Ketonal Duo is a non-steroidal anti-inflammatory drug that is intended for use in cases of pain in muscles and joints. Consider the instructions for using this medication, find out what indications and analogues it has.
The composition of the drug
One capsule contains 50 milligrams of the active substance, which is ketoprofen. Excipients are lactose along with magnesium stearate and silicon dioxide. The composition of the capsule shell of the drug is made of gelatin, titanium dioxide and a blue patented dye.
What does the instruction manual for Ketonal Duo tell us?
Pharmacological effects
This drug is a non-steroidal anti-inflammatory drug derived from propionic acid. It can have an analgesic, and at the same time anti-inflammatory and antipyretic effect. Ketonal Duo can block the action of COX-1 enzymes, and in addition, COX-2, and partially affects lipoxygenases, which inhibits the synthesis of prostaglandins.
This drug can stabilize lysosomal membranes, and at the highest concentrations, ketoprofen inhibits the synthesis of leukotrienes and bradykinin. The active component is ketoprofen, does not have any negative effect on the condition of articular cartilage.
Pharmacokinetics of the drug
Ketonal Duo is a dosage form that differs from the already known capsules in the way they release the main component. Modified-release capsules include two types of pellets: white and yellow. The active substance (ketoprofen) can be released very quickly from white pellets, and from yellow, on the contrary, slowly. This leads to a combination of quick and prolonged exposure.
By the strength of its effect, Ketonal Duo is not inferior to injections.
The presented drug is well absorbed immediately after oral administration. The bioavailability of ketoprofen in the form of standard capsules and those characterized by modified release is 90%.
Food intake does not affect the bioavailability of ketoprofen, but reduces the rate of absorption. After ingestion of the active substance in a dose of 150 milligrams in capsule form, characterized by modified release, the maximum concentration is 9036 nanograms per milligram for one and a half hours. This is confirmed by the instruction for Ketonal Duo.
Drug Distribution and Metabolism
The binding of ketoprofen to plasma protein (i.e., albumin) is approximately 99%. Ketoprofen easily penetrates the synovial fluid, where it reaches a 30 percent plasma concentration. Significant concentrations of the active substance in the synovial fluid are stable and last up to 30 hours, as a result of which the presence of pain and stiffness in the joints decreases for a long period of time.
Ketoprofen can undergo intensive metabolism as part of a microsomal liver enzyme that can bind to glucuronic acid, and then is excreted in the form of glucuronide. There are no active metabolites of ketoprofen.
Approximately 80% of the active ingredient is excreted in the urine mainly in the form of ketoprofen glucuronide. 10% leaves the body through the intestines. Against the background of the use of ketoprofen at a dose of 100 milligrams or more, excretion through the kidneys may be difficult.
Does Ketonal Duo help with toothache? We will talk about this at the end of the article.
Other drug information
In patients who suffer from severe kidney failure, a large proportion of the drug may be excreted through the intestines. Against the background of taking in high dosages, hepatic clearance also increases. Through the intestines, up to 40% of the drug is excreted.
In patients who suffer from liver failure, the plasma concentration of the main component is doubled, which is most likely due to hypoalbuminemia, and also due to the high level of unbound ketoprofen. Such patients are advised to prescribe such medications in minimal therapeutic doses.
In patients with kidney failure, ketoprofen clearance is reduced. However, dose adjustment is only required in cases of severe failure. In elderly people, the metabolism with the elimination of ketoprofen is much slower, which has clinical significance only for patients with severe renal failure.
Ketonal Duo: indications for use
The presented drug, as a rule, is prescribed by doctors as part of symptomatic therapy of painful, and in addition, inflammatory processes of different genesis. Thus, "Ketonal Duo" is appropriate for the appointment of inflammatory and degenerative diseases of the supporting and motor systems:
- In the presence of rheumatoid arthritis.
- With the appearance of seronegative arthritis, that is, with ankylosing spondylitis, ankylosing spondylitis, psoriatic or reactive arthritis and Reiter's syndrome.
- With gout and pseudogout.
- With the development of osteoarthrosis.
In addition, Ketonal Duo capsules are prescribed as part of the treatment of pain, with symptoms such as:
- The appearance of headaches.
- The presence of tendonitis, bursitis, myalgia, neuralgia, radiculitis.
- The development of post-traumatic and postoperative pain.
- The appearance of pain in cancer.
- The presence of algodismenorea.
How many days to take Ketonal Duo? The course of treatment is determined by the doctor.
This drug is used to produce an effect. The pain subsided, and the drug was stopped. If the pain syndrome is persistent, and the drug is taken for more than a month, then you should take blood tests (general and biochemistry), a urinalysis, and also conduct a series of examinations, for example, ultrasound of the abdomen and kidneys.
