Enantioselective pharmacokinetics of ketoprofen in piglets: the significance of neonatal age

Pharmacokinetic/pharmacodynamic modeling of ketoprofen and flunixin at piglet castration and tail-docking

This study performed population‐pharmacokinetic/pharmacodynamic (pop‐PK/PD) modeling of ketoprofen and flunixin in piglets undergoing routine castration and tail‐docking, utilizing previously published data. Six‐day‐old male piglets (8/group) received either ketoprofen (3.0 mg/kg) or flunixin (2.2 mg/kg) intramuscularly. Two hours post‐dose, piglets were castrated and tail docked. Inhibitory indirect response models were developed utilizing plasma cortisol or interstitial fluid prostaglandin E2 (PGE2) concentration data. Plasma IC50 for ketoprofen utilizing PGE2 as a biomarker was 1.2 μg/ml, and ED50 for was 5.83 mg/kg. The ED50 calculated using cortisol was 4.36 mg/kg; however, the IC50 was high, at 2.56 μg/ml. A large degree of inter‐individual variability (124.08%) was also associated with the cortisol IC50 following ketoprofen administration. IC50 for flunixin utilizing cortisol as a biomarker was 0.06 μg/ml, and ED50 was 0.51 mg/kg. The results show that the currently marketed doses of ketoprofen (3.0 mg/kg) and flunixin (2.2 mg/kg) correspond to drug responses of 33.97% (ketoprofen‐PGE2), 40.75% (ketoprofen‐cortisol), and 81.05% (flunixin‐cortisol) of the maximal possible responses. Given this information, flunixin may be the best NSAID to use in mitigating castration and tail‐docking pain at the current label dose.

Drug Interaction between Dexamethasone and Ketoprofen with Thiopental in Male Dogs: Effect on the Recovery from Anesthesia and Pharmacokinetics Parameters

Drug-drug interactions (DDIs) are an important part of clinical veterinary pharmacology. Forty-two healthy mixed breed male dogs were randomly divided into three groups. The control group (C) received normal saline (1 mg/kg) 5 minutes before intravenous administration of thiopental (17 mg/kg), the T1 group received ketoprofen (2.2 mg/kg), and the T2 group received dexamethasone (0.2 mg/kg) 5 minutes before thiopental, respectively. Clinical parameters of anesthesia, heart rate, respiration rate, and electrocardiography were measured. Serum samples were also used to assay thiopental concentration using the high-performance liquid chromatography (HPLC) method, and then, thiopental pharmacokinetic parameters were calculated. Changes in the heart rate and respiration were significant intragroup differences 5 and 10 minutes after anesthesia, respectively. Recovery time parameters showed a significant increase between T1 and control groups (P < 0.05). Elimination rate and half-life of thiopental in the T1 group compared to the control and T2 groups showed a significant decrease and increase, respectively. In addition, the distribution of thiopental in T1 showed a significant increase compared to other groups. However, thiopental clearance in T1 and T2 groups had no significant difference with control (P > 0.05). It can be concluded that drug interaction between ketoprofen and thiopental causes to change in the pharmacokinetics parameters and recovery time from anesthesia in comparison with dexamethasone.

Comparative Plasma and Interstitial Fluid Pharmacokinetics of Meloxicam, Flunixin, and Ketoprofen in Neonatal Piglets

Piglet castration and tail-docking are routinely performed in the United States without analgesia. Pain medications, predominately non-steroidal anti-inflammatory drugs, are used in the EU/Canada to decrease pain associated with processing and improve piglet welfare, however, past studies have shown the efficacy and required dose remain controversial, particularly for meloxicam. This study assessed the pharmacokinetics of three NSAIDs (meloxicam, flunixin, and ketoprofen) in piglets prior to undergoing routine castration and tail-docking. Five-day-old male piglets (8/group) received one of 3 randomized treatments; meloxicam (0.4 mg/kg), flunixin (2.2 mg/kg), ketoprofen (3.0 mg/kg). Two hours post-dose, piglets underwent processing. Drug concentrations were quantified in plasma and interstitial fluid (ISF) and pharmacokinetic parameters were generated by non-compartmental analysis. Time to peak concentration (T_max) of meloxicam, flunixin, and S(-)-ketoprofen in plasma were 1.21, 0.85, and 0.59 h, compared to 2.81, 3.64, and 2.98 h in the ISF, respectively. The apparent terminal half-life of meloxicam, flunixin and S(-)-ketoprofen were 4.39, 7.69, and 3.50 h, compared to 11.26, 16.34, and 5.54 h, respectively in the ISF. If drug concentrations in the ISF are more closely related to efficacy than the plasma, then the delay between the Tmax in plasma and ISF may be relevant to the timing of castration in order to provide the greatest analgesic effect.

