Ketoprofen

Arthritis Symptoms

Ketoprofen is used to treat the pain, tenderness, swelling, and stiffness caused by certain types of arthritis. These include:

• Osteoarthritis: A condition caused by the breakdown of the lining of the joints.
• Rheumatoid arthritis: An autoimmune condition caused by swelling of the lining of the joints.

Other Uses

In addition to treating chronic joint conditions, ketoprofen is used for the management of:

• Mild to moderate pain: General pain relief for various acute conditions.
• Menstrual pain: Relief from painful menstrual periods, also known as primary dysmenorrhea.

Ketoprofen works by blocking the body's production of certain natural substances that cause inflammation. This effect helps decrease swelling and pain, allowing for improved physical function in daily activities.

Mechanism of Action

Ketoprofen belongs to a class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs). It works by inhibiting the activity of enzymes called cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2).

These enzymes are responsible for the production of prostaglandins, which are chemicals the body releases in response to injury or certain diseases. Prostaglandins are major contributors to the sensation of pain, the development of fever, and the physical signs of inflammation, such as swelling and redness.

By blocking these enzymes, ketoprofen reduces the levels of prostaglandins in the body. This action results in:

• Pain relief: By reducing the chemicals that sensitize pain receptors.
• Reduced inflammation: By decreasing the substances that cause swelling and tissue irritation.
• Fever reduction: By affecting the body's temperature-regulating heat center in the brain.

While ketoprofen is effective at managing symptoms by interfering with these chemical pathways, it does not cure the underlying condition causing the pain or inflammation.

Common Side Effects

Many people using ketoprofen experience mild side effects. These may include:

• Stomach pain, heartburn, nausea, or vomiting
• Diarrhea, constipation, or gas
• Headache, dizziness, or nervousness
• Drowsiness or trouble sleeping
• Ringing in the ears

Serious Side Effects

Contact a healthcare provider immediately if you experience any of the following serious symptoms:

• Signs of an allergic reaction, such as skin rash, hives, itching, or swelling of the face, lips, tongue, or throat
• Difficulty breathing or swallowing
• Changes in vision
• Sudden weight gain or swelling in the arms, hands, feet, ankles, or lower legs
• Severe stomach pain or stools that are black, tarry, or contain red blood
• Vomiting blood or material that looks like coffee grounds
• Yellowing of the skin or eyes
• Pale skin, fast heartbeat, or excessive tiredness
• Painful or difficult urination, or cloudy or bloody urine

Cardiovascular Risks

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ketoprofen may increase the risk of serious cardiovascular thrombotic events, including heart attack and stroke. This risk may occur early in treatment and can increase with longer duration of use. Ketoprofen is contraindicated for the treatment of pain before or after coronary artery bypass graft (CABG) surgery.

Gastrointestinal Risks

Ketoprofen can cause serious gastrointestinal (GI) adverse events, including inflammation, bleeding, ulceration, and perforation of the stomach or intestines. These events can happen at any time during use and without warning symptoms. Older adults and those with a prior history of peptic ulcer disease or GI bleeding are at a higher risk for these serious complications.

Pregnancy and Kidney Health

Using ketoprofen around 20 weeks or later in pregnancy may cause serious kidney problems in the unborn baby, which can lead to low levels of amniotic fluid. It is generally advised to avoid NSAIDs during this period unless specifically directed by a healthcare provider. Additionally, long-term use of ketoprofen can lead to kidney injury, particularly in individuals with pre-existing kidney impairment, heart failure, or liver dysfunction.

Allergic Reactions and Skin Sensitivity

Ketoprofen should not be used by individuals who have experienced asthma, hives, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, sometimes fatal, anaphylactic reactions have been reported. Serious skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, can also occur without warning.

Other Precautions

• Liver Function: Elevations of liver enzymes may occur. Rare but severe liver reactions, including jaundice and hepatitis, have been reported.
• Fluid Retention: Edema and fluid retention have been observed, requiring caution for those with heart failure or high blood pressure.
• Anemia: Long-term use may cause a decrease in red blood cells (anemia), which may require monitoring of hemoglobin levels.

Pregnancy

Ketoprofen should generally be avoided during pregnancy unless a healthcare provider determines it is necessary. Using this medication starting at 20 weeks of pregnancy may cause rare but serious kidney problems in the unborn baby, which can lead to low levels of amniotic fluid. If use is required between 20 and 30 weeks, healthcare providers typically recommend the lowest effective dose for the shortest possible duration.

It is especially important to avoid ketoprofen starting at 30 weeks of pregnancy. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) during the third trimester can cause the premature closure of the ductus arteriosus, a vital blood vessel in the baby's heart. This can lead to serious heart or lung complications in the newborn.

Breastfeeding

It is not well-established whether ketoprofen passes into human breast milk or what effects it may have on a nursing infant. Because of the potential for side effects in the baby, healthcare providers usually recommend caution. A decision should be made with a medical professional to either stop breastfeeding or stop the medication, taking into account the importance of the drug to the mother.

Oral Formulations

Ketoprofen is primarily administered by mouth. The available oral forms include:

• Capsules: These are immediate-release formulations that release the medication into the system shortly after being swallowed.
• Extended-release capsules: These are long-acting formulations designed to release the medication slowly over a prolonged period.

FDA Approval and Indications

Ketoprofen is a nonsteroidal anti-inflammatory drug (NSAID) that received FDA approval for the management of signs and symptoms of rheumatoid arthritis and osteoarthritis. It is also approved for the treatment of mild to moderate pain and primary dysmenorrhea (menstrual cramps).

Boxed Warning

The FDA requires a boxed warning for ketoprofen due to serious potential safety risks associated with the NSAID class. These include:

• Cardiovascular Risk: Ketoprofen may increase the risk of serious cardiovascular thrombotic events, including myocardial infarction (heart attack) and stroke, which can be fatal. This risk may increase with the duration of use or in patients with known cardiovascular disease or risk factors.
• Gastrointestinal Risk: There is an increased risk of serious gastrointestinal (GI) adverse events, such as bleeding, ulceration, and perforation of the stomach or intestines. These events can occur at any time during use without warning symptoms and may be fatal. Elderly patients are at a higher risk for these serious GI complications.

Regulatory Safety Communications

In 2015, the FDA strengthened existing warnings for non-aspirin NSAIDs like ketoprofen, noting that the risk of heart attack or stroke can occur as early as the first weeks of using an NSAID and may increase with longer use or higher doses. Additionally, the FDA has issued safety alerts regarding the use of NSAIDs during pregnancy. Specifically, the agency recommends avoiding NSAIDs at 20 weeks or later in pregnancy because they can cause rare but serious kidney problems in the unborn baby, leading to low levels of amniotic fluid.

Alcohol and Ketoprofen Risks

Using alcohol while taking ketoprofen can increase the risk of serious side effects, particularly in the digestive system. Ketoprofen is a nonsteroidal anti-inflammatory drug (NSAID), and like other medications in this class, it can irritate the lining of the stomach and intestines.

Combining this medication with alcohol further raises the chance of developing:

• Stomach ulcers
• Bleeding in the stomach or intestines
• Perforation (holes) in the stomach or intestinal wall

The risk of stomach bleeding is significantly higher for people who consume three or more alcoholic drinks every day while using ketoprofen. Because these conditions can occur without warning and may be life-threatening, it is important to discuss your alcohol intake with a healthcare professional before using this medication.

Seek medical attention immediately if you experience signs of stomach bleeding, such as:

• Black, tarry, or bloody stools
• Vomit that looks like coffee grounds
• Severe or persistent stomach pain