No

Nonsteroidal Anti-Inflammatory Agent (NSAID)

Dental: Management of pain and swelling

Medical: Acute and long-term treatment of rheumatoid arthritis and osteoarthritis; primary dysmenorrhea; mild to moderate pain

B (D in 3rd trimester)

Known hypersensitivity to ketoprofen or other NSAIDs/aspirin

Use with caution in patients with congestive heart failure, dehydration, hypertension, decreased renal or hepatic function, history of GI disease (bleeding or ulcers), or those receiving anticoagulants; safety and efficacy in children <6 months of age have not yet been established

>10%:

Central nervous system: Dizziness

Dermatologic: Rash

Gastrointestinal: Abdominal cramps, heartburn, indigestion, nausea

1% to 10%:

Central nervous system: Headache, nervousness

Dermatologic: Itching

Endocrine & metabolic: Fluid retention

Gastrointestinal: Vomiting

Otic: Tinnitus

<1%: Congestive heart failure, hypertension, arrhythmias, tachycardia, confusion, hallucinations, mental depression, drowsiness, insomnia, aseptic meningitis, urticaria, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome, angioedema, polydipsia, hot flashes, gastritis, GI ulceration, cystitis, polyuria, agranulocytosis, anemia, hemolytic anemia, bone marrow suppression, leukopenia, thrombocytopenia, hepatitis, peripheral neuropathy, toxic amblyopia, blurred vision, conjunctivitis, dry eyes, decreased hearing, acute renal failure, allergic rhinitis, shortness of breath, epistaxis

Symptoms of overdose include apnea, metabolic acidosis, coma, and nystagmus; leukocytosis, renal failure

Management of a nonsteroidal anti-inflammatory drug (NSAID) intoxication is primarily supportive and symptomatic. Fluid therapy is commonly effective in managing the hypotension that may occur following an acute NSAID overdose, except when this is due to an acute blood loss. Seizures tend to be very short-lived and often do not require drug treatment. Although, recurrent seizures should be treated with I.V. diazepam. Since many of the NSAIDs undergo enterohepatic cycling, multiple doses of charcoal may be needed to reduce the potential for delayed toxicities.

CYP2C and 2C9 enzyme inhibitor

Increased effect/toxicity with probenecid, lithium

Increased toxicity of methotrexate

Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclo-oxygenase, which results in decreased formation of prostaglandin precursors

Peak levels in 1-2 hours

Absorption: Almost completely

Metabolism: In the liver

Half-life: 1-4 hours

Time to peak serum concentration: 0.5-2 hours

Elimination: Renal excretion (60% to 75%), primarily as glucuronide conjugates

Oral:

Children >12 years and Adults:

Rheumatoid arthritis or osteoarthritis: 50-75 mg 3-4 times/day up to a maximum of 300 mg/day

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

In order to minimize gastrointestinal effects, ketoprofen can be prescribed to be taken with food or milk; 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

chloride (S), sodium (S), bleeding time

Dizziness is common; may cause nervousness; may rarely cause insomnia, confusion, depression, or hallucinations

May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels

No information available to require special precautions

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®).

Take this medication exactly as directed; do not increase dose without consulting prescriber. Do not crush tablets or break capsules. Take with food or milk to reduce GI distress. Maintain adequate fluid intake (2-3 L/day of fluids unless instructed to restrict fluid intake). Do not use alcohol, aspirin, or aspirin-containing medication, and all other anti-inflammatory medications without consulting prescriber. You may experience drowsiness, dizziness, nervousness, or headache (use caution when driving or engaging in tasks requiring alertness until response to drug is known); anorexia, nausea, vomiting, or heartburn (frequent small meals, frequent mouth care, sucking lozenges, or chewing gum may help); fluid retention (weigh yourself weekly and report unusual (3-5 lb/week) weight gain). GI bleeding, ulceration, or perforation can occur with or without pain; discontinue medication and contact prescriber if persistent abdominal pain or cramping, or blood in stool occurs. Report breathlessness, difficulty breathing, or unusual cough; chest pain, rapid heartbeat, palpitations; unusual bruising/bleeding; blood in urine, stool, mouth, or vomitus; swollen extremities; skin rash or itching; acute fatigue; or changes in hearing or ringing in ears. Breast-feeding precautions: Consult prescriber if breast-feeding.

Dose must be lowest recommended in renal insufficiency and hypoalbuminemia. There are no clinical guidelines to predict which NSAID will give response in a particular patient. Trials with each must be initiated until response determined. Consider dose, patient convenience, and cost.

Capsule (Orudis®): 25 mg, 50 mg, 75 mg

Actron®, Orudis® KT [OTC]: 12.5 mg

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

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