Biomedicine & Pharmacotherapy 149 (2022) 112819

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Biomedicine & Pharmacotherapy

journal homepage: www.elsevier.com/locate/biopha

The comparison of dexketoprofen and other painkilling medications

(review from 2018 to 2021)
Joanna Kuczyńska a, b, Angelika Pawlak c, *, Barbara Nieradko-Iwanicka a
a
Chair and Department of Hygiene and Epidemiology, Medical University of Lublin, Chodzki 7 Street, 20-093 Lublin, Poland
b
Doctoral School, Medical University of Lublin, Poland
c
Students’ Scientific Association at the Chair and Department of Hygiene and Epidemiology, Medical University of Lublin, Chodzki 7 Street, 20-093 Lublin, Poland

A R T I C L E I N F O A B S T R A C T

Keywords: Dexketoprofen is an enantiomer of ketoprofen (S+) that belongs to nonsteroidal anti-inflammatory drugs and has
Dexketoprofen analgesic, anti-inflammatory, and antipyretic properties. Dexketoprofen has a stronger effect than ketoprofen,
Pain which makes it a readily used preparation. The review aims to find in recent original publications data about
Tramadol
dexketoprofen and its comparison with other painkilling medications. The systematic literature review was
Nonsteroidal anti-inflammatory drugs
conducted in November 2021 (2018 onwards). We selected 12 articles from PubMed, Google Scholar, Medline
Chemical compounds studied in this article:
Complete databases. In the last 4 years, there have been many publications that shed a new light on dexketo­
Dexketoprofen (PubChem CID: 667550)
Dexketoprofen trometamol (PubChem CID:
profen. The article is a comparative analysis of dexketoprofen’s action vs other nonsteroidal anti-inflammatory
177976) drugs and the combination of dexketoprofen with tramadol vs paracetamol with tramadol. The findings of the
Ketoprofen (PubChem CID: 3825) review confirm that dexketoprofen is a very good pain reliever more potent than paracetamol. Dexketoprofen
Paracetamol (PubChem CID: 1983) produces similar effects to lidocaine and dexmedetomidine. Complex preparations containing dexketoprofen and
Fentanyl (PubChem CID: 3345) tramadol are very effective painkilling tandem and are more effective than tramadol and paracetamol therapy in
Diclofenac sodium (PubChem CID: 5018304) the treatment of acute pain.
Tramadol (PubChem CID: 33741)
Metoclopramide (PubChem CID: 4168)
Lidocaine (PubChem CID: 3676)
Dexmedetomidine (PubChem CID: 5311068)

1. Introduction
Dexketoprofen has analgesic, anti-inflammatory, and antipyretic
properties, and belongs to non-steroidal anti-inflammatory drugs [1].
Dexketoprofen is a propionic acid derivative - (S+) enantiomer of
ketoprofen [1,2]. The action of the drug is mainly based on the inhibi­
tion of cyclooxygenases: constitutive (cyclooxygenase-1) responsible for
the synthesis of prostaglandins with physiological functions and induc­
ible (cyclooxygenase-2) responsible for the synthesis of
pro-inflammatory prostaglandins at the site of inflammation [1]. The
use of a single isomer of ketoprofen allows to reduce by 50% its effective
dose and simplifies the pharmacokinetics of the drug [3–5]. Dexketo­
profen is effective at low doses, does not produce serious adverse events,
and is well tolerated [6].
The analgesic effect of dexketoprofen begins approximately 30 min
after oral administration and lasts for 4–6 h regardless of gender and age
[7,8]. The Tmax is 30 min [1]. Dexketoprofen dissolves and absorbs
quickly from the gastrointestinal tract so that the drug can be adminis­
tered to the patient 15–20 min before a painful procedure [5,9–11].
About 99% of dexketoprofen is bound to plasma proteins, mainly al­
bumin. The half-life (T1/2) in the elimination phase is 1.65 h. After
conjugation with glucuronic acid in the liver, dexketoprofen is mainly
excreted by the kidneys. Only the S (+) enantiomer is detectable in the
urine, which indicates the lack of conversion of dexketoprofen to the R
(-) enantiomer. The drug does not accumulate in the body. Concomitant
consumption of food increases the time elapsing from the administration
of the drug to reaching its maximum concentration in the blood and
decreases the highest concentration of the drug observed in the blood,
but does not change its bioavailability [1,8,12]. The increase in time
necessary to reach the maximum plasma concentration seen if dexke­
toprofen is used after food consumption is caused by a slowed gastric
emptying. This would reduce the rate at which dexketoprofen arrives at

