Pronunciation:

(kee toe PROE fen)

U.S. Brand Names:

Generic Available:

Canadian Brand Names:

Use:

Use - Dental:

Pregnancy Risk Factor:

Pregnancy Implications:

Lactation:

Contraindications:

Warnings/Precautions:

Use of NSAIDs can compromise existing renal function especially when Clcr<30 mL/minute. CNS adverse effects such as confusion, agitation, and hallucination are generally seen in overdose or high-dose situations; however, elderly may demonstrate these adverse effects at lower doses than younger adults. Do not exceed 300 mg/day. Withhold for at least 4-6 half-lives prior to surgical or dental procedures.

Adverse Reactions:

>10%: Gastrointestinal: Dyspepsia (11%)

1% to 10%:

Central nervous system: Headache (3% to 9%), nervousness, dizziness, somnolence, insomnia, malaise, depression

Dermatologic: Rash, itching

Endocrine & metabolic: Fluid retention

Gastrointestinal: Vomiting (>1%), diarrhea (3% to 9%), nausea (3% to 9%), constipation (3% to 9%), abdominal distress/cramping/pain (3% to 9%), flatulence (3% to 9%), anorexia (>1%), stomatitis (>1%)

Genitourinary: Urinary tract infection (>1%)

Ocular: Visual disturbances

Otic: Tinnitus

Renal: Renal function impairment

<1% (Limited to important or life-threatening): Acute renal failure, agranulocytosis, allergic reaction, allergic rhinitis, anaphylaxis, anemia, angioedema, arrhythmia, aseptic meningitis, blurred vision, bone marrow suppression, confusion, CHF, conjunctivitis, cystitis, drowsiness, dry eyes, dyspnea, epistaxis, erythema multiforme, gastritis, GI ulceration, hallucinations, hearing decreased, hemolytic anemia, hepatitis, hot flashes, hypertension, leukopenia, peripheral neuropathy, photosensitivity, polydipsia, polyuria, Stevens-Johnson syndrome, tachycardia, thrombocytopenia, toxic amblyopia, toxic epidermal necrolysis, urticaria

Overdosage/Toxicology:

Drug Interactions:

ACE inhibitors: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure

Angiotensin II antagonists: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure

Anticoagulants (warfarin, heparin, LMWHs) in combination with NSAIDs can cause increased risk of bleeding.

Other antiplatelet drugs (ticlopidine, clopidogrel, aspirin, abciximab, dipyridamole, eptifibatide, tirofiban) can cause an increased risk of bleeding.

Corticosteroids may increase the risk of GI ulceration; avoid concurrent use.

Cyclosporine: NSAIDs may increase serum creatinine, potassium, blood pressure, and cyclosporine levels; monitor cyclosporine levels and renal function carefully

Gentamicin and amikacin serum concentrations are increased by indomethacin in premature infants. Results may apply to other aminoglycosides and NSAIDs.

Hydralazine's antihypertensive effect is decreased; avoid concurrent use

Lithium: Levels can be increased by NSAIDs; avoid concurrent use if possible or monitor lithium levels and adjust dose. Sulindac may have the least effect.

Loop diuretics: Efficacy (diuretic and antihypertensive effect) is reduced.

Methotrexate: NSAIDs may decrease the excretion of methotrexate; monitor.

Probenecid: Clearance of ketoprofen may be decreased.

Thiazides antihypertensive effects are decreased; avoid concurrent use

Verapamil plasma concentration is decreased by diclofenac; avoid concurrent use

Warfarin's INRs may be increased by piroxicam. Other NSAIDs may have the same effect depending on dose and duration. Monitor INR closely. Use the lowest dose of NSAIDs possible and for the briefest duration.

Ethanol/Nutrition/Herb Interactions:

Ethanol: Avoid ethanol (due to GI irritation).

Food: Although food affects the bioavailability of ketoprofen, analgesic efficacy is not significantly diminished; food slows rate of absorption resulting in delayed and reduced peak serum concentrations.

Mechanism of Action:

Pharmacodynamics/Kinetics:

Absorption: Almost complete

Protein binding: >99%, primarily albumin

Metabolism: Hepatic

Half-life elimination: Capsule: 2.5 hours; Capsule, extended release: 5.4 hours

Time to peak, serum: Capsule: 0.5-2 hours; Capsule, extended release: 6-7 hours

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

Dosage:

Children 16 years and Adults:

Rheumatoid arthritis or osteoarthritis:

Capsule: 50-75 mg 3-4 times/day up to a maximum of 300 mg/day

Capsule, extended release: 200 mg once daily

Mild to moderate pain: Capsule: 25-50 mg every 6-8 hours up to a maximum of 300 mg/day

OTC labeling: 12.5 mg every 4-6 hours, up to a maximum of 6 tablets/24 hours

Elderly: Initial dose should be decreased in patients >75 years; use caution when dosage changes are made

Dosage adjustment in renal impairment:

Mild impairment: Maximum dose: 150 mg/day

Severe impairment: Maximum dose: 100 mg/day

Dosage adjustment in hepatic impairment and serum albumin <3.5 g/dL: Maximum dose: 100 mg/day

Administration:

Test Interactions:

Dietary Considerations:

Patient Education:

Anesthesia and Critical Care Concerns/Other Considerations:

In short-term use, NSAIDs vary considerably in their effect on blood pressure. When NSAIDs are used in patients with hypertension, appropriate monitoring of blood pressure responses should be completed and the duration of therapy, when possible, kept short. The use of NSAIDs in the treatment of patients with congestive heart failure may be associated with an increased risk for fluid accumulation and edema; may precipitate renal failure in dehydrated patients.

Cardiovascular Considerations:

Dental Health: Effects on Dental Treatment:

NSAID formulations are known to reversibly decrease platelet aggregation via mechanisms different than observed with aspirin. The dentist should be aware of the potential of abnormal coagulation. Caution should also be exercised in the use of NSAIDs in patients already on anticoagulant therapy with drugs such as warfarin (Coumadin®).

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Capsule: 50 mg, 75 mg

Capsule, extended release (Oruvail®): 100 mg, 150 mg, 200 mg

Tablet (Orudis® KT): 12.5 mg [contains tartrazine and sodium benzoate]

International Brand Names: