: Begsan | Bi profenid | Fastum | Keto | Ketonal | Ketoprofen Ratiopharm | Ketorin | Profenid;
  • (EG) Egypt: Alcofan | Baskinta | Bi Alcofan | Bi profenid | Doloket | Emiprofen | Fastum | Flamibru | Flamidose | Flamoguard | Gesifast | Gesiket | Kefentech | Ketalgipan | Ketofan | Ketofen | Ketogesic | Ketolgin | Ketoprek | Ketoprof | Ketoxanil | Kiti | Kupan | Mepacofen | Orudis | Profenid;
  • (ES) Spain: Arcental | Extraplus | Fastum | Ketoprofeno ratiopharm | Ketosolan | Orudis;
  • (FI) Finland: Alrhumat | Keto | Ketocal | Ketofen | Ketomex | Ketorin | Orudis | Zon;
  • (FR) France: Bi profenid | Ketoprofene Arrow | Ketoprofene Biogaran | Ketoprofene EG | Ketoprofene g gam | Ketoprofene gnr | Ketoprofene irex | Ketoprofene ivax | Ketoprofene merck | Ketoprofene Pharmy II | Ketoprofene Qualimed | Ketoprofene Ranbaxy | Ketoprofene Ratiopharm | Ketoprofene rpg | Ketoprofene sandoz | Ketoprofene teva | Ketum | Profemigr | Profenid | Topfena | Toprec;
  • (GB) United Kingdom: Alrheumat | Fenoket | Jomethid xl | Ketocid | Ketonal | Ketoprofen Almus | Ketoprofen cox | Ketoprofen kent | Ketoprofen sandoz | Ketovail | Ketozip | Ketpron | Larafen | Orudis | Oruvail | Powergel | Tiloket | Valket;
  • (GR) Greece: Farbovil | Menaril | Oruvail;
  • (HK) Hong Kong: Cetoclean pain relieving plaster | Fastum | Harufen | Kefenrin | Kefentech | Kenhancer | Kepax | Ketoclean | Ketoclin | Ketofen | Ketokura | Mohrus | Orudis | Oruvail | Wah tat;
  • (HR) Croatia: Fastum | Ketogel | Ketonal | Ketonal Akut | Ketoprofen Farmal | Knavon | Knavon forte;
  • (HU) Hungary: Fastum | Keplat | Profenid;
  • (ID) Indonesia: Altofen | Anrema | Fetik | Flamed | Kaltrofen | Ketros | Lantiflam | Molaflam | Nasaflam | Nazovel | Noflam | Ovurila | Ovurila e | Profenid | Profika e | Pronalges | Protofen | Remapro | Rematof | Retrofen | Rhetoflam | Rofiden | Sanbeflam;
  • (IE) Ireland: Fastum | Orudis | Orugesic | Oruvail;
  • (IL) Israel: Oruvail | Profenid;
  • (IN) India: Fastum | Infen plaster | Ketopatch | Ketoplast | Rhofenid;
  • (IT) Italy: Alket | Artrosilene | Dolgosin | Euketos | Fastum | Flexen | Ibifen | Isofenal | Kefenid | Keplat | Ketartrium | Ketoplus | Ketoprofene | Ketoprofene Alm | Ketoprofene Almus | Ketoprofene doc | Ketoprofene EG | Ketoprofene Fnm | Ketoprofene union health | Ketoret | Ketoselect | Lasonil c.m | Liotondol | Meprofen | Oki | Okitask | Orudis | Reuprofen | Steofen | Toprek | Zepelindue;
  • (JO) Jordan: Fastum | Keflam | Ketofast | Profenid;
  • (JP) Japan: Aneol | Antofenon | Capisten | Epatec | Epatec aventis | Epatec fuji | Epatec zeria | Frestol | Glucose c2 test wao | Inflen | Keprofen | Ketamelin | Ketobun kp | Ketok | Ketoners | Ketopral | Ketoprofen kyorin | Ketoprofen Nichiiko | Ketoprofen nisshin kyorin sei | Ketoprofen teikoku | Ketoprofen xr teikoku | Ketopuro | Ketosten | Ketotax | Lemphen | Megeide | Megeide amel | Menamin | Mohrus | Orudis | Patell | Pestec | Rave | Raynanon | Raynanon chemiphar | Raynanon merck hoei | Rheila | Rheila harasawa | Riferon | Romal | Romal fuji | Romal takata | Sayakinen | Sector | Synprofen | Tohberick | Touchron | Treosin | Vindus s;
  • (KE) Kenya: Fastum | Flexen | Kop | Lolita | Topact;
