Ketoprofen

Ketoprofen

Systematic (IUPAC) name
(RS)-2-(3-benzoylphenyl)propanoic acid
Clinical data
AHFS/Drugs.com	monograph
MedlinePlus	a686014
Pregnancy category	C (D in 3rd trimester)
Legal status	AU: S3 (Pharmacist only) Prescription-only medicine
Routes of administration	Oral, topical, intravenous (veterinary use)
Pharmacokinetic data
Protein binding	99%
Biological half-life	2-2.5 hours
Identifiers
CAS Number	22071-15-4 Y
ATC code	M01AE03 (WHO) M01AE17, M02AA10
PubChem	CID: 3825
IUPHAR/BPS	4795
DrugBank	DB01009 Y
ChemSpider	3693 Y
UNII	90Y4QC304K Y
KEGG	D00132 Y
ChEBI	CHEBI:6128 N
ChEMBL	CHEMBL571 Y
Chemical data
Formula	C16H14O3
Molecular mass	254.281 g/mol
SMILES CC(c1cccc(c1)C(=O)c2ccccc2)C(=O)O
InChI InChI=1S/C16H14O3/c1-11(16(18)19)13-8-5-9-14(10-13)15(17)12-6-3-2-4-7-12/h2-11H,1H3,(H,18,19) Y Key:DKYWVDODHFEZIM-UHFFFAOYSA-N Y
NY (what is this?)  (verify)

Ketoprofen, (RS)2-(3-benzoylphenyl)-propionic acid (chemical formula C₁₆H₁₄O₃) is one of the propionic acid class of nonsteroidal anti-inflammatory drugs (NSAID) with analgesic and antipyretic effects. It acts by inhibiting the body's production of prostaglandin.

Available forms

Ketoprofen was available over-the-counter in the United States in the form of 12.5 mg coated tablets (Orudis KT and Actron), but this form has been discontinued. It is available by prescription as 50, 75, 100, 150, and 200 mg capsules.

Ketoprofen is also available as a 2.5% gel for topical application, and it is also available as a patch for topical analgesia and anti-inflammatory action. However, the gel is not sold in the United States.

Brand names in Australia are Orudis and Oruvail. It is available in Japan in a transdermal patch Mohrus Tape, made by Hisamitsu Pharmaceutical. It is available in the UK as Ketoflam and Oruvail, in Estonia as Keto, Ketonal, and Fastum Gel, in Finland as Ketorin, Keto, Ketomex, and Orudis; in France as Profénid, Bi-Profénid and Ketum; in Italy as Ketodol, Fastum Gel, Lasonil, Orudis and Oki; in Poland, Serbia, Slovenia and Croatia as Knavon and Ketonal; in Romania as Ketonal; in Mexico as Arthril; in Norway as Zon and Orudis; in Russia as ОКИ (OKI), Fastum Gel and Ketonal; in Spain as Actron; and in Venezuela as Ketoprofeno under an injectable solution of 100 mg and 150 mg capsules.

In Lithuania, ketoprofen is called Ketoprofenum and Ketoprofenas. For topical application: the name brands are Fastum with 2.5% (gel) which is over the counter, and Ketospray with 10% (liquid spray), which must be prescribed. In Switzerland, an innovative ketoprofen formulation based on transfersome technology for direct application on the skin above the site to be treated has been approved.

In some countries, the optically pure (S)-enantiomer (dexketoprofen) is available; its trometamol salt is said to be particularly rapidly reabsorbed from the gastrointestinal tract, having a rapid onset of effects.

The earliest report of therapeutic use in humans was in 1972

Indication

Ketoprofen is generally prescribed for arthritis-related inflammatory pains or severe toothaches that result in the inflammation of the gums.

Ketoprofen topical patches are being extensively used for treatment of musculoskeletal pain. The patches have been shown to provide rapid and sustained delivery to underlying tissues without significantly increasing levels of drug concentration in the blood when compared to the traditional oral administration. Ketoprofen undergoes metabolism in the liver via conjugation with glucoronic acid, CYP3A4 and CYP2C9 hydroxylation of the benzoyl ring, and reduction of its keto function. Ketoprofen is used for its antipyretic, analgesic, and anti-inflammatory properties by inhibiting cyclooxygenase-1 and -2 (COX-1 and COX-2) enzymes reversibly, which decreases production of proinflammatory prostaglandin precursors.

Ketoprofen can also be used for treatment of some pain, especially nerve pain such as sciatica, postherpetic neuralgia and referred pain for radiculopathy, in the form of a cream, ointment, liquid, spray, or gel, which may also contain ketamine and lidocaine, along with other agents which may be useful, such as cyclobenzaprine, amitriptyline, acyclovir, gabapentin, orphenadrine and other drugs used as NSAIDs or adjuvant, atypical or potentiators for pain treatment.

Efficacy

A systematic review and meta-analysis indicated "The efficacy of orally administered ketoprofen in relieving moderate-severe pain and improving functional status and general condition was significantly better than that of ibuprofen and/or diclofenac." A Cochrane review investigating ketoprofen as a single-dose oral analgesic in acute, moderate-to-severe postoperative pain concluded that its efficacy is equivalent to drugs such as ibuprofen and diclofenac. In particular, after dental surgery, doses >25 mg provide at least 50% pain relief to more than 60% of people treated, giving relief for about 5 hours.

Uses with other drugs

Ketoprofen should not be used in combination with other NSAIDs or corticosteroids, as this increases the risk of gastrointestinal (GI) ulceration. It should also be used with caution with other anticoagulants. It is commonly used with omeprazole, sucralfate, and cimetidine to help protect the GI tract.

Use in horses and other animals

Ketoprofen is a common NSAID, antipyretic, and analgesic used in horses and other equines. It is most commonly used for musculoskeletal pain, joint problems, and soft tissue injury, as well as laminitis. It is also used to control fevers and prevent endotoxemia. It is also used as a mild painkiller in smaller animals, generally following surgical procedures.

In horses, it is given at a dose of 2.2mg/kg/day. Studies have shown that it does not inhibit 5-lipoxygenase and leukotriene B4, as originally claimed. It is therefore not considered superior to phenylbutazone as previously believed, although clinical signs of lameness are reduced with its use. In fact, phenylbutazone was shown superior to ketoprofen in cases of experimentally-induced synovitis when both drugs were used at labeled dosages.

Administration

Ketoprofen, when administered intravenously, is recommended for a maximum of five days of use. Its analgesic and antipyretic effects begin to occur one to two hours following administration. The most common dosage is 1 mg/ lb, once per day, although this dosage may be lowered for ponies, which are most susceptible to NSAID side effects. It is also available as a capsule dosage form and a tablet.

Ecological problems

See also: Indian vulture crisis

Experiments have found ketoprofen, like diclofenac, is a veterinary drug causing lethal effects in red-headed vultures. Vultures feeding on the carcasses of recently treated livestock suffer acute kidney failure within days of exposure.