Ketorolac - instructions for use, analogs, testimonials and release forms (10 mg tablets, injections for injection) for the treatment of inflammation and pain in arthrosis, arthritis, trauma in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Ketorolac. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Ketorolac in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Ketorolac in the presence of existing structural analogues. Use to treat inflammation and pain in arthrosis, arthritis, trauma, oncology in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

Ketorolac - non-steroidal anti-inflammatory drug (NSAID), has a pronounced analgesic (analgesic) effect, has also an anti-inflammatory and moderate antipyretic effect. The mechanism of action is associated with nonselective inhibition of cyclooxygenase 1 and cyclooxygenase 2 activity catalyzing the formation of prostaglandins from arachidonic acid, which play an important role in the pathogenesis of pain, inflammation and fever. By the strength of the analgesic effect comparable to morphine, it significantly exceeds other NSAIDs. After intramuscular injection, the onset of analgesic effect is observed after 0.5 h, the maximum effect is achieved in 1-2 hours.

Composition

Ketorolac tromethamine + auxiliary substances.

Pharmacokinetics

Absorption at intramuscular injection is complete and fast. When ingestion Ketorolac is absorbed well in the digestive tract. The connection with plasma proteins is 99%. Penetrates into breast milk. More than 50% of the administered dose is metabolized in the liver with the formation of pharmacologically inactive metabolites. The main metabolites are glucuronides, which are excreted by the kidneys, and p-hydroxycetorolac. It is excreted 91% by the kidneys, 6% by the intestine.It is not excreted by hemodialysis. In patients with impaired renal function and senile age, the rate of excretion decreases.

Indications

Pain syndrome of strong and moderate severity:

• injuries;
• toothache;
• pain in the postpartum and postoperative period;
• oncological diseases;
• myalgia, arthralgia, neuralgia, sciatica;
• dislocations, sprains;
• rheumatic diseases.

It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, the progression of the disease is not affected.

Forms of release

The tablets covered with a cover of 10 mg.

Solution for intravenous and intramuscular injection (injections in ampoules for injection).

Other dosage forms, be it ointment, cream or gel, do not exist.

Instructions for use and dosing regimen

Pills

Adults with oral administration - 10 mg every 4-6 hours, if necessary - 20 mg 3-4 times a day.

Maximum doses: when ingestion or intramuscular injection - 90 mg per day; for patients with a body weight of up to 50 kg, with violations of kidney function, as well as for people over 65 years - 60 mg per day.

Ampoules

Intramuscularly. For parenteral administration to patients from 16 to 64 years of age with a body weight exceeding 50 kg, no more than 60 mg is administered intramuscularly for 1 administration; usually 30 mg every 6 hours.Adult patients with a body weight of less than 50 kg or with chronic kidney failure per injection are administered not more than 30 mg, usually 15 mg (no more than 20 doses per 5 days).

Side effect

• gastralgia;
• diarrhea, constipation;
• stomatitis;
• flatulence;
• nausea, vomiting;
• sensation of stomach overflow;
• decreased appetite;
• erosive and ulcerative lesions of the gastrointestinal tract (including with perforation and / or bleeding - abdominal pain, spasm or burning in the epigastric region, blood in the feces or melena, vomiting with blood or the type of "coffee grounds", nausea , heartburn and others);
• cholestatic jaundice;
• hepatitis;
• hepatomegaly;
• acute pancreatitis;
• acute renal insufficiency;
• back pain;
• hematuria (blood in the urine);
• hemolytic syndrome (hemolytic anemia, renal failure, thrombocytopenia, purpura);
• increased frequency of urination;
• increase or decrease in the volume of urine;
• nephritis;
• edema of renal genesis;
• hearing loss;
• tinnitus;
• impaired vision (including blurred vision);
• bronchospasm or dyspnoea;
• rhinitis;
• pulmonary edema;
• swelling of the larynx (dyspnea, difficulty breathing);
• headache;
• dizziness;
• drowsiness;
• aseptic meningitis (fever, severe headache, convulsions, stiff neck and / or back muscles);
• hyperactivity (mood changes, anxiety);
• hallucinations;
• depression;
• psychosis;
• fainting;
• increased blood pressure;
• Anemia, eosinophilia, leukopenia;
• bleeding from a postoperative wound;
• nose bleed;
• rectal bleeding;
• skin rash (including maculopapular rash);
• purpura;
• exfoliative dermatitis (fever with chills or without, hyperemia, densification or flaking of the skin, enlargement and / or soreness of palatine tonsils);
• hives;
• malignant exudative erythema (Stevens-Johnson syndrome);
• toxic epidermal necrolysis (Lyell's syndrome);
• burning or pain at the injection site;
• anaphylaxis or anaphylactoid reactions (skin discoloration of the face, skin rash, hives, skin itch, tachypnea or dyspnea, edema of the eyelids, periorbital edema, shortness of breath, shortness of breath, chest pain, wheezing);
• edema (face, legs, ankles, fingers, feet, weight gain);
• increased sweating;
• swelling of the tongue;
• fever.

