Drug reference

Ketoprofen

Non-selective COX inhibitor (NSAID) · Unknown

START

50 mg PO every 6–8 h with food (or 75 mg every 8 h)

TYPICAL MAX

300 mg/day

STOP IF

GI bleed, AKI, severe skin reaction, or cardiac event

WATCH

GI symptoms, renal function, BP; gastroprotection in high-risk

CDSCO approvedSchedule HATC M01AE03

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 30min · analgesia
PEAK: 1.5h · Tmax
t½: 2.5h · t½
DURATION: 7h · IR dose

EXCRETION

Renal — mainly as glucuronide

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Avoid third trimester (premature ductus closure / oligohydramnios); short-term use earlier per benefit-risk.

FDA category + note

Top interactionssee all 12 →

AminoglycosideSevereTextbookKDT 7e · p746
AminoglycosidesSevereTextbookKDT 7e
DapoxetineSevereTextbookKDT 7e
EnalaprilatSevereTextbookG&G 14e · p836

Mechanism

Reversibly inhibits cyclooxygenase-1 and -2, reducing prostaglandin synthesis — analgesic, antipyretic and anti-inflammatory effects; has some lipoxygenase inhibition (less clinically relevant).

Indications

Acute pain (musculoskeletal, dental, dysmenorrhoea)Osteoarthritis / rheumatoid arthritis / ankylosing spondylitisTopical gel for localised soft-tissue pain

Dosing

Adult: Acute pain: 50 mg PO every 6–8 h or 75 mg every 8 h. OA/RA: 75 mg 3 times daily or 50 mg 4 times daily; ER 200 mg once daily. Max 300 mg/day. Topical: apply 3–4 times daily.
Pediatric: Generally not recommended (limited data).
Renal adjustment: Reduce dose / avoid in moderate–severe impairment.
Hepatic adjustment: Reduce dose in significant hepatic disease.
Geriatric: Lower doses; GI/renal risk.
Max dose: 300 mg/day

Pharmacokinetics

Onset

~30 min (analgesia)

Peak effect

~0.5–2 h (Tmax IR)

Duration

~6–8 h (IR); ~24 h (ER)

Half-life

~1.5–3 h (longer in renal impairment)

Bioavailability

~90% (oral)

Protein binding

~99%

Metabolism

Hepatic glucuronidation

Excretion

Renal (mainly as glucuronide)

Contraindications

Aspirin / NSAID hypersensitivity (asthma/urticaria/angioedema)
Active GI bleeding / ulcer
Severe heart failure
Severe renal impairment
Third-trimester pregnancy
Coronary artery bypass perioperative period

Side effects

Common

Dyspepsia / nauseaAbdominal painDiarrhoeaHeadacheDizzinessPruritus

Serious

GI ulceration / bleeding / perforation
Cardiovascular thrombotic events (class)
Acute kidney injury
Severe skin reactions (SJS/TEN) — photosensitivity (topical)
Hepatotoxicity

Pregnancy & lactation

Pregnancy

Avoid third trimester (premature ductus closure / oligohydramnios); short-term use earlier per benefit-risk.

Lactation

Limited milk transfer; usually acceptable short-term.

Drug interactions

Aminoglycoside

Severe

Textbook

Increased risk of nephrotoxicity.

Avoid concurrent use.

Source: KDT 7e · p746

Aminoglycosides

Severe

Textbook

Increased aminoglycoside levels and potential toxicity.

Monitor aminoglycoside levels and renal function; adjust dosage as needed.

Source: KDT 7e

Dapoxetine

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider gastroprotective agents or alternative analgesics.

Source: KDT 7e

Enalaprilat

Severe

Textbook

Reduced effectiveness of ACE inhibitors. Marked hyperkalemia, potentially leading to cardiac arrhythmia.

Use with caution, especially in the elderly and in patients with hypertension, diabetes mellitus, or ischemic heart disease.

Source: G&G 14e · p836

Escitalopram + Clonazepam

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider gastroprotective agents or alternative analgesics.

Source: KDT 7e

Glucocorticoids

Severe

Textbook

Increased risk of gastritis, ulcer formation, and gastrointestinal bleeding. Glucocorticoids can also mask the symptoms of serious gastrointestinal disease, increasing the risk of perforated sigmoid diverticular abscesses.

Not explicitly stated, but implies caution and awareness of increased risk.

Source: G&G 14e · p1013

Quinolones

Severe

Textbook

Enhanced neurological adverse effects.

Use with caution, especially in patients with a history of epilepsy.

Source: G&G 14e · p1144

Acalabrutinib

Severe

Database

Drug interaction classified as: synergy