Contraindications
The presented drug has a wide list of various contraindications:
- The presence of hypersensitivity to the main component - ketoprofen, or other substances of the drug. In addition, this drug should not be used if there is sensitivity to substances such as salicylates and thiaprofenic acid.
- The presence of a complete or incomplete combination of bronchial asthma with recurrent polyposis of the nose and paranasal sinuses along with intolerance to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs.
- The presence of erosive and ulcerative lesions of the digestive system, which are in the phase of their exacerbation.
- The appearance of ulcerative colitis and Crohn's disease.
- The presence of hemophilia and other bleeding disorders.
- The presence of severe liver failure.
- The development of active liver disease.
- The development of severe renal failure.
- The presence of progressive kidney disease.
- The development of decompensated heart failure.
- This drug should not be taken against the background of the postoperative period after coronary artery bypass grafting.
- The appearance of gastrointestinal, cerebrovascular and other bleeding. And also with any suspicion of possible bleeding.
- The presence of diverticulitis.
- The appearance of inflammatory bowel disease.
- Presence of confirmed hyperkalemia.
- The development of chronic dyspepsia.
- Children under 15 years old, and in addition, in the third trimester of pregnancy due to the danger to the fetus.
- During breastfeeding.
- Patient intolerance to lactose along with lactase deficiency and glucose syndrome and galactose malabsorption.
When should the drug be prescribed with caution?
With caution, injections and capsules "Ketonal Duo" is prescribed in the following cases:
- A history of peptic ulcer.
- Bronchial asthma.
- Clinically expressed cerebrovascular pathologies, as well as vascular and heart diseases.
- Peripheral artery disease along with dyslipidemia and progressive liver disease.
- Hepatic failure, hyperbilirubinemia and alcoholic cirrhosis.
- Renal and chronic heart failure along with arterial hypertension.
- Blood diseases, dehydration and diabetes.
- Digestive ulcer in combination with the presence of Helicobacter pylori infection.
- Severe somatic diseases along with smoking.
- Concomitant therapy with anticoagulants, for example, Warfarin.
- Treatment with antiplatelet agents, for example, acetylsalicylic acid.
- The use of oral glucocorticosteroids, for example, Prednisolone.
- Simultaneous administration of selective inhibitors, for example, Sertraline, Citalopram.
What Ketonal Duo helps with, now we know.
Drug dosage
This medicine should be used by mouth. The standard dose for adults and children over 15 years old is 150 milligrams. This amount of active substance contains one capsule.
Capsules can be taken during or after meals. Drink the drug with water, you can also use milk. In this case, the total volume of liquid should be at least 100 milliliters. The maximum dose of ketoprofen per day is 200 milligrams.
Side effects
This drug may cause certain side effects. So, the blood and lymphatic system in rare cases is associated with hemorrhagic anemia, purpura, agranulocytosis, thrombocytopenia and impaired bone marrow hematopoiesis. The immune system can respond with an anaphylactic reaction.
The functioning of the nervous system while using Ketonal Duo may be accompanied by headaches, dizziness, drowsiness, paresthesia, convulsions, a violation of taste sensations and emotional lability. The senses react with the appearance of fuzzy visual perception and tinnitus.
Patients may also have heart failure along with increased pressure and vasodilation. The respiratory system reacts with exacerbation of bronchial asthma, the appearance of bronchospasm and rhinitis. I must say that bronchospasm is mainly observed in patients who are hypersensitive to non-steroidal anti-inflammatory drugs.
The digestive system during the use of this drug may be accompanied by nausea, vomiting, dyspepsia, abdominal pain, constipation, diarrhea, bloating, gastritis, peptic ulcer and stomatitis. Exacerbation of colitis with Crohn's disease, intestinal bleeding and perforation is less common. The liver and bile ducts respond with hepatitis, an increase in transaminases, and in addition, bilirubin.
A rash and itching may appear on the skin. Photosensitivity may also occur along with alopecia, urticaria, angioedema, erythema, bullous rash and toxic epidermal necrolysis.
The urinary system can respond to acute renal failure, interstitial nephritis, nephritic syndrome, and abnormal renal function indices.
Among other adverse symptoms, edema with increased fatigue, an increase in body weight in patients, and so on, are observed.
Overdose
Symptoms of an overdose of pain medication “Ketonal Duo”, like other cases with an excess of ketoprofen, can be noted by the appearance of nausea, vomiting, pain in the abdomen, melena, impaired consciousness, respiratory depression, convulsions and renal failure.
