Clinical Drug Investigation

, Volume 32, Issue 4, pp 221–233 | Cite as

Non-Steroidal Anti-Inflammatory Drugs and Gastroprotection with Proton Pump Inhibitors

A Focus on Ketoprofen/Omeprazole
  • Antonio Gigante
  • Ignacio TagarroEmail author
Review Article


Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed agents for rheumatic disorders such as osteoarthritis (OA), rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Despite the known association between NSAID use and gastropathy, however, only around one-third of patients at risk of NSAID-induced gastrointestinal toxicity receive adequate gastroprotection, and as many as 44% of these patients are non-adherent. We review the co-prescription of proton pump inhibitors (PPIs) for the prevention of NSAID-induced gastropathy, with a particular focus on the first fixed-dose NSAID/PPI formulation: ketoprofen/omeprazole modified-release capsules.

The ketoprofen/omeprazole fixed-dose combination is available in doses of 100 mg/20 mg, 150 mg/20 mg or 200 mg/20 mg as a single capsule for once-daily administration. Ketoprofen monotherapy has been shown to be generally equivalent to other NSAIDs when used in the treatment of OA. In RA, ketoprofen has demonstrated equivalent efficacy to diclofenac, indometacin, piroxicam, aceclofenac, phenylbutazone, naproxen and flurbiprofen. Studies comparing ketoprofen with ibuprofen and sulindac in patients with RA have, in general, favoured ketoprofen. Studies in AS have generally reported similar efficacy between ketoprofen and phenylbutazone and pirprofen.

Prophylaxis with omeprazole is effective for the prevention of gastroduodenal ulcers, maintenance of remission and alleviation of dyspeptic symptoms in NSAID recipients. Omeprazole is well tolerated, and adverse events are generally gastrointestinal in nature.

The fixed-dose combination of ketoprofen and omeprazole has demonstrated bioequivalence to the respective monotherapies. The incidence of digestive symptoms and the need for dose reduction was reported to be lower with the combination than with its components.

Ketoprofen/omeprazole modified-release capsules are the first fixed-dose NSAID/PPI formulation to be approved. This formulation ensures compliance with the gastroprotective prophylaxis, as whenever the NSAID is taken, the PPI is co-administered. Additionally, the once-daily formulation has the potential to improve adherence to anti-inflammatory therapy.


Ankylose Spondylitis Omeprazole Ketoprofen Misoprostol Nimesulide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Both authors contributed to this work. Ignacio Tagarro conceived the article outline. Antonio Gigante provided critical intellectual input in refining the review to its final form. Ignacio Tagarro is an employee of Meda Pharmaceuticals, Madrid, Spain. Antonio Gigante has no conflicts of interest that are directly relevant to the content of this article. The authors thank Claire Byrne and Gillian Keating of inScience Communications, a Wolters Kluwer business, who provided medical writing assistance at all stages of the development of this manuscript. Medical writing assistance was funded by Meda.


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Copyright information

© Adis Data Information BV 2012

Authors and Affiliations

  1. 1.Clinical Orthopaedics-Department of Molecular Pathology and Innovative TherapiesPolytechnic University of MarcheAnconaItaly
  2. 2.Meda Pharmaceuticals, Parque E. San Fernando, Edif. BerlínMadridSpain

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