* Corresponding author.
E-mail addresses: asia9384@o2.pl (J. Kuczyńska), 54212@student.umlub.pl (A. Pawlak), barbaranieradkoiwanicka@umlub.pl (B. Nieradko-Iwanicka).

https://doi.org/10.1016/j.biopha.2022.112819
Received 22 January 2022; Received in revised form 1 March 2022; Accepted 9 March 2022
Available online 14 March 2022
0753-3322/© 2022 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).
J. Kuczyńska et al.
Fig. 1. PRISMA flow diagram.
the small intestine, the primary site of absorption. The type of food eaten
does not matter [8].
Dexketoprofen is available in Poland both as an over-the-counter
drug in the form of 25 mg tablets and granules for oral solution and as
a prescription drug (in the form of solution for injections). Dexketo­
profen is very effective in treating nociceptive, inflammatory, somatic,
and visceral pain. It is used for the symptomatic treatment of mild to
moderate pain, such as muscle pain, dysmenorrhea, and toothache, and
in the treatment of moderate to severe acute pain e.g. treatment of
postoperative pain, renal colic pain, and neuromuscular pain [1,2,
13–16].
Scientists are looking for a new form of dexketoprofen with sustained
release, which is a big challenge in the case of a drug with high solubility
and rapid elimination [17,18]. Moreover, research is conducted to
discover new applications of dexketoprofen in epilepsy and oncology
[19–23].
The side effects of dexketoprofen may be from the gastrointestinal
tract (diarrhea, vomiting, ulcer, bleeding from the upper gastrointestinal
tract), the central nervous system (dizziness, headache, drowsiness, fa­
tigue, malaise), the circulatory system, liver (increase in the activity of
liver enzymes in the blood), kidneys, respiratory system (asthma exac­
erbation), ear and labyrinth, systemic reactions (urticaria, sweating),
deterioration of the number and function of platelets and photo­
sensitizing effect on the skin [24]. In 2015, Olmez et al. described
esophagitis due to dexketoprofen use in a 21-year-old man [25]. Kılıc
et al. claimed that dexketoprofen may have cytotoxic, cytostatic, geno­
toxic effects on healthy human lymphocytes, depending on its concen­
tration and duration of exposure [26]. Kayipmaz et al. described acute
dystonic reaction due to dexketoprofen [27].
In this review, the authors aimed to find the most recent clinical trials
comparing dexketoprofen with other drugs.
2. Materials and methods
Standard up-to-date criteria were followed for review of the
2
Biomedicine & Pharmacotherapy 149 (2022) 112819
literature data. A search for English-language articles in the Medline
Complete, PubMed, Google Scholar was performed. The databases were
searched in November 2021 with phrases: ‘dexketoprofen’, ‘dexketo­
profen and treatment’, ‘dexketoprofen and tramadol’. More than 700
results were found. A total of 168 articles published between 2018 and
November 2021 were scanned. After skimming abstracts, 12 articles
were chosen for this systematic review (Fig. 1).
3. Results and discussion
Al et al. [28] conducted a randomized controlled trial to compare the
analgesic efficacy of dexketoprofen, paracetamol, and fentanyl in pa­
tients suffering from renal colic. The pain was assessed before drug
administration and at 15 and 30 min after drug intake. At 15 min, the
effectiveness of the drugs in each group was at a similar level. At 30 min,
dexketoprofen was more effective than paracetamol and fentanyl. Au­
thors concluded that dexketoprofen was more effective in reducing pain
than fentanyl and paracetamol [28]. However there was a potential bias:
the study excluded people older than 65 years of age and individuals
with the Visual Analogue Scale result < 4 cm.
In another prospective randomized, double-blind, controlled trial
completed and published by Serinken et al. [29] the effect of dexketo­
profen was compared with that of paracetamol in patients who suffered
from primary dysmenorrhea. Authors concluded that dexketoprofen and
paracetamol were effective in reducing pain in patients with primary
dysmenorrhea, despite better Visual Analogue Scale scores after dex­
ketoprofen administration, the difference between the drugs was not
clinically significant [29]. The eligibility and exclusion criteria do not
suggest potential bias.
In another prospective, randomized, double-blind, controlled clinical
trial by Yilmaz et al. [30] the effectiveness of dexketoprofen and para­
cetamol in the treatment of musculoskeletal traumatic pain were
compared. Before taking the drug and 15, 30, and 60 min after admin­
istration of the pharmaceutical, the pain was measured. After one hour,