In case of an overdose, you should rinse your stomach and take the necessary amount of activated carbon. It is advisable to perform symptomatic treatment. The effect of ketoprofen on the digestive system is attenuated with the help of drugs that reduce the secretion of the glands of the stomach, for example, proton pump inhibitors and prostaglandins. In cases of kidney failure, hemodialysis is recommended.
Drug interaction
Ketoprofen tablets - Ketonal Duo, can weaken the effects of diuretics and antihypertensive drugs. In addition, it enhances the work of oral hypoglycemic and anticonvulsant medications. Joint use with other non-steroidal anti-inflammatory drugs, salicylates, and in addition, with ethanol can increase the risk of undesirable effects on the digestive system.
The simultaneous use with such groups of drugs as anticoagulants, thrombolytics and antiplatelet agents increases the risk of bleeding. Concomitant use with potassium, potassium-sparing diuretic, low molecular weight heparin and cyclosporins may increase the risk of hyperkalemia.
The presented drug increases the concentration of cardiac glycosides in plasma. It also helps to increase slow calcium channel blockers, cyclosporins, and methotrexates. Against this background, the toxicity of methotrexates and the nephrotoxicity of cyclosporins increase. The simultaneous use of the drug "Ketonal Duo" with probenecids significantly reduces the clearance of ketoprofen in the blood.
Special instructions for using the medication
Against the background of prolonged use of non-steroidal anti-inflammatory drugs, it is necessary to monitor the state of the blood, as well as the function of the kidneys and liver, especially in patients in old age (over 65).
In addition, caution and pressure monitoring when using ketoprofen in the treatment of patients with hypertension and heart, as well as vascular diseases are necessary. These pathologies can lead to fluid retention in the body. Like other non-steroidal anti-inflammatory drugs, ketoprofen can mask the symptoms of infectious diseases.
How long does Ketonal Duo work? The drug relieves pain for about 5-6 hours. The use of the drug in the recommended dosage does not affect the ability to drive a car. But, nevertheless, patients who notice non-standard effects while taking Ketonal Duo are advised to exercise caution when engaging in hazardous activities. This applies to those that require increased attention and speed of psychomotor reaction.
Ketonal Duo and alcohol
The simultaneous use of alcohol and this drug can exacerbate the therapeutic effect, which increases the risk of bleeding. There is also a high percentage of poisoning and liver damage.
Pregnancy Use
The process of inhibition of prostaglandin synthesis can have an undesirable effect on the course of pregnancy, as well as on embryonic development. Information that was obtained during an epidemiological study when using synthesis inhibitors in the early stages confirms the increased risk of spontaneous abortion and the development of heart disease.
Prescribing this drug to pregnant women during the first two trimesters is allowed only in situations where the health benefits of a woman justify the likely risk to the fetus.
Ketoprofen is completely contraindicated in pregnant women in the third trimester due to the possibility of the formation of weakness of uterine activity during childbirth. It can also cause premature closure of the ductus arteriosus, an increase in bleeding time, oligohydramnios and renal failure are not ruled out.
At the moment, there is no information on the allocation of ketoprofen with milk. Thus, if there is a need to take ketoprofen by a nursing woman, it is required to stop breastfeeding.
What are the analogues of Ketonal Duo? Consider in detail how it can be replaced.
Analogues of the drug
Among the most popular analogues of the Ketonal Duo drug are such drugs as Fastum Gel along with the usual Ketonal, Bystrumgel, Arthrosilen, Flexen, Flamax Fort, Arketal and Artrum ".
Reviews about the drug
Doctors call the presented remedy an interesting non-steroidal anti-inflammatory drug, which combines a high speed of achieving the effect with a long duration of action. Against the backdrop of severe inflammatory diseases, the effect of this medicine, according to experts, can last up to 20 hours.
As for moderately expressed inflammations, then against their background the total duration of the effect is equal to the declared 24 hours. Like other drugs with ketoprofen, the analgesic effect of the drug partially prevails over the anti-inflammatory effect.
Patients themselves write in their reviews of Ketonal Duo that it is an excellent medicine that perfectly relieves pain with inflammatory phenomena. It is often prescribed for people with symptoms of renal colic, acute cystitis, prostatitis and urethritis, which is done as part of complex therapy.
Among the minuses, patients in the reviews on Ketonal Duo note an excessively strong effect of the drug on the digestive system. In addition, it is not suitable for patients with peptic ulcer disease and generally has a large number of contraindications. It is not uncommon for patients to complain of dyspeptic disorders. Consumers are not happy with the high cost of the medicine, which starts at 400 rubles per package.
Nevertheless, the presented drug is a fairly popular and often bought remedy. People note its powerful analgesic effect, and also say that it acts very softly and quickly, already 10 minutes after taking it, relieves, for example, toothache. Also, patients like its convenient dosage.