In Brief
| Ketoprofen | |
|---|---|
| Overall NNT at 50 mg | 2.9 (95% CI 2.4–3.7) |
| In dental pain | 1.8 (1.5–2.2), 3 studies, 190 participants |
| In other surgery | 4.2 (3.0–6.7), 5 studies, 404 participants |
| Significance of the gap | P < 0.00006 |
| Germany | Prescription-only, no exceptions |
| France | Almost all prescription; one OTC form at 25 mg |
| Italy | 68 of 105 oral packs OTC, up to 80 mg per dose |
An average is the most treacherous quantity in medicine. It describes a group and almost never describes a person. Ketoprofen is a rare case where that is visible directly in the review's own numbers.
Two Pictures Instead of One
The overall figure for ketoprofen 50 mg is an NNT of 2.9. It looks modest and places the drug at the bottom of the five. But split it by type of procedure and the average ceases to exist:
| Type of pain | NNT | Data |
|---|---|---|
| After tooth extraction | 1.8 (1.5–2.2) | 3 studies, 190 participants |
| After other surgery | 4.2 (3.0–6.7) | 5 studies, 404 participants |
The difference is more than twofold, and it is statistically significant: P below 0.00006. The two subgroups' confidence intervals do not overlap.
The Cochrane authors note this gap separately and call it unusual. Most analgesics differ between pain types, but rarely by this much.
The practical conclusion is direct. The average of 2.9 describes no real situation: it sits between two different results, and no patient falls into it.
The Same in Dexketoprofen
Dexketoprofen is the active half of the ketoprofen molecule, so its doses are halved. Its split is the same: 2.7 in dental pain against 5.7 in other procedures.
That is an important detail: the peculiarity belongs to the substance itself, not to a particular formulation or manufacturer.
Why This Might Be
The review offers no explanation, and it is honest to say that none exists. A plausible hypothesis: pain after tooth extraction has a pronounced inflammatory component, and ketoprofen is a potent suppressor of prostaglandin synthesis — that is, it works along precisely the inflammatory route.
But that is a hypothesis rather than a demonstrated mechanism, and presenting it as established fact would be the same overreach this whole series warns against.
Where It Is Sold — and Why the Common Claim Is Wrong
The statement «oral ketoprofen is prescription-only in Europe» is common and wrong. Checking the national registers of three countries gives three different pictures.
Germany — prescription-only, no exceptions. In the regulation that lists prescription-only substances, ketoprofen appears as a bare entry, with no qualifier by dose, duration or route. For contrast: neighbouring dexibuprofen has its over-the-counter carve-out written in explicitly — up to 200 mg per dose, 600 mg a day, no longer than four days. Ketoprofen has no such carve-out, so over-the-counter oral forms cannot exist there.
France — almost all prescription. Profenid, Ketum and the modified-release forms all sit on the prescription list. But there is one exception: Toprec 25 mg, the single over-the-counter entry, for adults and adolescents from 15, at most three tablets a day. The duration limit sits in the leaflet — five days for pain.
Italy — the most permissive of the three. Of 105 oral ketoprofen packs, 68 are sold without prescription. These are mostly the lysine salt and low strengths: 40 mg granulate and tablets, 25 mg effervescent, drops, 25 mg capsules. The highest over-the-counter single dose of the three countries is 80 mg. Italian documents set no numerical day limit: duration is described as «limited to overcoming the pain episode».
Safety
- Stomach. Ketoprofen sits among the NSAIDs with a notable gastrointestinal risk; with a history of peptic ulcer, only on a doctor's decision.
- Kidneys and blood pressure. As with the whole class, it reduces renal blood flow and can raise blood pressure.
- Never two NSAIDs at once. The analgesia does not add up; the risk does.
- Over-the-counter does not mean harmless. In Italy ketoprofen is sold freely at doses up to 80 mg, but it is the same drug with the same risks; the absence of a day limit in the documents does not mean weeks of use are safe.
The Bottom Line
Ketoprofen illustrates neatly why painkiller rankings deserve caution. Its place at the bottom of the list is set by an average that does not exist in reality: in dental pain it performs like the leader, in other procedures markedly worse.
Choose by situation rather than by table, and for dental pain it is one of the better-founded options. As for «ketoprofen is prescription-only in Europe» — that belief is worth dropping: it holds for Germany alone.
About buying
The drug is in the catalogue: OKI (ketoprofen lysine salt) 80 mg. No price is shown — prescription medicines are ordered through the chat, and the administrator confirms availability and cost. The prescribing stays with a doctor: this guide explains what is known about the drug, it does not replace a consultation.
