Ketorolac: What is it? Dosage, Uses, Side Effects, Precautions and Interactions

It is a member of the pyrrolo-pyrrole group of nonsteroidal anti-inflammatory drugs (NSAIDs).

The chemical name ketorolac tromethamine is (±) -5-benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid, composed of 2-amino-2- (hydroxymethyl) -1,3-propanediol (1: 1).

Ketorolac tromethamine is a racemic mixture of [-] S and [+] R ketorolac tromethamine. Ketorolac tromethamine can exist in three crystalline forms. All forms are equally soluble in water.

Ketorolac tromethamine has a pKa of 3.5 and an n-octanol / water partition coefficient of 0.26. The molecular weight of Ketorolac tromethamine is 376.41. Its molecular formula is C 19 H 24 N2O 6 .

Toradol (ketorolac tromethamine) oral is available in round, white, film-coated tablets, printed in red. Each tablet contains 10 mg of ketorolac tromethamine, the active ingredient, with added lactose, magnesium stearate and microcrystalline cellulose.

The white film coating contains hydroxypropyl methylcellulose, polyethylene glycol and titanium dioxide.

The tablets are printed with red ink that includes FD & C Red # 40 Aluminum Lake as a colorant. There is a large T printed on both sides of the tablet, as well as the word Toradol (ketorolac tromethamine) on one side, and the word ROCHE on the other.

Ketorolac is used for the short-term treatment of moderate to severe pain in adults. It is usually used before or after medical procedures or after surgery.

Pain reduction helps you recover more comfortably so you can return to your normal daily activities. This medicine is a nonsteroidal anti-inflammatory drug (NSAID).

It works by blocking the production of certain natural substances that cause inflammation in your body. This effect helps reduce swelling, pain or fever. Ketorolac should not be used for mild or prolonged pain conditions (such as arthritis ).

Ketorolac is used for the short-term treatment of moderate to severe pain. Generally, it is not prescribed for more than five days. Ketorolac is effective when administered with paracetamol to control pain in newborns because it does not depress breathing as opioids do.

Ketorolac is also an adjunct to opioid medications and improves pain relief. It is also used to treat dysmenorrhea. Ketorolac is used to treat idiopathic pericarditis, where it reduces inflammation.

Ketorolac is used to control pain in the short term, lasts no more than five days and can be administered orally, by intramuscular injection, intravenously and by nasal spray.

Ketorolac is administered initially by intramuscular or intravenous injection. Oral therapy is only used as a continuation of the intramuscular or intravenous starting point.

Ketorolac is used during eye surgery to maintain mydriasis or “relaxation” of the iris muscles that will allow surgeons to perform cataract surgery. Ketorolac is effective in the treatment of ocular itching.

The ophthalmic formulation of ketorolac is associated with a decrease in the development of macular edema after cataract surgery and is more effective only than as a combined opioid / keterolac treatment. Ketorolac has also been used to control the pain of corneal abrasions.

During treatment with ketorolac, doctors monitor the manifestation of adverse effects and side effects. Laboratory tests are often used, such as liver function tests, bleeding time, BUN, serum creatinine, and electrolyte levels, and help identify possible complications.

Important information about Ketorolac

You should not use ketorolac if you have recent or active bleeding (including bleeding inside the body), a head injury, stomach ulcer, severe kidney disease, a bleeding or blood-clotting disorder.

Also a history of severe allergic reaction to aspirin or an NSAID, if you are scheduled for surgery, if you are in the last stage of pregnancy or if you are breast-feeding a baby.

You should not use ketorolac if you also take pentoxifylline , probenecid, aspirin, or other NSAIDs.

Ketorolac may increase your risk of heart attack or fatal stroke, especially if you use it long-term or take high doses, or if you have heart disease.

Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft or CABG).

Ketorolac can also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while using ketorolac, especially in older adults. You should not take this medicine if you already have bleeding in your stomach or intestines.

Do not drink alcohol while taking Ketorolac. Alcohol can increase the risk of stomach bleeding caused by ketorolac.

Before taking Ketorolac

Ketorolac may increase your risk of heart attack or fatal stroke, especially if you use it long-term or take high doses, or if you have heart disease.

Even people without heart disease or risk factors may suffer a stroke or heart attack while taking this medication.

Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft or CABG).

Ketorolac can also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while using Ketorolac, especially in older adults.

You should not use Ketorolac if you are allergic to ketorolac, or if you have:

  • Stomach ulcer active or recent, stomach bleeding or intestinal bleeding.
  • A hemorrhagic or blood clotting disorder.
  • A closed head injury or bleeding in the brain.
  • Bleeding from a recent surgery.
  • Severe kidney disease or dehydration.
  • A history of asthma or a severe allergic reaction after taking aspirin or an NSAID.
  • If you have surgery scheduled (especially bypass surgery).
  • If you are in the last pregnancy or are breastfeeding a baby.

