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NSAID — Non-selective COX Inhibitor (S-enantiomer of Ketoprofen) Pregnancy: Avoid — especially third trimester

Dexketoprofen (Acute Musculoskeletal Pain)

Brand names: Keral, Enantyum

Adult dose

Dose: 50 mg IV/IM over 15 minutes every 8–12 hours; 25 mg oral every 8 hours
Route: Intravenous or Intramuscular or Oral
Frequency: Every 8–12 hours (IV/IM); every 8 hours (oral)
Max: 150 mg/day (IV/IM for maximum 2 days); 75 mg/day (oral)
IV formulation primarily used for acute severe musculoskeletal pain in ED and post-operative settings. Give IV dose over at least 15 minutes. IV use limited to maximum 2 days — transition to oral NSAID. Do not combine with other NSAIDs.

Paediatric dose

Route:
Not licensed in patients under 18 years

Dose adjustments

Renal

Avoid if eGFR <30 mL/min; reduce dose if eGFR 30–59 mL/min

Hepatic

Avoid in severe hepatic impairment

Clinical pearls

  • NICE NG124 and BNF: IV/IM dexketoprofen is an option for moderate-to-severe acute musculoskeletal pain where oral NSAIDs cannot be taken — particularly useful in ED for fractures, dislocations, and acute back pain
  • Non-inferior analgesic efficacy to morphine in several RCTs for acute musculoskeletal pain, with lower risk of respiratory depression, nausea, and sedation — NSAID analgesia is often underestimated for acute orthopaedic pain
  • S-enantiomer of ketoprofen: higher analgesic potency at lower dose than racemic ketoprofen; lower GI toxicity profile
  • IV administration — slow infusion essential to prevent injection site reactions and perivascular pain; do not give as rapid IV push
  • Not for prolonged use: maximum 2 days IV/IM before transitioning to oral NSAID or alternative analgesic

Contraindications

  • Active peptic ulcer
  • Severe renal impairment (eGFR <30 mL/min)
  • Severe heart failure
  • NSAID/aspirin hypersensitivity
  • Severe hepatic impairment
  • Pregnancy (third trimester)

Side effects

  • GI irritation and ulceration
  • Renal impairment
  • Injection site pain (IM) and phlebitis (IV)
  • Cardiovascular events
  • Hypersensitivity reactions

Interactions

  • Anticoagulants — increased bleeding risk
  • Other NSAIDs — additive toxicity; do not combine
  • Lithium — increased lithium levels

Monitoring

  • Renal function in elderly or dehydrated patients
  • GI symptoms
  • Injection site (IV use)

Reference: BNFc; BNF 90; NICE NG124; SPC Keral; RCT Dexketoprofen vs Morphine (acute musculoskeletal pain). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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