Ketorolac is a non-steroidal anti-inflammatory drug that is used for management of moderate to severe pain.
- To control pain in newborns
- As an alternative or adjuvant to opioid medications
- For treatment of dysmenorrhea
- In idiopathic pericarditis to reduce inflammation
- In oral & nasal therapy
- Ketorolac eye drops have been used for management of corneal abrasions.
- As an eye drop after or before eye surgery
- Ocular itching
- For prevention from developing macular edema after cataract surgery
DOSAGE FOR KETOROLAC
Dosage forms available:
- Film coated tablet: 10 mg, 20 mg
- Injectable solution: 15 mg/ml, 30 mg/ml
- Ophthalmic drops: 5 mg/ml
- Ophthalmic solutions: 0.4%
- Ointment: 2%
- In moderate to severe pain in adults: 20 mg twice a day for not more than 5 days.
- Intravenous (IV): 30 mg as single dose or 30 mg every 6 hours; not to exceed 120 mg/day.
- In children from 2-16 years: Single dose: 0.5 mg/kg IV/IM once; not to exceed 15 mg
- Other doses depend on factors like the type & location of infection, bacteria, age, sex, presence of underlying diseases, immunity & doctor’s guidance.
Missed dose: Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
a) Using gastric lavage & induction of vomiting
b) Maintaining hydration.
- Abdominal pain
- Diarrhea or constipation
- Ringing in the ears
- Pale skin
- Allergic reaction.
ADVERSE EFFECTS ARISING FROM KETOROLAC
- High blood pressure
- Increased heart rate
- Heart failure
- Hypersensitivity of the skin
- Low platelet & WBC count
- Insomnia & anxiety
- Infertility in females
- Inflammation of the kidney cells
- Renal failure
- Liver failure
- Steven-Johnson Syndrome
PRECAUTIONS & CONTRAINDICATIONS
Ketorolac is contraindicated & precaution is advised in patients with conditions like:
- In patients with cardiovascular or heart problems.
- Contraindicated in patients that are supposed to undergo bypass surgery.
- In patients with gastrointestinal risks & diseases.
- Contraindicated in labor & delivery
- Patients with coagulation disorders or taking anti-coagulation medications.
- In renal dysfunction
- In liver dysfunction
- Patients that are taking diuretics & ACE inhibitors
- Contraindicated as epidural injection
- Allergy to hypersensitivity to NSAIDs
- In patients with elevated immune response.
INTERACTIONS OF KETOROLAC
- Ketorolac & warfarin together can lead to an increased GI bleeding risk.
- Reduction in protein binding capacity of ketorolac seen when given in combination with aspirin.
- In presence of diuretics, the effect of the latter is reduced.
- Administration of ketorolac & probencid results in an increased plasma concentration of ketorolac.
- Produces an increased level of lithium concentration when given together.
- Ketorolac has a potential to increase the toxicity of methotrexate.
- Ketorolac may diminish the antihypertensive effect of ACE inhibitors and/or angiotension II receptor antagonists.
- Use of the drug along with antiepileptic drugs shows reduced effectiveness of the latter.
- Ketorolac when taken with psychoactive drugs can present hallucinations.
- There is an increased risk of gastrointestinal bleeding when selective serotonin reuptake inhibitors (SSRIs) are combined with Ketorolac.
- Toxicity to the kidney is presented when taken with cyclosporin.
IN PREGNANCY, BREAST FEEDING & CHILDREN
- Pregnancy: The drug should be avoided in pregnancy due to human fetal risk.
- Breast Feeding: Not much evidence or studies are present, although ketorolac is excreted in the breast milk in multiple doses.
- Children: Used in surgeries & as alternative to primary NSAIDs.