Some medicines can cause unwanted or dangerous effects when used with Ketorolac. Your doctor may need to change your treatment plan if you use any of the following medications:

To make sure Ketorolac is safe for you, tell your doctor if you ever had:

  • Heart disease, high blood pressure, high cholesterol, diabetes or if you smoke.
  • Heart attack, stroke or blood clot.
  • Stomach ulcers or bleeding.
  • Inflammatory bowel disease, ulcerative colitis or Crohn’s disease .
  • Liver disease
  • Kidney disease (or if you are on dialysis ).
  • Asthma .
  • Fluid retention.

The use of ketorolac during the last 3 months of pregnancy can harm the unborn baby. Ketorolac may also increase the risk of uterine bleeding and should not be used during labor and delivery. Tell your doctor if you are pregnant.

Ketorolac can pass into breast milk and may harm a nursing baby. Do not breast-feed while using this medication. Ketorolac is not approved for use by children under 2 years of age.

How to use

Typically, ketorolac is given first as an injection, and then as an oral medication (orally). The injection is given into a muscle or into a vein through an intravenous line. A health care provider will give you the injection.

Read the Medication Guide and, if available, the patient information leaflet that your pharmacist gives you before you start taking Ketorolac and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication orally, usually every 4 to 6 hours with a full glass of water (8 ounces or 240 milliliters), or as directed by your doctor. Do not lie down for at least 10 minutes after taking this medicine.

If stomach upset occurs while taking this medication, take it with food, milk or an antacid.

The dose is based on your medical condition and response to treatment. To reduce your risk of stomach bleeding and other side effects, take this medication at the lowest effective dose for the shortest time possible.

Do not increase your dose, take it more often or take it for more than 5 days. If you still have pain after 5 days, talk to your doctor about other medications you can use. Do not take more than 40 milligrams in a 24-hour period.

If you are taking this medication “as needed” (not on a regular schedule), remember that analgesics work best if they are used when the first signs of pain appear. If you wait until the pain gets worse, the medication may not work as well.

Tell your doctor if your condition worsens or if your pain is not relieved. Store at room temperature away from moisture, heat and light. Keep the bottle tightly closed when not in use.

Read all patient information, medication guides and instruction sheets provided. Ask your doctor or pharmacist if you have any questions.

Dosage and Uses:

Dosage forms:

Tablet

  • 10mg.

Injectable solution

  • 15mg/ml.
  • 30mg/ml.

Prefilled syringe

  • 15mg/ml.
  • 30mg/ml.
  • 60mg/2 ml.

Moderately intense acute pain

Short-term treatment (≤5 days) of moderately severe acute pain requiring analgesia at the opioid level; Not indicated for minor or chronic pain conditions

IV : 30 mg in single dose or 30 mg every 6 hours; It should not exceed 120mg / day.

IM : 60 mg in single dose or 30 mg every 6 hours; It should not exceed 120mg / day.

PO : 20 mg once after IV or IM therapy, THEN 10 mg q4-6hr; It should not exceed 40 mg / day.

Dosing considerations

Always start with parenteral therapy; oral administration indicated only as a continuation of the IV / IM dosage, if necessary.

The duration of therapy should not exceed 5 days.

The dose beyond the maximum or marked doses will not provide better efficacy, but will increase the risk of serious adverse events.

Decrease the daily dose in patients> 65 years, <50 kg or with moderately elevated serum creatinine.

Modifications of doses

Renal insufficiency :

Severe : Contraindicated.

Moderate (moderately elevated serum creatinine) : use 50% of the recommended dose; must not exceed 60mg / day IM / IV

Liver deterioration

Not studied; With precaution; discontinue if symptoms of liver toxicity appear.

Side effects

Stomach upset, nausea, vomiting, constipation, diarrhea, gas, dizziness or drowsiness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist immediately.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medicine can raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor immediately if you have any of these unlikely but serious side effects: fainting, fast / strong heartbeat, changes in hearing (such as ringing in the ears), mental / mood changes (confusion, depression ).

Also persistent / intense headache, stomach pain, sudden / unexplained weight gain, swelling of hands or feet, changes in vision (such as blurred vision), unusual tiredness.

Tell your doctor immediately if you develop these rare but serious bruises / hemorrhages, signs of kidney problems (such as change in the amount of urine), signs of infection (such as fever, chills, persistent sore throat), meningitis symptoms ( such as unexplained neck stiffness, fever).

This medication can rarely cause severe (possibly life-threatening) liver disease. Seek immediate medical attention if you have any symptoms of liver damage, including: dark urine, stomach / abdominal pain, persistent nausea / vomiting, yellowing eyes / skin.

A very serious allergic reaction to this medication is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching / swelling (especially of the face / tongue / throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not mentioned above, contact your doctor or pharmacist.

Ketorolac precautions

Before taking ketorolac, tell your doctor or pharmacist if you are allergic to it; or aspirin or other nonsteroidal anti-inflammatory drugs-NSAIDs (such as ibuprofen, naproxen , celecoxib); or if you have any other allergies.