the study was terminated, and if the pain persisted after that time,
J. Kuczyńska et al.
patients received rescue medication, which was fentanyl. During the
study, no statistically significant difference in Numerical Rating Scale
and Visual Analogue Scale was found between the paracetamol group
and the dexketoprofen group. The median pain reduction on the Visual
Analogue Scale after 1 h was 50 in the dexketoprofen group and 55 in
the paracetamol group. After 60 min, the median pain reduction on the
Numerical Rating Scale in both groups was 5. According to the Verbal
Rating Scale, 57 patients in the dexketoprofen group and 37 in the
paracetamol group reported severe pain at the beginning of the study.
After 60 min, one patient from both groups reported that the severe pain
persisted. Based on the results of the studies, the efficacy of dexketo­
profen and paracetamol in reducing the intensity of pain in musculo­
skeletal injury was similar [30]. Potential bias: the study excluded
people older than 65 years and a Visual Analogue Scale result < 5 cm. It
must be emphasized however that elderly people are prone to falls and
fractures (and musculoskeletal traumatic pain), although statistically
injuries are most common in males 15–24 years of age.
In a prospective, randomized, double-blind, controlled clinical trial
by Demirozogul et al. [31] the efficacy of paracetamol and dexketo­
profen in reducing musculoskeletal pain was compared. The pain re­
ported by patients included pain in the neck, shoulder, back, hip, and
knee. The pain was measured before drug administration and at 15, 30,
and 60 min. Comparing the Numerical Rating Scale of people with all
pain locations showed that dexketoprofen was statistically more effec­
tive than paracetamol. Comparing the Visual Analogue Scale pain scale
of people with all pain locations, it was shown that dexketoprofen was
more effective in pain relief than paracetamol within 30 and 60 min
from the start of the study. There was no statistically significant differ­
ence in efficacy between the drugs in relieving neck, shoulder, hip, and
knee pain. However there was a significant difference between dexke­
toprofen and paracetamol in back pain. Based on the results of the
studies, it was found that dexketoprofen showed a better analgesic effect
in all pain locations compared to paracetamol [31]. Potential bias: the
study excluded individuals older than 65 years. On the other hand is the
> 60 age group of patients who most often complain about chronic pain
due to osteoarthritis. Those patients seek for effective and safe medi­
cation for joint and neck pain. It is a pity that they were not included in
the study group.
Individuals suffering from migraine were subjects in the study con­
ducted by Yavuz et al. [32] It was a randomized, single-center, dou­
ble-blind, controlled trial in which they assessed the safety and efficacy
of intravenous metoclopramide (group 1), metoclopramide in combi­
nation with dexketoprofen (group 2) and dexketoprofen (group 3) in the
treatment of acute migraine attacks. The pain was measured at baseline
and 15 and 30 min. There was no significant difference in pain reduction
between group 2 vs group 1 and 3 at 15 min. The treatment in group 2
had better results at 30 min than group1 and group 3. The study
concluded that at 15 min there was no significant difference in Visual
Analogue Scale scores between the three treatment groups, but at
30 min treatment with metoclopramide together with dexketoprofen
showed superiority over dexketoprofen and metoclopramide, which
were used alone [32]. Currently, metoclopramide has been approved as
a drug used in combination with painkillers to increase the absorption of
these medications for acute migraine attacks. The eligibility and exclu­
sion criteria do not suggest any bias.
Ear, nose and throat disease specialist also use dexketoprofen in their
patients. Cimen et al. [33] in a randomized, prospective, controlled,
double-blind study compared intravenous dexketoprofen with paracet­
amol for the treatment of sore throat. Patients were assessed at 15, 30,
45, 60, 90, and 120 min from taking the medicine. There was no supe­
riority of paracetamol over dexketoprofen- both drugs reduced the sore
throat equally [33]. The eligibility and exclusion criteria do not suggest
any bias.
In 2021, Akbas et al. compared dexketoprofen and lidocaine for
treatment of tension-type headache [34]. One group received an intra­
venous infusion of 1.5 mg/kg lidocaine and the second group the
3
Biomedicine & Pharmacotherapy 149 (2022) 112819