Use of non-steroidal anti-inflammatory drugs in porcine health management

OBJECTIVE

Treatment of inflammation and pain management is an important topic in the welfare of pigs. It is very difficult for veterinary practitioners to choose the most appropriate product for a certain problem. This review aims to summarise and discuss the characteristics of different non-steroidal anti-inflammatory drugs (NSAIDs), as well as paracetamol and metamizole, available for pigs in the European Union.

METHODS

The databases Pubmed, Google Scholar, CliniPharm CliniTox and European Medicines Agency were searched. Relevant terms (eg,'meloxicam', 'fever', 'swine', 'pig', 'inflammation', 'castration', 'pain') were used to search for original articles, reviews and books. Only peer-reviewed articles were used. References from studies were also analysed in order to find additional relevant studies.

CONCLUSION

Studies which have investigated the efficacy of NSAIDs for different conditions, using different treatment regimens, are scarce. Most studies focused on the efficacy of NSAID-related pain alleviation in piglet castration, as well as the anti-inflammatory potential of NSAIDs in experimental inflammation models. Little research has been carried out on the use of metamizole, tolfenamic acid, paracetamol and sodium salicylate and their effect in pigs.

Use of Meloxicam or Ketoprofen for Piglet Pain Control Following Surgical Castration

Surgical castration of piglets is performed routinely on commercial pig farms, to prevent boar taint and minimize aggression. While this procedure is known to be painful, piglets are generally not provided any analgesic for pain relief, leading to welfare concerns. The objectives of this study were to assess the efficacy of two non-steroidal anti-inflammatory drugs (NSAIDs), meloxicam (MEL) (0.4 mg/kg or 1.0 mg/kg) and ketoprofen (KET) (6.0 mg/kg) in reducing behavioral indicators of pain in castrated piglets. This study also examined the utility of the Piglet Grimace Scale (PGS) as a pain assessment tool. Nineteen litters of 5-days-old male piglets (n = 120) were used and piglets within a litter were randomly assigned to one of eight possible treatments: 0.4 mg/kg MEL-castrated or uncastrated, 1.0 mg/kg MEL-castrated or uncastrated, 6.0 mg/kg KET-castrated or uncastrated, saline (castrated control), or sham (uncastrated control). Treatments were administered intramuscularly (IM) 20 min prior to surgical castration. Piglets were video recorded for 1 h pre-procedure, for 8 h immediately post-castration and for another hour, 24 h post-procedure. Twenty-one behaviors and postures were scored continuously for the first 15 min of each hour and 1,156 still images of piglet faces were collected and scored using the PGS. Within each treatment group post-castration, castrated piglets displayed significantly more pain-related behaviors than uncastrated piglets (0.4 mg/kg MEL: p = 0.0339, 1.0 mg/kg MEL: p = 0.0079, 6.0 mg/kg KET: p = 0.0034, Controls: p < 0.0001). Castrated piglets also grimaced significantly more post-procedure than uncastrated piglets (p = 0.0061). Compared to the castrated control, none of the NSAID treatments significantly reduced piglet pain behaviors (0.4 mg/kg MEL: p = 1.0000, 1.0 mg/kg MEL: p = 0.9995, 6.0 mg/kg KET: p = 0.4163) or facial grimacing. Piglets demonstrated significantly more pain behaviors 24 h post-castration than at all other time points (p < 0.0001). The PGS was a less effective measure to detect acute pain; however, our findings suggest it does have utility as a pain assessment tool in neonatal pigs. Our findings also indicate that the use of these NSAIDs were ineffective at alleviating castration-associated pain in piglets.

