Index
Ketorolac tromethamine is a non-steroidal anti-inflammatory drug (NSAID).
It is indicated for the short-term treatment (up to 5 days in adults) of moderately severe acute pain requiring analgesia at the opioid level and only as a continuation treatment after intravenous administration or IM dosing of ketorolac tromethamine, if necessary.
Dosage of Dolac
Ophthalmic eye itching associated with seasonal allergic conjunctivitis
Adult: as 0.5% solution: apply one drop to the affected eye four times a day.
Ophthalmic prophylaxis and reduction of postoperative eye inflammation
Adult: as 0.5% solution: inject one drop into the right eye four times a day, starting 24 hours after cataract surgery and continuing until the first two weeks of the postoperative period.
Postoperative (oral) pain
Adult: moderate to severe: 20 mg, followed by 10 mg 4-6 hrly as a therapy to continue parenteral administration. Max: 40 mg daily. Maximum duration: 5 days (combined parenteral and oral).
Elderly: 10 mg, followed by 10 mg 4-6 hr as therapy for continued parenteral administration. Max: 40 mg daily.
Parenteral postoperative pain
Adult: moderate to severe: initially 10 mg, followed by 10-30 mg 4-6 hr as needed (up to 2 hr during the initial postoperative period) intravenously or IV bolus for ≥15 seconds. Max: 90 mg daily. Maximum duration: 2 days.
Elderly: Max: 60 mg per day.
The oral formulation should not be given as a starting dose.
Use minimum effective dose for the individual patient.
Do not shorten the dosing interval to 4 to 6 hours.
The total duration of treatment in adult patients: the combined duration of use of IV or IM dosing of ketorolac tromethamine and ketorolac tromethamine tablets should not exceed five days.
Contraindications
- Patients with hypersensitivity to ketorolac, aspirin, or other NSAIDs. It was not designed as a prophylactic analgesic before surgery and intraoperative use.
- Patient with a history of asthma, active account, or history of peptic ulcer, history or history of bleeding or gastrointestinal perforation; suspected or confirmed cerebrovascular hemorrhage, hemorrhagic diathesis, incomplete hemostasis, high risk of bleeding.
- Complete or partial syndrome of nasal polyps, angioedema, or bronchospasm.
- Patient at risk of kidney failure due to volume depletion or dehydration.
- Treatment of perioperative pain in the context of CABG surgery.
- Moderate to severe kidney failure. Concomitant use with probenecid, lithium, pentoxifylline, anticoagulants, other NSAIDs, or aspirin.
Dolac special precautions
Patient with a history of hypertension and heart failure, predisposition to reduced vol and renal blood flow.
Patient weight <50 kg. Higher. Mild kidney or liver failure. Pregnancy and breastfeeding.
Adverse drug reactions
- Drowsiness.
- Dizziness
- Headache.
- Mental and sensory changes.
- Psychotic reactions.
- Sweating
- Dry mouth.
- However.
- Fever.
- Seizures
- Myalgia.
- Meningitis.
- Aseptic
- HA.
- Dyspnoea.
- Pulmonary edema.
- Bradycardia
- Chest pain.
- Palpitations
- Fluid retention.
- Increases in blood urea and creatinine.
- Acute renal failure.
- Edema.
- Hyponatremia.
- Hyperkalemia.
- Urinary frequency or retention.
- Nephritic syndrome.
- Flank pain with or without hematuria.
- Thrombocytopenia
- Epistaxis.
- Inhibition of platelet aggregation.
- Hematoma.
- Redness or paleness
- Pancreatitis.
- Changes in liver function
- Hepatitis.
- Liver failure.
- Pain at the site of infection.
Potentially fatal
- Anaphylaxis.
- Severe skin reactions (e.g., exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis).
- Myocardial infarction.
- Stroke
- Digestive bleeding.
- Perforation or ulceration
Symptoms of overdose
- Abdominal pain.
- Sickness.
- Vomiting
- Hyperventilation
- Peptic ulceration.
- Erosive gastritis and kidney dysfunction.
Management of overdose
Consider gastric lavage or administration of activated charcoal within 1 hour of ingestion.
Interactions
Increased risk of gastrointestinal ulceration or bleeding with corticosteroids, SSRIs, or antiplatelet agents.
May increase the toxicity of methotrexate. Increased risk of nephrotoxicity with diuretics, cyclosporine, tacrolimus, ACE inhibitors, or angiotensin II receptor antagonists. Hallucinations can occur with psychoactive drugs (e.g., fluoxetine, thiothixene, alprazolam).
Concurrent use with anticonvulsant therapy (e.g., phenytoin, carbamazepine) rarely causes seizures.
Potentially fatal
Increased risk of bleeding associated with ketorolac with anticoagulants, aspirin or other NSAIDs, and pentoxifylline.
Increase plasma concentration and half-life with probenecid. It increased plasma lithium concentration.
Mechanism of action of the Dolac
Description: Dolac reversibly inhibits the enzymes cyclooxygenase-1 and -2 (COX-1 and -2), which results in a decrease in the formation of prostaglandin precursors.
It exhibits a minimal anti-inflammatory effect in its analgesic dose. Start approximately 30 minutes (IM / IV). Duration: 4-6 h.
Pharmacokinetics
Absorption: rapid and complete absorption after IM administration.
Bioavailability: 80-100% (oral); about 4% (ophth).
Time to maximum plasma concentration: approximately 30-60 min (IM).
Distribution: Crosses the placenta and enters breast milk (small amounts); poorly penetrates the blood-brain barrier.
The volume of distribution: approximately 13 L. Plasma protein binding:> 99%.
Metabolism: Convergence with glucuronic acid; hydroxylation in the liver to form p-hydroxycetorolac.
Excretion: via urine (approximately 90% as unchanged drug, conjugated and hydroxylated metabolites); stool (remaining dose).
Terminal elimination half-life: approximately 4-6 h.
Storage
- Dolac should be stored between 15-30 ° C.
- Protect from light.