intravenous infusion of dexketoprofen at the dose of 50 mg. Pain mea­
surement was performed at 0, 20, 30, 60, 90, and 120 min. Researchers
followed up the patients for 1 week after the treatment for the presence
of any adverse effects. The delta values of Visual Analogue Scale scores
in all periods were statistically significantly higher in the lidocaine
group than in the dexketoprofen group. [34]. In this study, dexketo­
profen was more effective in relieving pain compared to lidocaine. Po­
tential bias: the study excluded individuals with the Visual Analogue
Scale result < 4 cm. We understand that is a cut-off point in many
treatment strategies. Low intensity pain in many individuals does not
require pharmacological intervention. However many people with low
or moderate pain without medication feel discomfort, and the negative
effect could be absenteeism or presenteeism with reduced concentration
and less efficacy at work.
Similarly to Yavuz et al. [32], Gur et al. [35] also treated migraine
attacks with dexketoprofen. Lidocaine was the comparator. Pain mea­
surement was performed at 0, 20, 30, 60, and 90 min. The Visual
Analogue Scale score was significantly lower in the lidocaine group in
the 20th and 30th min. The number of patients revisiting the emergency
department within 48–72 h was statistically lower in the lidocaine
group [35]. The study showed that lidocaine was more effective than
dexketoprofen at the beginning of the study, no difference was noticed
later in the study. So the final conclusion was that dexketoprofen had a
similar analgesic effect as lidocaine. Potential bias was noticed: the
study excluded people older than 65 years.
Seyhan et al. [36] published the results of their randomized study on
the treatment of renal colic with dexketoprofen vs lidocaine. One group
of subjects received 2% lidocaine for nerve blockage and the second
group received an intravenous injection of 50 mg dexketoprofen. Pain
measurement was performed at 0, 5, 15, 30, 45, and 60 min. Lidocaine
relieves renal colic pain more effectively than dexketoprofen at all time
points [36]. The study shows that lidocaine is better for pain relief than
intravenous dexketoprofen in patients with renal colic. Potential bias:
the study excluded people older than 70 years. In Poland, especially in
the south-east regions kidney stones and renal colic are very common in
all age groups due to hard water. Emergency room personnel must be
proficient at diagnosing and treatment of renal colic attacks in their
patients. Practical advice about kidney stones development prophylaxis
by use of water filters and drinking boiled water is helpful too.
There is also an interesting animal study on dexketoprofen by Taylan
et al. [37]. It is worth to describe it in detail. The authors conducted a
study in which the effect of dexketoprofen and dexmedetomidine on
conduction blockade of the sciatic nerve in male Wistar albino rats was
analyzed. There were 3 groups of animals: the untreated control, the
dexketoprofen, and the dexmedetomidine group. After euthanasia the
sciatic nerve was isolated. Dexketoprofen and dexmedetomidine were
added to the nerve chamber at cumulative doses: 10–9 M, 10–8 M,
10–7 M, 10–6 M, 10–5 M in a volume of 0.1 ml. At 5 and 10 min after
taking each drug dose, the combined action potentials, area under the
curve, and maximum depolarization were recorded. Both drugs in a
dose-dependent manner significantly decreased the combined action
potentials parameters. This was reversible compared to control, and
combined action potentials for dexmedetomidine and dexketoprofen
returned to baseline after 15 min. As a result of using a dose of 10–5 M
with both drugs, the area under the curve values decreased after 5 and
10 min. At 10 min after ingestion of a 10–5 M dose, the area under the
curve values was lower in the dexmedetomidine group than in the
dexketoprofen group but as compared to the control, there was no sta­
tistically significant difference. There was a reduction in area under the
curve at 5 and 10 min after taking 10–6 and 10–5 M doses of dexme­
detomidine and for dexketoprofen given at the same doses. There was no
significant difference between the two groups in terms of maximum
depolarization values. The highest doses used in the study resulted in a
significant reduction in the maximum combined action potentials de­
rivative compared to the control group at 5 and 10 min. Dexketoprofen
and dexmedetomidine showed no significant differences in inhibition of
J. Kuczyńska et al. Biomedicine & Pharmacotherapy 149 (2022) 112819