Contraindications

• hypersensitivity;
• complete or incomplete combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses and intolerance to acetylsalicylic acid or other NSAIDs (including in the anamnesis);
• urticaria, rhinitis caused by taking an NSAID (in history);
• intolerance of drugs pyrazolone series;
• hypovolemia (regardless of the cause that caused it);
• erosive and ulcerative lesions of the gastrointestinal tract in the stage of exacerbation;
• hypocoagulation (including hemophilia), bleeding or a high risk of their development;
• severe renal failure (creatinine clearance less than 30 ml / min);
• severe hepatic insufficiency or active liver disease;
• condition after aortocoronary bypass surgery;
• confirmed hyperkalemia;
• pregnancy (3 trimester), the period of childbirth, lactation period;
• inflammatory bowel disease;
• children under 16 years of age (safety and efficacy not established).

Application in pregnancy and lactation

Ketorolac is contraindicated in pregnancy (3 trimester), childbirth and lactation.

Use with caution in pregnancy in 1 and 2 trimesters.

Use in children

Contraindicated in children under 16 years of age (efficacy and safety not established).

Application in elderly patients

Use with caution in the elderly (over 65 years).

special instructions

Before prescribing the drug, it is necessary to clarify the question of the previous allergy to ketorolac or NSAIDs. Because of the risk of developing allergic reactions, the first dose is administered under close supervision of the doctor.

Hypovolemia increases the risk of developing nephrotoxic adverse reactions. If necessary, you can prescribe in combination with narcotic analgesics. It is not recommended to be used as a medicine for premedication, maintenance of anesthesia.

When combined with other NSAIDs, fluid retention, cardiac decompensation, and increased blood pressure may occur. The effect on platelet aggregation stops after 24-48 hours. Do not use simultaneously with Paracetamol for more than 5 days.

Patients with blood clotting disorder are appointed only with a constant control of the number of platelets, it is especially important for postoperative patients requiring careful control of hemostasis.

To reduce the risk of NSAID-gastropathy, antacids, misoprostol, Omeprazole are prescribed.

The risk of developing drug complications increases with prolonged treatment (in patients with chronic pain) and increasing the dose of the drug more than 40 mg per day. To reduce the risk of developing adverse events from the gastrointestinal tract, a minimum effective dose should be used with the minimum possible short course.

Impact on the ability to drive vehicles and manage mechanisms

During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Drug Interactions

Admission with other NSAIDs, glucocorticosteroids, ethanol (alcohol), corticotropin, calcium preparations increases the risk of ulceration of the gastrointestinal mucosa and the development of gastrointestinal bleeding.

Simultaneous appointment with anticoagulant drugs - derivatives of coumarin and indanedione, heparin, thrombolytic agents (alteplase, streptokinase, urokinase),antiplatelet drugs, cephalosporins, valproic acid and Acetylsalicylic acid (aspirin) increases the risk of bleeding.

Reduces the effect of antihypertensive and diuretic drugs (reduces the synthesis of prostaglandins in the kidneys).

The appointment together with Methotrexate increases hepato- and nephrotoxicity (their joint appointment is possible only with the use of low doses of the latter and control of its concentration in the plasma).

At appointment with other nefrotoksicnymi medical products (including with preparations of gold) the risk of development nefrotoksichnosti raises.

Drugs that block tubular secretion, reduce the clearance of ketorolac and increase its concentration in the plasma. Increases the effect of narcotic analgesics.

Myelotoxic drugs increase the manifestation of hematotoxicity of the drug.

Analogues of the drug Ketorolac

Structural analogs for the active substance:

• Adolor;
• Akyular;
• Vatorlak;
• Dolak;
• Dolomin;
• Cetadrope;
• Ketalgin;
• Ketanov;
• Ketokam;
• Ketolac;
• Ketorol;
• Ketorolac Rhompharm;
• Ketorolak Eskom;
• Ketorolac tromethamine;
• Ketofril
• Thoradol;
• Torolac.

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