Avoid drinking alcohol You can increase your risk of stomach bleeding.

Consult a doctor or pharmacist before using any medication for cold, allergy or pain. Many medicines that are obtained without a prescription contain aspirin or other medicines similar to Ketorolac.

Taking certain products together can make you take too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen or naproxen .

This product may contain inactive ingredients, which can cause allergic reactions or other problems. Consult your pharmacist for more details.

Before taking this medication, tell your doctor or pharmacist your medical history, especially of:

  • Asthma (including history of worsening breathing after taking aspirin or other NSAIDs).
  • Bleeding or coagulation problems, blood disorders (such as anemia).
  • Heart disease (such as a previous heart attack)
  • High blood pressure , liver disease.
  • Growths in the nose ( nasal polyps ).
  • Throat / stomach / intestinal problems (such as bleeding, heartburn, ulcers)
  • Stroke.
  • Swelling of the ankles / feet / hands.

Sometimes, kidney problems can occur with the use of NSAID drugs, including ketorolac. Problems are more likely to occur if you are dehydrated, have heart failure or kidney disease, are an older adult, or if you take certain medications (see also the Drug Interactions section).

Drink plenty of fluids as directed by your doctor to avoid dehydration and tell your doctor right away if you have a change in the amount of urine.

This medicine may cause dizziness or drowsiness. Do not drive, use machinery, or perform activities that require alertness until you are sure you can perform those activities safely. Avoid alcoholic beverages.

This medicine may cause stomach / intestinal bleeding. Daily use of alcohol and tobacco, especially when combined with this medication, may increase your risk of stomach bleeding. Limit alcohol consumption and stop smoking. Consult your doctor or pharmacist for more information.

This medicine can make you more sensitive to the sun. Limit your time to the sun. Avoid tanning booths and solar lamps. Wear sunscreen and wear protective clothing when outdoors. Tell your doctor immediately if the sun is burning or if you have blisters / redness on the skin.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, over-the-counter medications, and herbal products).

Older adults may be more sensitive to the effects of the drug, especially bleeding in the stomach / intestines or kidney problems. The use of high doses for a long time may increase this risk.

Before using this medicine, women of childbearing potential should talk with their doctor about the benefits and risks (such as miscarriage, problems getting pregnant). Tell your doctor if you are pregnant or if you plan to become pregnant.

During pregnancy, this medication should be used only when clearly necessary.

Its use is not recommended during the first and last trimesters of pregnancy due to possible harm to the unborn baby and interference with normal labor / delivery.

This medicine passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Interactions with other medications can change how your medications work or increase the risk of serious side effects. This document does not contain all possible drug interactions.

Keep a list of all the products you use (including over-the-counter and non-prescription medicines and herbal products) and share it with your doctor and pharmacist. Do not start, stop or change the dosage of any medication without your doctor’s approval.

Some products that may interact with this medicine include:

  • Aliskiren, ACE inhibitors (such as captopril, lisinopril).
  • Angiotensin II receptor blockers (such as losartan , valsartan).
  • Lithium, methotrexate, probenecid, corticosteroids (such as prednisone ), other medicines that can affect the kidneys (including cidofovir, “water pills” / diuretics such as furosemide ).

This medication may increase the risk of bleeding when taken with other medications that can also cause bleeding.

Examples include antiplatelet medications such as clopidogrel, “anticoagulants” such as dabigatran / enoxaparin / warfarin , among others.

Carefully check all prescription and non-prescription labels, as many medications contain analgesics / antipyretics (aspirin, NSAIDs such as ibuprofen or naproxen).

These medications are similar to ketorolac and may increase the risk of side effects if taken together.

However, if your doctor told you to take aspirin at a low dose to prevent a heart attack or stroke (usually at doses of 81-325 milligrams a day), you should continue to take aspirin unless your doctor tells you otherwise.

Ask your doctor or pharmacist for more details.

Ketorolac overdose

If someone has an overdose and has severe symptoms, such as fainting or difficulty breathing, call emergency. Otherwise, call a poison control center immediately.

Symptoms of an overdose may include severe stomach pain, vomiting that looks like coffee beans, extreme drowsiness, slow / shallow breathing.

Do not share this medicine with others.

Laboratory and / or medical tests (including blood pressure, kidney function tests) may be done to detect side effects. Check with your doctor for more details.

This medication has been prescribed only for your current condition. Do not use it later for another condition unless your doctor tells you to. A different medicine might be necessary in this case.

Dosage of Ketorolac lost

If you are taking this medication on a regular schedule (not just “as needed”) and you miss a dose, take it as soon as you remember. If you are near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Ketorolac storage

Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medications out of the reach of children and pets.

Do not throw medicines into the toilet or pour them into the drain unless instructed to do so. Discard this product correctly when it has expired or is no longer necessary. Consult your pharmacist or local waste disposal company for more information on how to dispose of your product safely.