Table1
The clinical studies comparing dexketoprofen with other painkilling medications.
Author/year Number Number of Dose of Comparator drug Route of Tests used Effect Side effects
of publication of groups/number of dexketoprofen and dose administration
patients people in the
and age group/sex

Al et al./2018 300 aged 3 groups/100 50 mg 2 µg/kg fentanyl, intravenous Visual dexketoprofen has a Of the fentanyl
16–65 patients each/ 10 mg of AnalogueScale better analgesic group, three
years 216 male and 84 paracetamol effect than fentanyl patients had
were female and paracetamol in hypotension, nine
renal colic reported dizziness,
one had a
headache, and one
vomited.
One patient in the
dexketoprofen and
paracetamol
groups reported
dizziness and
vomiting each.
Serinken 99 aged 2 groups/49 in 50 mg 1 g of paracetamol intravenous Visual no significant One patient taking
et al./2018 19–23 dexketoprofen AnalogueScale clinical difference dexketoprofen
years group and 50 in between the studied reported nausea
paracetamol drugs in primary and another
group/women dysmenorrhea person reported
dry mouth, while
one patient taking
paracetamol
reported nausea
and vomiting.
Yilmaz et al./ 200 aged 2 groups/100 50 mg 1 g of paracetamol intravenous Visual Analogue the analgesic effect No side effects
2019 23–50 patients each/126 Scale, Verbal of both drugs was were observed
years men and 74 Rating Scale, similar in
women Numerical musculoskeletal
Rating Scale traumatic pain
Demirozogul 200 aged 2 groups/100 50 mg 1 g of paracetamol intravenous Visual Analogue dexketoprofen was No side effects
et al./2019 18–65 patients each/104 Scale, Numerical better at relieving were observed
years men and 96 Rating Scale pain than
women paracetamol in all
pain locations in
musculoskeletal non-
traumatic pain
Yavuz et al./ 150 aged 3 groups/50 50 mg 10 mg intravenous Visual metoclopramide/ No side effects
2020 18 years patients each/43 metoclopramide, AnalogueScale dexketoprofen were observed
and over men and 107 10 mg therapy gave better
women metoclopramide in results than the
combination with monotherapies used
50 mg in the study in acute
dexketoprofen migraine headache
Cimen et al./ 200 aged 2 groups/98 in 50 mg 1 g of paracetamol intravenous Difficulty the analgesic effect None
2021 18 years dexketoprofen Swallowing of both drugs was
and over group and 102 in Scale, Sore similar in sore throat
paracetamol Throat Intensity
group/78 men and Scale, Throat
122 women Swelling Scale,
Sore Throat
Relief Scale
Akbas et al./ 120 aged 2 groups/60 50 mg 1.5 mg/kg intravenous Visual dexketoprofen was There was no
2021 18 years patients each/75 lidocaine AnalogueScale more effective in statistically
and over men and 45 relieving pain significant
women compared to difference in the
lidocaine in tension- number of adverse
type headache effects between
the study groups
during the 1-week
follow-up period
Gur et al./ 100 aged 2 groups/50 50 mg 1.5 mg/kg intravenous Visual Lidocaine was more None
2021 33–54 patients each/42 lidocaine bolus, AnalogueScale effective than
years men and 58 1 mg lidocaine/kg dexketoprofen at the
women infusion (first beginning of the
30 min), 0.5 mg/kg study, no difference
infusion for a was noticed later in
further 30 min the study in migraine
intravenously attack headaches
Seyhan et al./ 126 aged 2 groups/3 50 mg 2% lidocaine intravenous Visual Lidocaine was more None of the
2021 19–61 patients each/70 AnalogueScale effective at relieving patients in the two
years pain than
(continued on next page)

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J. Kuczyńska et al. Biomedicine & Pharmacotherapy 149 (2022) 112819

Table1 (continued )
Author/year Number Number of Dose of Comparator drug Route of Tests used Effect Side effects
of publication of groups/number of dexketoprofen and dose administration
patients people in the
and age group/sex

men and 56 dexketoprofen in groups had side

women renal colic effects
Gay-Escoda 653 aged 3 groups/60 in 25 mg with Paracetamol orally summed pain dexketoprofen/ The most common
et al./2019 18–63 dexketoprofen/ tramadol 650 mg with intensity tramadol therapy is side effects were:
years tramadol group, 75 mg tramadol 75 mg differences, % more effective than vomiting, nausea,
262 in max summed tramadol/ dizziness, and
paracetamol/ pain intensity paracetamol after somnolence.
tramadol group differences, total removal of the molar
and 131 in pain relief, %
placebo/65 men max total pain
and 388 women relief
Hanna et al./ 652 aged 3 groups/259 in 25 mg with Paracetamol orally Pain Intensity dexketoprofen/ No serious adverse
2021 18 years dexketoprofen/ tramadol 650 mg with -Numerical tramadol therapy is reaction was
and over tramadol group, 75 mg tramadol 75 mg Rating Scale more effective than reported
262 in tramadol/
paracetamol/ paracetamol after
tramadol group removal of the molar
and 131 in
placebo/265men
and 387 women

nerve conduction. At higher doses, dexmedetomidine reduces the con­
duction of fast-conducting fibers, and dexketoprofen dose-dependently
inhibits fast- and medium-conductive fibers, while time-dependent it
inhibits slow-conducting fibers. It was concluded that dexketoprofen
and dexmedetomidine, through different modes of action, have a better
anesthetic effect on peripheral nerves [37].
Dexketoprofen is considered a valuable painkiller by the dentists. In
a multicentre, randomized, double-sham, double-blind, parallel-group,
placebo-controlled clinical trial, Gay-Escoda et al. [15] compared the
safety and efficacy of orally administered tramadol in combination with
dexketoprofen vs tramadol administered together with paracetamol in
the treatment of moderate to severe pain after removal of the third,
lower, partially or a completely erupted molar. The primary efficacy
endpoint was the achievement of complete pain relief within 6 h after
taking your medicine. The highest sustained analgesia was recorded 6 h
after taking tramadol in combination with dexketoprofen. Based on the
results of the research, it was concluded that dexketoprofen at the dose
of 25 mg combined with tramadol at the dose of 75 mg therapy is more
effective than tramadol/paracetamol in the treatment of acute pain after
molar extraction, moreover, it is characterized by stronger and lasting
analgesia and a faster onset of action [15]. The eligibility and exclusion
criteria do not suggest any bias.
Another study focusing on the use of dexketoprofen for dental
problems was conducted and published by Hanna [5]. The study eval­
uated the analgesic efficacy of the dexketoprofen at the dose of 25 mg in
combination with tramadol at the dose of 75 mg compared with the
tramadol75/paracetamol650 combination in the treatment of acute
extraction pain of a third, impacted molar. It was noted that the dex­
ketoprofen/tramadol therapy was superior to the tramadol/paracetamol
therapy in terms of duration, speed of onset, and intensity of analgesia
no matter what the initial pain intensity was [5]. The results were in
agreement with the findings of Gay-Escoda et al. [15]. Potential bias: the
study excluded individuals rating their pain in the Numerical Rating
Scale < 4. In daily practice dentists may not offer painkillers to in­
dividuals rating their pain < 4, but each patient should be instructed
what to do in case the pain recurs or intensifies with time.
The most recent clinical studies comparing dexketoprofen with other
painkilling medications in treatment of renal colic, dysmenorrhea,
musculoskeletal pain, migraine, sore throat, headache and after molar
teeth removal were summarized in Table 1. The animal study [37]
described above was not included in the table. In migraine treatment
dexketoprofen should not be the first choice treatment [32,35], neither
in renal colic [36]. On the market there is an oral prescription drug
containing dexketoprofen in combination with tramadol, which was
proven to be highly effective in acute pain after molar teeth removal [5,
15].
4. Conclusions
The findings of the review confirm that dexketoprofen is a very good
pain reliever that is more potent than paracetamol. Dexketoprofen has a
similar effect to lidocaine and dexmedetomidine. Dexketoprofen at the
dose of 25 mg combined with tramadol at the dose of 75 mg therapy is
effective in relieving acute and postoperative pain. The combination of
metoclopramide and dexketoprofen gave better results than mono­
therapies in patients with migraine.
CRediT authorship contribution statement
Joanna Kuczyńska: Conceptualization, Methodology, Investiga­
tion, Writing – review & editing, Visualization. Angelika Pawlak:
Writing – review & editing, Visualization. Barbara Nieradko-Iwa­
nicka: Project administration.
Formatting of funding sources
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
The authors declared no conflict of interest.
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