Ketonal Retard (Ketoprofen)

• Ketoprofen is indicated for inflammatory and painful conditions affecting the musculoskeletal system.
• Pain: Provides symptomatic relief of mild to moderate pain.
• Rheumatoid arthritis: Reduces joint inflammation and improves functional ability.
• Osteoarthritis: Alleviates joint pain and enhances mobility.
• Ankylosing spondylitis: Decreases spinal inflammation and stiffness.

• Ketoprofen exerts its effect by non‑selectively inhibiting cyclooxygenase‑1 (COX‑1) and cyclooxygenase‑2 (COX‑2) enzymes, which blocks the conversion of arachidonic acid to prostaglandins. The reduction in prostaglandin synthesis diminishes inflammation, pain signaling, and fever generation at the site of tissue injury. By decreasing prostaglandin‑mediated vasodilation and sensitization of nociceptors, ketoprofen also limits edema and the peripheral amplification of pain, contributing to its analgesic and anti‑inflammatory properties.

Ketoprofen may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Gastrointestinal discomfort, such as dyspepsia or nausea.
• Headache or dizziness.
• Mild skin rash or itching.
• Elevated liver enzymes detected in laboratory tests.
• Fluid retention leading to peripheral edema.
• Tinnitus or ringing in the ears.

Serious or Rare Side Effects

• Gastrointestinal bleeding, ulceration, or perforation.
• Severe hepatic injury or jaundice.
• Acute kidney injury or worsening of chronic renal disease.
• Cardiovascular events such as myocardial infarction or stroke.
• Life‑threatening skin reactions (e.g., Stevens‑Johnson syndrome).
• Anaphylaxis or severe hypersensitivity reactions.

• When prescribing ketoprofen, clinicians should evaluate individual risk factors and monitor for adverse events.
• Assess gastrointestinal risk: Use the lowest effective dose and consider gastro‑protective agents in high‑risk patients.
• Monitor renal function: Check serum creatinine and electrolytes, especially in the elderly or those with pre‑existing kidney disease.
• Use lowest effective dose: Limit duration of therapy to the shortest period necessary for symptom control.
• Avoid in known hypersensitivity: Do not prescribe to patients with a documented allergy to ketoprofen or other NSAIDs.
• Caution with cardiovascular disease: Evaluate risk of thrombotic events, particularly in patients with established heart disease.
• Avoid in late pregnancy: NSAIDs are contraindicated during the third trimester due to fetal risks.
• Store at ambient temperature: Keep in the original packaging, protect from moisture and direct sunlight.

Ketoprofen can interact with several drug classes, requiring careful assessment before co‑administration.

Major Interactions (Avoid)

• Anticoagulants (e.g., warfarin): Increased risk of serious bleeding.
• Other NSAIDs or aspirin: Heightened gastrointestinal toxicity.
• Lithium: Potential for lithium toxicity due to reduced renal clearance.
• Methotrexate: Enhanced methotrexate toxicity, especially at high doses.

Moderate Interactions (Monitor Closely)

• Antihypertensives (e.g., ACE inhibitors, ARBs, diuretics): May diminish blood‑pressure‑lowering effect and impair renal function.
• Corticosteroids: Additive risk of gastrointestinal ulceration.
• Selective serotonin reuptake inhibitors (SSRIs): Increased bleeding tendency.
• Beta‑blockers: Possible reduction in antihypertensive efficacy.