Is ketoprofen (Nonsteroidal Anti-Inflammatory Drug (NSAID)) the same as dexketoprofen (NSAID)?

Ketoprofen vs. Dexketoprofen: Understanding the Difference

No, ketoprofen is not the same as dexketoprofen. Dexketoprofen is the active (S)-(+)-enantiomer of racemic ketoprofen, which is responsible for the therapeutic effects, while ketoprofen contains both active and inactive enantiomers. 1

Chemical and Pharmacological Differences

• Composition:

  • Ketoprofen: Contains both (S)-(+) and (R)-(-) enantiomers in equal amounts (racemic mixture)
  • Dexketoprofen: Contains only the (S)-(+)-enantiomer, which is the therapeutically active component 1, 2

• Potency and Dosing:

  • Dexketoprofen is expected to provide equivalent analgesia to ketoprofen at approximately half the dose 1, 3
  • Example: Dexketoprofen 25 mg is theoretically equivalent to ketoprofen 50 mg 4

Clinical Evidence on Efficacy

• Analgesic Efficacy:

  • Ketoprofen at 50 mg provides at least 50% pain relief in approximately 57% of patients compared to 23% with placebo (NNT 2.9) 5
  • Dexketoprofen at 20-25 mg provides at least 50% pain relief in approximately 52% of patients compared to 27% with placebo (NNT 4.1) 5

• Comparative Studies:

  • One study showed that dexketoprofen trometamol 25 mg three times daily was more effective than ketoprofen 50 mg three times daily in the treatment of knee osteoarthritis 4
  • McQuay et al. demonstrated that a combination of oral dexketoprofen 25 mg with tramadol 75 mg was superior to both medications alone for postoperative pain control 6

Pharmacokinetic Differences

• Absorption Rate:

  • Dexketoprofen trometamol (salt form) is more rapidly absorbed with a time to maximum plasma concentration of 0.25-0.75 hours 1
  • Ketoprofen has a slower absorption with a time to maximum plasma concentration of 0.5-3 hours for the (S)-(+)-enantiomer 1

• Bioavailability:

  • The relative bioavailability of oral dexketoprofen (12.5 and 25 mg) is similar to that of oral racemic ketoprofen (25 and 50 mg, respectively), as measured by the area under the concentration-time curve values for (S)-(+)-ketoprofen 2

Clinical Applications

• Both ketoprofen and dexketoprofen are classified as propionic acid derivatives within the NSAID family 6
• Both are used for similar indications including:
  • Postoperative pain management 6, 5
  • Osteoarthritis 6, 4
  • Acute pain conditions 6

Safety Considerations

• The theoretical advantage of dexketoprofen is potentially fewer gastrointestinal adverse events at equivalent analgesic doses, though this has not been consistently demonstrated in all studies 3, 5
• Both drugs carry similar cardiovascular and renal risk profiles as other NSAIDs 6
• In single doses, both drugs appear to be well-tolerated with adverse event rates similar to placebo 5

Practical Implications

• When switching from ketoprofen to dexketoprofen, the dose should be approximately halved to maintain equivalent analgesic efficacy 1, 2
• The choice between these medications may depend on:
  • Speed of onset needed (dexketoprofen has faster absorption) 1
  • Patient-specific factors including prior response to either medication
  • Availability and cost considerations

In conclusion, while ketoprofen and dexketoprofen are closely related, they are not the same medication. Dexketoprofen represents a refined version of ketoprofen, containing only the therapeutically active enantiomer.