ケトプロフェン

動物種別の用量

投与経路

禁忌

• Known hypersensitivity to ketoprofen or other NSAIDs
• Active gastrointestinal ulceration or bleeding
• Significant renal or hepatic impairment
• Late pregnancy (due to risk of premature closure of the patent ductus arteriosus)
• Intra-arterial administration
• Dehydrated, hypovolaemic, or hypotensive patients
• Patients with pre-existing gastrointestinal disease
• Patients with blood clotting problems
• Pregnant animals
• Animals < 6 weeks of age

有害事象

• Horses: Gastric mucosal damage, GI ulceration, renal crest necrosis, mild hepatitis, injection site inflammation (IM)
• Dogs and Cats: Vomiting, anorexia, gastrointestinal ulceration, renal toxicity
• General: Masking of infection signs (inflammation, hyperpyrexia)
• Gastrointestinal signs (vomiting, diarrhea, anorexia)
• Gastrointestinal ulceration and bleeding
• Renal toxicity (especially in dehydrated/hypotensive patients)
• Hepatic accumulation (in patients with liver disease)
• Potential precipitation of cardiac failure (rare/unknown risk in animals)

薬物相互作用

• Aminoglycosides (gentamicin, amikacin) · Increased risk for nephrotoxicity.
• Anticoagulants (heparin, LMWH, warfarin) · Increased risk for bleeding.
• Aspirin · Plasma levels of ketoprofen could decrease; increased likelihood of GI adverse effects (blood loss). Concomitant use is not recommended.
• Bisphosphonates (alendronate) · May increase risk for GI ulceration.
• Corticosteroids · Concomitant administration significantly increases the risks for GI adverse effects and ulceration.
• Cyclosporine · May increase risk for nephrotoxicity.
• Fluconazole · May increase NSAID levels.
• Furosemide · Ketoprofen may reduce the saluretic and diuretic effects of furosemide.
• Highly Protein Bound Drugs (phenytoin, valproic acid, sulfonamides) · Ketoprofen is 99% protein-bound and may displace other drugs, leading to increased serum levels and duration of action.
• Methotrexate · Serious toxicity has occurred when NSAIDs are used concomitantly; use with extreme caution.
• Probenecid · May cause a significant increase in serum levels and half-life of ketoprofen.
• Other NSAIDs · Increased risk of severe gastrointestinal ulceration and renal toxicity. Do not administer concurrently or within 24 hours. · major

モニタリング

• Clinical efficacy (reduction in pain, lameness, or fever)
• Adverse effects (monitor for vomiting, diarrhea, melena, or anorexia)
• Baseline and periodic liver and renal function tests (BUN, Creatinine, ALT, AST) are recommended with long-term therapy
• Clinical signs of gastrointestinal ulceration (vomiting, melena, anorexia)
• Renal parameters (BUN, Creatinine, USG) especially in older or compromised patients
• Hepatic enzymes
• Hydration status and blood pressure

過量投与

As with any NSAID, overdosage can lead to severe **gastrointestinal** and **renal** toxicity. * **Dogs**: The LD50 after oral ingestion is reported to be 2000 mg/kg, but exposures as low as **0.44 mg/kg** have caused GI ulcers. Common clinical signs of toxic exposure include vomiting. * **Cats**: Highly sensitive; have developed renal toxicity at doses as low as **0.7 mg/kg**. * **Horses**: Generally tolerate higher doses. Doses up to 11 mg/kg IV once daily for 15 days showed no toxicity. However, severe laminitis occurred at 33 mg/kg/day (15X label dose) for 5 days. At 55 mg/kg/day (25X label dose), horses developed anorexia, depression, icterus, abdominal swelling, gastritis, nephritis, and hepatitis. **Treatment**: * **Decontamination**: Emetics and/or activated charcoal are appropriate for recent oral exposures. * **GI Protection**: Use of gastrointestinal protectants (e.g., omeprazole, sucralfate, misoprostol) is strongly warranted if GI effects are expected. * **Renal Protection**: Aggressive IV fluid diuresis is warranted to support renal perfusion if renal effects are expected.