NSAID — Non-selective COX Inhibitor (S-enantiomer of Ketoprofen) Pregnancy: Contraindicated during the third trimester of pregnancy and during breast-feeding. Inhibition of prostaglandin synthesis may adversely affect pregnancy and/or embryo/foetal development; epidemiological data raise concern about an increased risk of miscarriage, cardiac malformation and gastroschisis after use of a prostaglandin synthesis inhibitor in early pregnancy. From the 20th week of pregnancy onward use may cause oligohydramnios from foetal renal dysfunction, and ductus arteriosus constriction has been reported after second-trimester treatment; during the first and second trimesters it should not be given unless clearly necessary, at the lowest dose for the shortest duration. Use may impair female fertility and is not recommended in women attempting to conceive.

Dexketoprofen (Acute Musculoskeletal Pain)

Brand names: Keral, Enantyum

Dexketoprofen is the single active enantiomer of the propionic-acid NSAID ketoprofen, used here for short-term relief of acute musculoskeletal pain such as sprains, low back pain and post-traumatic soft-tissue injury.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 12.5 mg (half a 25 mg tablet) every 4 to 6 hours, or 25 mg every 8 hours, according to the nature and severity of the pain

Route: Oral — swallow the tablet with a sufficient amount of fluid, for example a glass of water

Frequency: Every 4 to 6 hours (12.5 mg) or every 8 hours (25 mg)

Max: The total daily dose should not exceed 75 mg

Fetched SPC: 'Keral 25 mg film-coated tablets' (https://www.medicines.org.uk/emc/product/159/smpc). Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms. Dexketoprofen is not intended for long term use and treatment must be limited to the symptomatic period. Concomitant administration with food delays the absorption rate, so in acute pain administration at least 30 minutes before meals is recommended. ELDERLY: start therapy at the lower end of the dosage range (50 mg total daily dose); the dose may be increased to that recommended for the general population only after good general tolerance has been ascertained. HEPATIC IMPAIRMENT: patients with mild to moderate hepatic impairment should start at a reduced dose (50 mg total daily dose) and be closely monitored; dexketoprofen should not be used in severe hepatic impairment. PAEDIATRIC (no per-kg dose is stated, so no structured paediatric dose is recorded): dexketoprofen has not been studied in children and adolescents, safety and efficacy have not been established, and the product should not be used in children and adolescents — verify any under-18 analgesia against a children's formulary.

Dose adjustments

Renal

Reduce the initial dosage to 50 mg total daily dose in patients with mildly impaired renal function (creatinine clearance 60 to 89 ml/min). Dexketoprofen should not be used in patients with moderate to severe renal impairment (creatinine clearance 59 ml/min or less) — this is a contraindication.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance, to any other NSAID, or to any of the excipients
Patients in whom substances with a similar action (for example acetylsalicylic acid or other NSAIDs) precipitate attacks of asthma, bronchospasm, acute rhinitis, or cause nasal polyps, urticaria or angioneurotic oedema
Known photoallergic or phototoxic reactions during treatment with ketoprofen or fibrates
Active peptic ulcer or gastrointestinal haemorrhage, any history of gastrointestinal bleeding, ulceration or perforation (including that related to previous NSAID therapy), chronic dyspepsia, Crohn's disease or ulcerative colitis
Other active bleeding or bleeding disorders, haemorrhagic diathesis and other coagulation disorders
Severe heart failure; moderate to severe renal impairment (creatinine clearance 59 ml/min or less); severely impaired hepatic function (Child-Pugh score 10 to 15)
Severe dehydration caused by vomiting, diarrhoea or insufficient fluid intake
Third trimester of pregnancy and the lactation period

Side effects

Nausea and/or vomiting, abdominal pain, diarrhoea, dyspepsia (common); gastritis, constipation, dry mouth, flatulence (uncommon); peptic ulcer, ulcer haemorrhage or perforation (rare)
Headache, dizziness, somnolence (common); paraesthesia, syncope, insomnia, anxiety (uncommon)
Palpitations (uncommon), tachycardia and hypertension (rare), hypotension and flushing (uncommon)
Rash (uncommon); urticaria, acne, increased sweating (rare); Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, facial oedema, photosensitivity reaction and pruritus (very rare)
Acute renal failure and polyuria (rare); nephritis or nephrotic syndrome (very rare); hepatocellular injury and abnormal liver function tests; neutropenia and thrombocytopenia (rare)

Clinical monograph

How it works

It is a non-selective inhibitor of cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin-mediated inflammation and nociceptive sensitisation; the S(+)-enantiomer carries the analgesic activity.

Prescribing in practice

Use the lowest effective dose for the shortest possible duration to limit gastrointestinal, renal and cardiovascular risk, and consider gastroprotection in those at risk of ulceration.
Contraindicated in active peptic ulceration, significant renal or hepatic impairment, severe heart failure and the third trimester of pregnancy.
Caution with concomitant anticoagulants, antiplatelets, SSRIs, diuretics, ACE inhibitors and other NSAIDs because of additive bleeding and renal risk.

Monitoring

Monitor blood pressure, renal function and for gastrointestinal symptoms in those on prolonged courses or with risk factors.

Counselling the patient

Take with or after food to reduce stomach upset.
Report black stools, vomiting blood, indigestion or unexplained swelling.
This is intended for short-term use only, not regular long-term pain control.

Evidence & guidelines

MHRA and NICE advice on NSAIDs emphasises using the lowest effective dose for the shortest duration owing to dose-related gastrointestinal and cardiovascular risk.

Reference: NICE NG124; SPC Keral; RCT Dexketoprofen vs Morphine (acute musculoskeletal pain); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways