Ketorol - instructions for use, analogs, testimonials and release forms (10 mg tablets, injectable injections, gel or ointment 2%) drugs for the treatment of pain with menstruation, dental, headache and other pain in adults, children and pregnancy

In this article, you can read the instructions for using the drug Ketorol. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Ketorol 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. Ketorol analogues in the presence of existing structural analogs.Use for treatment of dental, head and other types of pain, with menstruation in adults, children, as well as during pregnancy and lactation.

Ketorol - Non-steroidal anti-inflammatory drug. Ketorolac (active ingredient Ketorol) has a pronounced analgesic effect, it also has an anti-inflammatory and moderate antipyretic effect.

The mechanism of action is associated with a non-selective inhibition of the activity of the enzymes COX-1 and COG-2, mainly in peripheral tissues, which results in inhibition of the biosynthesis of prostaglandins - modulators of pain sensitivity, thermoregulation and inflammation. Ketorolac is a racemic mixture of [-] S- and [+] R-enantiomers, with the analgesic effect due to the [-] S-enantiomer.

The drug does not affect opioid receptors, does not depress respiration, does not cause drug dependence, does not have sedative and anxiolytic effects.

By the strength of the analgesic effect comparable to morphine, it significantly exceeds other NSAIDs.

After intramuscular injection and taking the drug inside, the beginning of analgesic action is observed after 30 minutes and 1 hour, the maximum effect is achieved in 1-2 hours.

Pharmacokinetics

After ingestion Ketorol is well absorbed from the digestive tract. After intramuscular injection, ketorolac is rapidly and completely absorbed from the injection site into the systemic bloodstream. 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 and p-hydroxycetorolac. It is excreted by the kidneys (91%) and through the intestine (6%). Glucuronides are excreted in the urine. It is not excreted by hemodialysis.

Indications

• pain syndrome of medium and strong intensity of various genesis (headache, toothache, pain during menstruation) (including pain in the postoperative period, with cancer).

Forms of release

Tablets, film-coated 10 mg.

Solution for intravenous and intramuscular injection (injections in ampoules for injection) 30 mg / ml.

Gel for ointment for external use 2%.

Instructions for use and dosage

Ketorol tablets are administered orally once or repeatedly, depending on the severity of the pain syndrome. Once - in a dose of 10 mg, with repeated admission - 10 mg to 4 times a day, depending on the severity of pain. The maximum daily dose should not exceed 40 mg.

The duration of treatment with oral intake should not exceed 5 days.

The injection solution is administered intramuscularly in minimally effective doses, selected according to the intensity of the pain and the response of the patient. If necessary, it is also possible to additionally prescribe opioid analgesics in reduced doses.

Adults under 65 years of age the drug is administered intramuscularly at a dose of 10-30 mg once or depending on the severity of the pain syndrome of 10-30 mg every 4-6 hours.

Elderly patients over the age of 65 or with impaired renal function the drug is prescribed IM in a dose of 10-15 mg once or depending on the severity of the pain syndrome at 10-15 mg every 4-6 hours.

With the / m introduction the maximum daily dose for patients under the age of 65 years is 90 mg, for patients over 65 years old or with renal dysfunction 60 mg.

The duration of treatment with parenteral administration should not exceed 5 days.

When switching from parenteral administration of the drug to oral administration, the total daily dose of both dosage forms on the day of transfer for patients under the age of 65 years should not exceed 90 mg, for patients over the age of 65 years or with renal dysfunction 60 mg.In this case, the dose of the drug for oral administration on the day of transition should not exceed 30 mg.

Side effect

• gastralgia;
• diarrhea;
• stomatitis;
• flatulence;
• constipation;
• vomiting;
• sensation of stomach overflow;
• nausea;
• erosive and ulcerative lesions of the gastrointestinal tract (including with perforation and / or bleeding - abdominal pain, spasm or burning in the epigastric region, melena, vomiting like "coffee grounds", nausea, heartburn);
• pain in the lower back with or without hematuria and / or azotemia;
• hemolytic uremic syndrome (hemolytic anemia, renal failure, thrombocytopenia, purpura);
• frequent urination;
• increase or decrease in the volume of urine;
• edema of renal genesis;
• bronchospasm;
• rhinitis;
• swelling of the larynx (dyspnea, difficulty breathing);
• headache;
• dizziness;
• drowsiness;
• hallucinations;
• depression;
• psychosis;
• hearing loss;
• tinnitus;
• impaired vision (including blurred vision);
• fainting;
• Anemia, eosinophilia, leukopenia;
• nose bleed;
• rectal bleeding;
• skin rash (including maculopapular rash);
• purpura;
• exfoliative dermatitis (fever with chills or without, redness, dermatitis or peeling of the skin, swelling and / or tenderness of the tonsils);
• hives;
• Stevens-Johnson syndrome;
• Lyell's syndrome;
• 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);
• burning or pain at the injection site;
• swelling of the face, legs, ankles, fingers, feet;
• increase in body weight;
• increased sweating.