PK/PD modeling of flunixin meglumine in a kaolin-induced inflammation model in piglets

Flunixin is marketed in several countries for analgesia in adult swine but little is known about its efficacy in piglets. Thirty-two piglets (6-8 days old) were randomized to receive placebo saline (n = 11, group CONTROL) or flunixin meglumine intravenously at 2.2 (n = 11, group MEDIUM) or 4.4 (n = 10, group HIGH) mg/kg, 10 hr after subcutaneous injection of kaolin in the left metacarpal area. A hand-held algometer was used to determine each piglet's mechanical nociceptive threshold (MNT) from both front feet up to 50 hr after treatment (cut-off value of 24.5 newton). Serial venous blood samples were obtained to quantify flunixin in plasma using LC-MS/MS. A PKPD model describing the effect of flunixin on the mechanical nociceptive threshold was obtained based on an inhibitory indirect response model. A two-compartmental PK model was used. A significant effect of flunixin was observed for both doses compared to control group, with 4.4 mg/kg showing the most relevant (6-10 newton) and long-lasting effect (34 hr). The median IC50 was 6.78 and 2.63 mg/ml in groups MEDIUM and HIGH, respectively. The ED50 in this model was 6.6 mg/kg. Flunixin exhibited marked antinociceptive effect on kaolin-induced inflammatory hyperalgesia in piglets.

Effects of post-partum administration of ketoprofen on sow health and piglet growth

The effect of the non-steroidal anti-inflammatory drug ketoprofen on the post farrowing phase of sows was studied in a randomized, blinded, placebo-controlled trial. Ketoprofen (3mg/kg) was administered intramuscularly to 20 healthy sows for 3 days post-partum (p.p.). The control group (n=20) received a saline placebo. Backfat, number of days of constipation and days before feed refusal were measured. Body condition (BCS) and shoulder sores were scored for 1 week p.p. Changes in BCS, backfat and shoulder sore scores were analysed with ANOVA. Blood was collected on days -1, 0, 5 and 14 with respect to medication. Aspartate aminotransferase (AST), creatinine kinase (CK), haptoglobin and serum amyloid A (SAA) were quantified and analysed with a Mann-Whitney U test. BCS and backfat decreased less following ketoprofen administration than with the placebo (-0.08 ± 0.2 vs. -0.8 ± 0.2, 1.0 ± 0.8mm vs. -2.0 ± 0.9 mm, respectively; P<0.05 for both) during the first 2 weeks of lactation. The shoulder sore score deterioration was milder during days 4-6 p.p. with ketoprofen than placebo (P<0.05). Duration of constipation was shorter with ketoprofen than placebo (5.5 ± 0.3 vs. 6.4 ± 0.3 days p.p.; P<0.05). Incidences of feed refusal occurred later in the ketoprofen group than in the placebos (9.6 ± 0.9 vs. 3.8 ± 0.8 days p.p.; P<0.05). AST and SAA values were higher after ketoprofen administration than placebo on day 5 p.p. (P<0.05). It was concluded that ketoprofen appeared to benefit sows during the first 2 weeks post farrowing, but caused some tissue irritation.

Enantiospecific ketoprofen concentrations in plasma after oral and intramuscular administration in growing pigs

Background

Ketoprofen is a non-steroidal anti-inflammatory drug which has been widely used for domestic animals. Orally administered racemic ketoprofen has been reported to be absorbed well in pigs, and bioavailability was almost complete. The objectives of this study were to analyze R- and S-ketoprofen concentrations in plasma after oral (PO) and intra muscular (IM) routes of administration, and to assess the relative bioavailability of racemic ketoprofen for both enantiomers between those routes of administration in growing pigs.

Methods

Eleven pigs received racemic ketoprofen at dose rates of 4 mg/kg PO and 3 mg/kg IM in a randomized, crossover design with a 6-day washout period. Enantiomers were separated on a chiral column and their concentrations were determined by liquid chromatography-tandem mass spectrometry. Pharmacokinetic parameters were calculated and relative bioavailability (F_rel) was determined for S and R –ketoprofen.

Results

S-ketoprofen was the predominant enantiomer in pig plasma after administration of the racemic mixture via both routes. The mean (± SD) maximum S-ketoprofen concentration in plasma (7.42 mg/L ± 2.35 in PO and 7.32 mg/L ± 0.75 in IM) was more than twice as high as that of R-ketoprofen (2.55 mg/L ± 0.99 in PO and 3.23 mg/L ± 0.70 in IM), and the terminal half-life was three times longer for S-ketoprofen (3.40 h ± 0.91 in PO and 2.89 h ± 0.85 in IM) than R-ketoprofen (1.1 h ± 0.90 in PO and 0.75 h ± 0.48 in IM). The mean (± SD) relative bioavailability (PO compared to IM) was 83 ± 20% and 63 ± 23% for S-ketoprofen and R-ketoprofen, respectively.

Conclusions

Although some minor differences were detected in the ketoprofen enantiomer concentrations in plasma after PO and IM administration, they are probably not relevant in clinical use. Thus, the pharmacological effects of racemic ketoprofen should be comparable after intramuscular and oral routes of administration in growing pigs.