  • (KR) Korea, Republic of: Alrheumat | Amapro | Amaprogel | Antiphlamine keto | Antiphlamine roll | Anycare 24 | Choa Strong joint | Conacort | Coolgreen | Cutfen one | Cyprogel | Dapro | Fastum | Fenpro | Gelofen | Gettwo | Harufen | Harufen-L | K cataplasma | Kebanon | Kebanox | Kedalpon | Kefen | Kefentec | Kefentech | KefenTech-L | Kefu | Kellon | Kely | Kenhancer | Kenofen | Kenon l | Kenon s | Kepax | Kepem | Kepron | Keprotek | Keropin | Kesfen-L | Kestra | Keterfen | Keterfen s | Keto s | Ketoclin | Ketofain | Ketofam | Ketofen | Ketofilm | Ketopop | Ketopro | Ketoprofen kuhnil | Ketoro | Ketotop | Ketotop el | Ketotop l | Medis | Mendamketo | Newfen | Odis | Orafen | Orapain | Oruvail | Painil | Powerstap skinny | Profenid | Rapen | Rheuma | Rheuma gold | Rheuma rx | Rheumaken | Rheumaprofen | Rheutin | S-gel | Saksinpen | Sapmann | Sarafen | Spo-k | Topren | Torex | Trasen | Trast finger | Zenol gold | Zenoltop s;
  • (KW) Kuwait: Fastum | Oruvail | Profenid;
  • (LB) Lebanon: Bi profenid | Fastum | Flexen | Ketartrium | Ketolgin | Oruvail | Profemigr | Profenid | Toprec | Trovex | Trovex MR;
  • (LT) Lithuania: Begsan | Fastum | Flexen | Keto | Ketonal | Ketoprofen sopharma | Profenid | Valusal;
  • (LU) Luxembourg: Fastum | Rofenid | Rofenid e;
  • (LV) Latvia: Begsan | Bi profenid | Fastum | Gabrilen | Keto | Ketonal | Profenid | Spinax | Valusal;
  • (MA) Morocco: Bi profenid | Flexen | Ketoflex | Ketum | Nofene | Oruvail | Profenid;
  • (MX) Mexico: Arthrill | Bibix | Efiken | Fastufrem | Ferandrom | K profen | Kefentech | Ketoflex | Ketoprofeno | Ketoprofeno gi | Menariprem | Neobengue | Notifin | Oki 3a | Painsik | Profenid | Profenid retard;
  • (MY) Malaysia: Apo-keto | Deprofen | Fastum | Kefentech | Kenhancer | Kenofen | Ketoclean | Ketodis | Ketofen | Ketopro | Ketoprofen YSP | Ketotop | Kop | Orudis | Oruvail | Proxen | Sanbeflam;
  • (NG) Nigeria: Fastum;
  • (NL) Netherlands: Orudis | Oscorel | Rilies;
  • (NO) Norway: Orudis | Zon;
  • (NZ) New Zealand: Orudis | Oruvail;
  • (PE) Peru: Bi profenid | Devren | Di profeket | Di-kefeprof | Diprofen | Dolofast | Doloketazon | Dolosciens | Flogofin TU LCH | Halprelin | Kenoplast kefentech | Ketopan | Ketoprofeno | Ketoprox | Ketragesico | Ketragesico forte | Kortal | Profeket | Profenid | Talflex bi;
  • (PH) Philippines: Ketofen | Ketoplast | Ketotop | Lafayette ketoprofen | Orudis | Oruvail;
  • (PK) Pakistan: Artrocol | Dowfen | Etopar | Fastum | Fusinorm H | Kefentech | Ketfren | Ketoflex | Ketogesic | Ketonal | Ketonorfen | Ketotop | Ketpro | Mobifen | Mykit | Orudis | Oruvail | Painflamed | Prefen | Profen | Profenid | Proket | Stayfen | Ticon | Topketo | Toprofin;
  • (PL) Poland: Bi profenid | Fastum | Febrofen | Ketokaps max | Ketokaps Med | Ketolek | Ketonal | Ketonal active | Ketonal forte | Ketoprofen lgo | Ketoprofen SF | Ketoprofen Ziaja | Ketoprofenum fastum | Ketoprom | Ketopronil | Ketores | Oki | Opokan keto | Orudis | Oruvail | Profenid | Refastin | Ultrafastin;
  • (PR) Puerto Rico: Orudis | Oruvail;
  • (PT) Portugal: Artrofene | Cetoprofeno | Deflogix | Kepin | Keplat | Profenid;
  • (PY) Paraguay: Doloketazon | Flogostone;
  • (QA) Qatar: Fastum | Ketofan | Ketofan SR | Profenid;
  • (RO) Romania: Fastum | Flexen | Ketalgon | Ketard | Ketomag | Ketonal | Ketoprofen fiterman | Ketoprofen hyperion | Ketoprofen ozone | Ketoprofen slavia | Ketoprofen SR | Ketoprofen tis | Ketoproxin;
  • (RU) Russian Federation: Artrosilene | Artrum | Bystrumcaps | Bystrumgel | Fast fort | Fastum | Febrofid | Flamax | Flamax forte | Flexen | Keplat | Ketonal | Ketoprofen organica | Ketoprofen teva | Ketoprofen verte | Ketoprofen vertex | Ketoprofen vp | Ketoprofen vramed | Ketoprovel | Knavon | Oruvail | Pentalgin extra gel | Profenid | Spazgel | Triosmart | Valusal;