Contraindications

• "aspirin" asthma;
• bronchospasm;
• angioedema;
• hypovolemia (regardless of the cause that caused it);
• dehydration;
• erosive and ulcerative lesions of the gastrointestinal tract in the phase of exacerbation;
• peptic ulcers;
• hypocoagulation (including hemophilia);
• hepatic and / or renal failure (plasma creatinine above 50 mg / l);
• hemorrhagic stroke (confirmed or suspected);
• hemorrhagic diathesis;
• simultaneous reception with other NSAIDs;
• high risk of bleeding (including after operations);
• violation of hematopoiesis;
• pregnancy, childbirth;
• lactation period (breastfeeding);
• children and adolescents under 16;
• increased sensitivity to ketorolac or other NSAIDs.

Application in pregnancy and lactation

The drug is contraindicated for use in pregnancy and lactation (breastfeeding).

special instructions

It should be taken into account that the effect of the drug on platelet aggregation persists for 24-48 hours.

Hypovolemia increases the risk of adverse reactions from the kidneys.

If necessary, ketorol can be prescribed in combination with opioid analgesics.

It is not recommended to use Ketorol concurrently with Paracetamol for more than 5 days.

Patients with a violation of blood clotting drug prescribed only with a constant control of the number of platelets; This is especially important in the postoperative period and requires careful monitoring of hemostasis.

Ketorol is not used to treat chronic pain.

Impact on the ability to drive vehicles and manage mechanisms

Since a significant proportion of patients with Ketorol develop side effects from the CNS (drowsiness, dizziness, headache), it is recommended to avoid performing work that requires increased attention and quick response (driving vehicles, working with mechanisms).

Drug Interactions

Simultaneous use of ketorolac with Acetylsalicylic acid or other NSAIDs, calcium preparations, GCS, ethanol (alcohol), corticotropin can lead to the formation of gastrointestinal ulcers and the development of gastrointestinal bleeding.

Co-administration of Ketorol with paracetamol increases the risk of developing nephrotoxicity, with methotrexate-hepato- and nephrotoxicity.

Against the background of the use of ketorolac, a decrease in the clearance of Methotrexate and lithium and the increased toxicity of these substances are possible. The joint administration of ketorolac and methotrexate is possible only with the use of low doses of the latter (in this case, the concentration of methotrexate in the blood plasma should be monitored).

Probenecid reduces plasma clearance and the volume of ketorolac distribution, increases the concentration in the blood plasma and increases the half-life of the latter.

Simultaneous administration with indirect anticoagulants, heparin, thrombolytic agents, antiaggregants, cefoperazone, cefotetan and Pentoxifylline increases the risk of bleeding.

Ketorol reduces the effect of antihypertensive and diuretic drugs (eg.decreases the synthesis of prostaglandins in the kidneys).

When combining Ketorol with opioid analgesics, the doses of the latter can be significantly reduced.

Antacids do not affect the absorption of ketorolac.

At simultaneous application with Ketorol hypoglycemic action of insulin and oral hypoglycemic preparations increases (therefore the dose recalculation is necessary).

The joint administration of Ketorol with sodium valproate causes a disruption of platelet aggregation.

Ketorolac increases the concentration of Verapamil and Nifedipine in blood plasma.

When Ketorol is prescribed with other nephrotoxic drugs (including with gold preparations), the risk of developing nephrotoxicity increases.

Drugs that block tubular secretion, reduce the clearance of ketorolac and increase its concentration in the blood plasma.

Pharmaceutical interaction

Solution for injection should not be mixed in one syringe with morphine sulfate, promethazine and hydroxyzine due to precipitation.

Pharmaceutically incompatible with a solution of tramadol, lithium preparations.

Solution for injection is compatible with saline solution, 5% Dextrose solution, Ringer's solution and Ringer's lactate solution, Plasmalite solution,as well as with infusion solutions containing aminophylline, Lidocaine hydrochloride, dopamine hydrochloride, human short-acting insulin and Heparin sodium salt.

Analogues of Ketorol

Structural analogs for the active substance:

• Adolor;
• Akyular LS;
• Dolak;
• Dolomin;
• Ketalgin;
• Ketanov;
• Ketolac;
• Ketorolac;
• Ketorolac Rhompharm;
• Ketorolac-OBL;
• Ketorolak-Eskom;
• Ketorolac tromethamine;
• Ketofril;
• Thoradol;
• Torolac.

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