Acute mild-to-moderate pain
First line
Non-steroidal anti-inflammatory drugs, propionic acid derivatives
ATC code: M01AE17 (Dexketoprofen)
Brand names
Enantyum
Dexketoprofen is the dextrorotatory enantiomer of ketoprofen (S-(+)-ketoprofen), the active form. It non-selectively inhibits cyclooxygenases COX-1 and COX-2, blocking prostaglandin and thromboxane synthesis. Analgesic and anti-inflammatory effect develops within 30 minutes after oral administration, peak at 30-60 minutes. Half-life 1.65 hours – substantially shorter than racemic ketoprofen. Efficacy is comparable to diclofenac 50 mg and ibuprofen 400 mg at lower dose and with faster onset.
First line
Dexketoprofen 25 mg orally or 50 mg IM/IV is first-line therapy for acute mild-to-moderate pain: postoperative pain, dental pain, primary dysmenorrhea, musculoskeletal pain. Cochrane review Barden 2009 (10 RCTs, n=2155) showed NNT=3.2 for 20-25 mg in postoperative pain – comparable to other NSAIDs. Advantage of dexketoprofen is faster onset (30 minutes vs 60 minutes for ibuprofen and paracetamol). Maximum daily dose 75 mg (three 25 mg doses). Treatment course should not exceed 7 days.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Dexketoprofen is a nonsteroidal anti-inflammatory drug (NSAID). It is prescribed for short-term symptomatic treatment of acute pain (AEMPS Ficha Técnica). For unconfirmed migraine, any headache, or vigor in fatigue, dexketoprofen is not used: for migraine, triptans and other proven options work; for fatigue, NSAIDs do not help (they are not an anti-fatigue drug). Regular dexketoprofen use creates risks of severe gastrointestinal bleeding, perforation, cardiovascular events, and acute kidney injury. If dexketoprofen was prescribed for migraine or vigor, consider seeking a second opinion.
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Use cautiously in trimesters 1-2; contraindicated in trimester 3 (risk of premature closure of the ductus arteriosus and impaired fetal renal function).
Contraindicated during breastfeeding: drug is excreted in breast milk.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Dexketoprofen is evaluated for the following indications with varying evidence strength: Acute mild-to-moderate pain (evidence tier A), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Dexketoprofen (≥ 1 in 100): Nausea, heartburn, abdominal discomfort, Diarrhoea, Headache, dizziness, Rash, Transaminase elevation. See the Safety section for uncommon and serious reactions.
FDA category C. Use cautiously in trimesters 1-2; contraindicated in trimester 3 (risk of premature closure of the ductus arteriosus and impaired fetal renal function).
Contraindicated during breastfeeding: drug is excreted in breast milk.
Dexketoprofen is contraindicated in: Hypersensitivity to NSAIDs; Active peptic ulcer disease; GI bleeding; Severe hepatic or renal impairment; Severe heart failure (NYHA IV). Full list in the Safety section.