  • (SA) Saudi Arabia: Fastum | Fenajet | Ketofan | Oruvail | Profenid;
  • (SE) Sweden: Orudis | Prodon | Siduro | Zon;
  • (SG) Singapore: Alketo | Apo-keto | Fastum | Kefentech | Kefentech air | Kenhancer | Orudis | Oruvail;
  • (SI) Slovenia: Fastum | Ketonal | Ketoprofen vitabalans;
  • (SK) Slovakia: Fastum | Ketonal | Profenid;
  • (TH) Thailand: Fastum | Flexen | Kaprofen | Ketoprofen Ratiopharm | Lolita | Orudis | Oruvail | Profenid | Rhumafen | Rofepain;
  • (TN) Tunisia: Flexen | Ketalgic | Ketofen | Ketomed | Ketoprof | Ketoprogel | Ketum | Profenid;
  • (TR) Turkey: Artrocol | Bi profenid | Fastjel | Keto jel | Ketofen | Profenid | Vaniket;
  • (TW) Taiwan: Ansiton | Antonin | Chie tung ning | Dar tong pyng | Dofen | Fastum | Febin | Flexen | Isihtonnin | Kee an yan | Kefentech | Kenhancer | Kepinton | Kepro | Keto | Keto pap | Ketoen | Ketofan | Ketofen | Ketofen-h | Ketofen-s | Ketofpan | Keton pap | Ketophen | Ketoprofen Update | Ketoprofene | Ketor | Ketotop | Kutong | Mero | Oruvail | Ping Tung Ning | Proben | Profenadd | Profenid | Sepronin | Soften | Suilanton | Sukeyen | Sutofen | Tofen | Torofen;
  • (UA) Ukraine: Artrocol | F gel | Fastofen | Fastum | Ketonal | Ketonal retard | Nobi gel;
  • (UG) Uganda: Fastum | Ketofen;
  • (UY) Uruguay: Kefentech | Ketofen | Ketofen LP | Ketomax lp | Ketoprofeno | Novobealgia | Orudis | Orudis E | Profenid | Ruprof | Sindol | Sindol E;
  • (VE) Venezuela, Bolivarian Republic of: Bioketof | Dolomax | Fastum | Kefentech | Kelfen | Keto | Ketodac | Ketogesic | Ketoprof | Ketoprofeno | Keydol | Lindilan | Profenid | Profenol;
  • (VN) Viet Nam: Flexen | Keflafen;
  • (ZA) South Africa: Fastum | Ketoflam | Myproflam | Orucote | Orugel | Oruject | Oruvail
  1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
  2. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 209: Obstetric analgesia and anesthesia. Obstet Gynecol. 2019;133(3):e208-e225. doi:10.1097/AOG.0000000000003132 [PubMed 30801474]
  3. Balevi B, “Ketorolac Versus Ibuprofen: A Simple Cost-Efficacy Comparison for Dental Use,” J Can Dent Assoc, 1994, 60(1):31-2. [PubMed 8293359]
  4. Bannwarth B, Lagrange F, Péhourcq F, et al, "(S)-Ketoprofen Accumulation in Premature Neonates With Renal Failure Who Were Exposed to the Racemate During Pregnancy," Br J Clin Pharmacol, 1999, 47(4):459-60. [PubMed 10366240]
  5. Bermas BL. Non-steroidal anti inflammatory drugs, glucocorticoids and disease modifying anti-rheumatic drugs for the management of rheumatoid arthritis before and during pregnancy. Curr Opin Rheumatol. 2014;26(3):334-340. [PubMed 24663106]
  6. Bhangu A, Singh P, Fitzgerald JE, Slesser A, Tekkis P. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg. 2014;38(9):2247-2257. doi: 10.1007/s00268-014-2531-1. [PubMed 24682313]
  7. Bhatt DL, Scheiman J, Abraham NS, et al, “ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risk of Antiplatelet Therapy and NSAID Use. A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents,” J Am Coll Cardiol, 2008, 52(18):1502-17. [PubMed 19017521]
  8. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 [PubMed 33942342]
  9. Bloor M, Paech M. Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation. Anesth Analg. 2013;116(5):1063-1075. [PubMed 23558845]
  10. Bond GR, Curry SC, et al, “Generalized Seizures and Metabolic Acidosis After Ketoprofen Overdose,” Vet Hum Toxicol, 1989, 31:369.
  11. Brooks PM and Day RO, “Nonsteroidal Anti-inflammatory Drugs - Differences and Similarities,” N Engl J Med, 1991, 324(24):1716-25. [PubMed 2034249]
  12. Capone ML, Sciulli MG, Tacconelli S, et al, “Pharmacodynamic Interaction of Naproxen With Low-Dose Aspirin in Healthy Subjects,” J Am Coll Cardiol, 2005, 45(8):1295-301. [PubMed 15837265]
  13. Catella-Lawson F, Reilly MP, Kapoor SC, et al, “Cyclooxygenase Inhibitors and the Antiplatelet Effects of Aspirin,” N Engl J Med, 2001, 345(25):1809-17. [PubMed 11752357]
  14. Chalasani NP, Hayashi PH, Bonkovsky HL, et al. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109(7):950-966. [PubMed 24935270]
  15. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council [published correction appears in J Pain. 2016;17(4):508-510]. J Pain. 2016;17(2):131-157. doi: 10.1016/j.jpain.2015.12.008. [PubMed 26827847]
  16. Conlin P, Moore T, Swartz S, et al, “Effect of Indomethacin on Blood Pressure Lowering by Captopril and Losartan in Hypertensive Patients,” Hypertension, 2000, 36(3):461-5. [PubMed 10988282]
  17. Cooper SA, “Ketoprofen in Oral Surgery Pain: A Review,” J Clin Pharmacol, 1988, 28(12 Suppl):40-6. [PubMed 3072357]
  18. Dathe K, Hultzsch S, Pritchard LW, Schaefer C. Risk estimation of fetal adverse effects after short-term second trimester exposure to non-steroidal anti-inflammatory drugs: a literature review. Eur J Clin Pharmacol. 2019;75(10):1347-1353. doi:10.1007/s00228-019-02712-2 [PubMed 31273431]
  19. Dougados M, Béhier JM, Jolchine I, et al. Efficacy of celecoxib, a cyclooxygenase 2–specific inhibitor, in the treatment of ankylosing spondylitis. a six-week controlled study with comparison against placebo and against a conventional nonsteroidal antiinflammatory drug. Arthritis Rheum. 2001;44(1):180-185. [PubMed 11212158]
  20. Ferraris VA, Saha SP, Oestreich JH, et al, “2012 Update to the Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients Having Cardiac and Noncardiac Operations,” Ann Thorac Surg, 2012, 94(5):1761-81. [PubMed 23098967]
  21. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi: 10.1210/jc.2015-4061. [PubMed 26934393]
  22. Hawkey CJ, Karrasch JA, Szczepañski L, et al, “Omeprazole Compared With Misoprostol for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs,” N Engl J Med, 1998, 338(11):727-34. [PubMed 9494149]
  23. Heerdink ER, Leufkens HG, Herings RM, et al, “NSAIDs Associated With Increased Risk of Congestive Heart Failure in Elderly Patients Taking Diuretics,” Arch Intern Med, 1998, 158(10):1108-12. [PubMed 9605782]
  24. Hersh EV, “The Efficacy and Safety of Ketoprofen in Postsurgical Dental Pain,” Compendium, 1991, 12(4):234. [PubMed 1893388]
  25. Holland S, Silberstein SD, Freitag F, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-1353. [PubMed 22529203]
  26. Hoppmann RA, Peden JG, and Ober SK, “Central Nervous System Side Effects of Nonsteroidal Anti-inflammatory Drugs. Aseptic Meningitis, Psychosis, and Cognitive Dysfunction,” Arch Intern Med, 1991, 151(7):1309-13. [PubMed 2064481]
  27. Horsley RD, Vogels ED, McField DAP, et al. Multimodal postoperative pain control is effective and reduces opioid use after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2019;29(2):394-400. doi: 10.1007/s11695-018-3526-z. [PubMed 30317488]
  28. Jacqz-Aigrain E, Serreau R, Boissinot C, et al. Excretion of ketoprofen and nalbuphine in human milk during treatment of maternal pain after delivery. Ther Drug Monit. 2007;29(6):815-818. [PubMed 18043481]
  29. Jacobi J, Fraser GL, Coursin DB, et al, “Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult,” Crit Care Med, 2002, 30(1):119-41. Available at http://www.sccm.org/pdf/sedatives.pdf [PubMed 11902253]
