NSAID (S-enantiomer of ketoprofen) Pregnancy: Contraindicated during the third trimester of pregnancy and during lactation. During the first and second trimester dexketoprofen should not be given unless clearly necessary, and if used the dose should be kept as low and the duration as short as possible - prostaglandin synthesis inhibition may adversely affect pregnancy and embryo/foetal development, with epidemiological concern about increased risk of miscarriage, cardiac malformation and gastroschisis in early pregnancy. From the 20th week of pregnancy onward it may cause oligohydramnios from foetal renal dysfunction and ductus arteriosus constriction - consider antenatal monitoring after exposure for several days from gestational week 20 and discontinue if either is found. In the third trimester all prostaglandin synthesis inhibitors may expose the foetus to cardiopulmonary toxicity (premature constriction/closure of the ductus arteriosus and pulmonary hypertension) and renal dysfunction, and the mother and neonate to prolonged bleeding time and inhibition of uterine contractions. Use may impair female fertility and is not recommended in women attempting to conceive.

Dexketoprofen

Brand names: Keral, Sympal

Dexketoprofen is a non-steroidal anti-inflammatory drug (the active enantiomer of ketoprofen) used for the short-term relief of mild to moderate acute pain.

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 every 4-6 hours, or 25 mg every 8 hours, according to the nature and severity of pain

Route: Oral - the tablet should be swallowed with a sufficient amount of fluid (e.g. one glass of water). Concomitant administration with food delays the absorption rate, so in acute pain it is recommended that administration is at least 30 minutes before meals. Source product: Keral 25 mg film-coated tablets.

Frequency: Every 4-6 hours for the 12.5 mg dose, or every 8 hours for the 25 mg dose

Max: The total daily dose should not exceed 75 mg. Reduced maximum of 50 mg total daily dose in the elderly, in mild to moderate hepatic impairment and in mild renal impairment.

Source: UK SPC (eMC) 4.2 for Keral 25 mg film-coated tablets (https://www.medicines.org.uk/emc/product/159/smpc). VERBATIM: 'According to the nature and severity of pain, the recommended dosage is generally 12.5 mg (half a tablet) every 4-6 hours or 25 mg every 8 hours. The total daily dose should not exceed 75 mg.' The 12.5 mg dose is half of a 25 mg tablet. DURATION: 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. ELDERLY: start therapy at the lower end of the dosage range (50 mg total daily dose); the dosage 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 therapy at reduced doses (50 mg total daily dose) and be closely monitored; dexketoprofen should not be used in severe hepatic impairment (Child-Pugh 10-15, which is a contraindication). PAEDIATRIC: 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. CAUTION: use with concomitant other NSAIDs, including cyclooxygenase-2 selective inhibitors, should be avoided; caution in patients receiving concomitant medicines that could increase the risk of ulceration or bleeding such as oral corticosteroids, anticoagulants such as warfarin, SSRIs or antiplatelet agents such as acetylsalicylic acid. Combination therapy with protective agents (e.g. misoprostol or a proton pump inhibitor) should be considered for patients at gastrointestinal risk. NOTE: the eMC 4.5 interactions section was not retrieved in this bundle and no US label was available - source the UK SPC 4.5 separately.

Dose adjustments

Renal

The initial dosage should be reduced to 50 mg total daily dose in patients with mildly impaired renal function (creatinine clearance 60-89 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 (e.g. 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, or any history of gastrointestinal bleeding, ulceration or perforation (including bleeding or perforation related to previous NSAID therapy); chronic dyspepsia
Other active bleeding or bleeding disorders; haemorrhagic diathesis and other coagulation disorders
Crohn's disease or ulcerative colitis
Severe heart failure
Moderate to severe renal impairment (creatinine clearance 59 mL/min or less)
Severely impaired hepatic function (Child-Pugh score 10-15)
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)
Headache, dizziness, somnolence, insomnia, anxiety (common/uncommon)
Gastritis, constipation, dry mouth, flatulence (uncommon); peptic ulcer, peptic ulcer haemorrhage or perforation (rare, sometimes fatal, particularly in the elderly)
Rash (common); urticaria, acne, increased sweating (uncommon); Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, photosensitivity reaction (rare)
Palpitations, flushing, hypertension, hypotension; oedema, hypertension and cardiac failure have been reported in association with NSAID treatment
Acute renal failure, polyuria (rare); nephritis or nephrotic syndrome (very rare)
Anaphylactic reaction including anaphylactic shock (rare); bronchospasm, dyspnoea

Clinical monograph

How it works

It non-selectively inhibits cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin synthesis and thereby producing analgesic, anti-inflammatory and antipyretic effects.

Prescribing in practice

Like other NSAIDs it carries risks of gastrointestinal ulceration and bleeding, cardiovascular and renal adverse effects, so it should be used at the lowest effective dose for the shortest duration.
Contraindicated in active or previous peptic ulceration/GI bleeding, severe heart failure, significant renal impairment and in late pregnancy.
Use caution with other NSAIDs, anticoagulants, antiplatelets, and drugs affecting renal function, and consider gastroprotection in at-risk patients per current prescribing references.

Monitoring

Assess renal function, blood pressure and for gastrointestinal symptoms, particularly in older or at-risk patients and with longer use.

Counselling the patient

Take with or after food and use it only for short-term pain relief.
Stop and seek advice if you develop indigestion, black stools or signs of gastrointestinal bleeding.
Avoid taking other anti-inflammatory painkillers (including over-the-counter ones) at the same time.

Evidence & guidelines

NSAID gastrointestinal, cardiovascular and renal risks are well established and reflected in MHRA advice and the SPC.

Reference: NICE NG100; NICE CKS NSAIDs; MHRA; 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.

Pathways