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Indications

Ketorolac Tromethamine is used to treat moderate to severe acute post-operative pain in the short term.

Pharmacology

The non-steroidal anti-inflammatory medication ketorolac tromethamine is a powerful painkiller (NSAIDs). It works by preventing prostaglandin formation by inhibiting the cyclooxygenase enzyme system. At its analgesic dose, it has a minor anti-inflammatory action.

Dosage & Administration

Tablet-

Recommended dose is 10 mg every 4-6 hours. It should be used short-term only (up to 7 days) and are not recommended for chronic use. Doses exceeding 40 mg/day is not recommended.

Injection-

Ketorolac injection may be used as a single or multiple doses, on a regular or when necessary schedule for the management of moderately severe, acute pain that requires analgesia at the opioid level, usually in a postoperative setting. When administering Ketorolac injection, the IV bolus must be given over no less than 15 seconds. The IM administration should be given slowly and deeply into the muscle. The analgesic effect begins within 30 minutes with maximum effect in 1 to 2 hours after dosing IV or IM. Duration of analgesic effect is usually 4 to 6 hours.

Single-Dose Treatment-

IM Dosing (Adult):

Patients <65 years of age: One dose of 60 mg.

Patients >65 years of age, renally impaired and/or less than 50 kg of body weight: One dose of 30 mg.

IV Dosing (Adult):

Patients <65 years of age: One dose of 30 mg.

Patients >65 years of age, renally impaired and/or less than 50 kg of body weight: One dose of 15 mg.

IV or IM Dosing (2 to 16 years of age):

IM Dosing: One dose of 1 mg/kg up to a maximum of 30 mg.

IV Dosing: One dose of 0.5 mg/kg up to a maximum of 15 mg.

Multiple-Dose Treatment (IV or IM)-

Patients <65 years of age: The recommended dose is 30 mg Ketorolac injection every 6 hours. The maximum daily dose should not exceed 120 mg. Patients >65 years of age, renally impaired patients and patients less than 50 kg: The recommended dose is 15 mg Ketorolac injection every 6 hours. The maximum daily dose for these populations should not exceed 60 mg. For breakthrough pain, do not increase the dose or the frequency of Ketorolac Tromethamine.

Conversion from Parenteral to Oral Therapy: Ketorolac tablets may be used either as monotherapy or as follow-on therapy to parenteral Ketorolac. When Ketorolac tablets are used as a follow-on therapy to parenteral Ketorolac, the total combined daily dose of ketorolac (oral + parenteral) should not exceed 120 mg in younger adult patients or 60 mg in elderly patients on the day the change of formulation is made. On subsequent days, oral dosing should not exceed the recommended daily maximum of 40 mg. Ketorolac IM should be replaced by Ketorolac tablet as soon as feasible. The total duration of combined parenteral and oral treatment should not exceed 5 days.

Interaction

Ketorolac Tromethamine's negative effects are exacerbated by other NSAIDs or aspirin.

Anticoagulants: Increase the effectiveness of anticoagulants.

Reduce the antihypertensive effect of beta blockers.

Angiotensin-converting enzyme inhibitors (ACE inhibitors) raise the risk of renal impairment.

Methotrexate: Increase methotrexate toxicity.

Contraindications

Patients who are hypersensitive to ketorolac or other NSAIDs should avoid taking it. It should not be given to youngsters under the age of sixteen. It's also not a good idea to use it as a pre-surgery analgesic.

Side Effects

Nausea, vomiting, gastro-intestinal hemorrhage, melana, peptic ulcer, pancreatitis, anxiety, sleepiness, headache, excessive thirst, fatigue, bradycardia, hypertension, palpitation, chest discomfort, female infertility, and pulmonary edema are some of the most common adverse effects.

Pregnancy & Lactation

Ketorolac Tromethamine is classified as Category C by the US Food and Drug Administration for use during pregnancy. So, unless the potential benefits to the other outweigh the potential hazards to the unborn, Ketorolac Tromethamine should be avoided during pregnancy and lactating.

Precautions & Warnings

Patients over the age of 65 should be treated with caution. Patients with a current or suspected peptic ulcer, gastrointestinal hemorrhage, asthma, or liver failure should use caution.

Therapeutic Class

Non-Opioid Analgesics, Drugs for Rheumatoid Arthritis.

Storage Conditions

Keep away from light and heat in a dry location. Keep out of children's reach.