  30. Ketoprofen extended release capsules [prescribing information]. Morgantown, WV: Mylan Pharmaceuticals; October 2020.
  31. Ketoprofen [prescribing information]. East Brunswick, NJ: Avet Pharmaceuticals Inc; May 2021.
  32. Ketoprofen [product monograph]. Vaughan, Ontario, Canada: AA Pharma Inc; May 2022.
  33. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guidelines for the Evaluation and management of chronic kidney disease. Kidney Int. 2013;3(suppl):1-150.
  34. Knodel LC, “Preventing NSAID-Induced Ulcers: The Role of Misoprostol,” Consult Pharm, 1989, 4:37-41.
  35. Martin E, Vickers B, Landau R, Reece-Stremtan S. ABM clinical protocol #28, peripartum analgesia and anesthesia for the breastfeeding mother. Breastfeed Med. 2018;13(3):164-171. doi:10.1089/bfm.2018.29087.ejm [PubMed 29595994]
  36. Matyas RA, Mumford SL, Schliep KC, et al. Effects of over-the-counter analgesic use on reproductive hormones and ovulation in healthy, premenopausal women. Hum Reprod. 2015;30(7):1714-23. doi:10.1093/humrep/dev099 [PubMed 25954035]
  37. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16(2):175-247. doi:10.1016/j.soard.2019.10.025 [PubMed 31917200]
  38. Micu MC, Micu R, Ostensen M. Luteinized unruptured follicle syndrome increased by inactive disease and selective cyclooxygenase 2 inhibitors in women with inflammatory arthropathies. Arthritis Care Res (Hoboken). 2011;63(9):1334-1338. [PubMed 21618455]
  39. Morgan TO, Anderson A, and Bertram D, “Effect of Indomethacin on Blood Pressure in Elderly People With Essential Hypertension Well Controlled on Amlodipine or Enalapril,” Am J Hypertens, 2000, 13(11):1161-7. [PubMed 11078175]
  40. Page J and Henry D, “Consumption of NSAIDs and the Development of Congestive Heart Failure in Elderly Patients: An Underrecognized Public Health Problem,” Arch Intern Med, 2000, 160(6):777-84. [PubMed 10737277]
  41. pms-Ketoprofen (ketoprofen) [product monograph]. Montreal, Quebec, Canada: Pharmascience Inc; June 2010.
  42. Pope JE, Anderson JJ, and Felson DT, “A Meta-analysis of the Effects of Nonsteroidal Anti-inflammatory Drugs on Blood Pressure,” Arch Intern Med, 1993, 153(4):477-84. [PubMed 8435027]
  43. Pounder R, “Silent Peptic Ulceration: Deadly Silence or Golden Silence?” Gastroenterology, 1989, 96(2 Pt 2 Suppl):626-31. [PubMed 2642448]
  44. Reece-Stremtan S, Campos M, Kokajko L; Academy of Breastfeeding Medicine. ABM clinical protocol #15: analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeed Med. 2017;12(9):500-506. doi:10.1089/bfm.2017.29054.srt [PubMed 29624435]
  45. Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases practice guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651-1653. doi:10.1002/hep.26359 [PubMed 23463403]
  46. Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol. 2020;72(4):529‐556. doi:10.1002/art.41191 [PubMed 32090480]
  47. Soussan C, Gouraud A, Portolan G, et al. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014;70(11):1361-1366. [PubMed 25183382]
  48. Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(4):459-474. doi: 10.1038/ajg.2016.41. [PubMed 26925883]
  49. Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016;40(9):2065-2083. doi: 10.1007/s00268-016-3492-3. [PubMed 26943657]
  50. US Food and Drug Administration (FDA). FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. 2015. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory.
  51. US Food and Drug Administration (FDA). FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid. https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic. Published October 15, 2020. Accessed October 20, 2020.
  52. Verbeeck RK, “Pharmacokinetic Drug Interactions With Nonsteroidal Anti-inflammatory Drugs,” Clin Pharmacokinet, 1990, 19(1):44-66. [PubMed 2199127]
  53. Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Care Res (Hoboken). 2016;68(2):151-166. doi: 10.1002/acr.22708. [PubMed 26401907]
  54. Yeomans ND, Tulassay Z, Juhasz L, et al, “A Comparison of Omeprazole With Ranitidine for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs,” N Engl J Med, 1998, 338(11):719-26. [PubMed 9494148]
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