Ketorolac

Table of contents

  • Brand Names
  • Chemistry
  • Pharmacologic Category
  • Mechanism of Action
  • Therapeutic Use
  • Pregnancy and Lactation Implications
  • Contraindications
  • Warnings and Precautions
  • Adverse Reactions
  • Genes that may be involved
  • Substrate of
  • Inhibits
  • Drug Interactions
  • Nutrition/Nutraceutical Interactions
  • Dosage
  • Pharmacokinetics and Pharmacodynamics
  • Special Considerations

Brand Names

Europe

Austria: Acular; Belgium: Aculare; Denmark: Acular, Toradol; Finland: Acular, Toradol; France: Acular; Germany: Acular; Greece: Acular, Errkes, Toradol; Ireland: Acular; Italy: Acular, Benketol, Girolac, Ketorolac, Kevindol, Lixidol, Nasvical, Rolacsin, Toradol; Latvia: Algikey, Ketanov, Ketorolac; Lithuania: Ketanov, Ketolgan; Luxembourg: Aculare; Malta: Acular; Netherlands: Acular; Poland: Acular; Portugal: Acular, Cetorolac, Elipa, Toradol; Romania: Ketanov, Ketorol; Spain: Acular, Algikey, Ketorolaco, Toradol; Sweden: Toradol; UK: Acular, Ketorolac, Toradol.

North America

Canada: Acular, Ketorolac, Toradol; USA: Acular, Acuvail, Ketorolac, Sprix.

Latin America

Argentina: Acular, Blocadol, Dolten, Kelac, Kemanat, Ketopharm, Ketorolac, Klenac, Poenkerat, Sinalgico, Teledol, Tenkdol, Unicalm; Brazil: Acular, Cetorolaco de Trometamina, Cetrolac, Toragesic; Mexico: Acularen, Aitornet, Apotoke, Brunacol, Celfax, Doket, Dolac, Dolcoplaz, Dolikan, Efimerol, Estopein, Exorol, Finlac, Geldako, Gesilac, Glicima, Godek, Kendol, Kendolit, Ketorolaco, Ketrol, Koprak, Lacdol, Lacomin, Lendaco, Lenaken, Lokefar, Lorotec, Mavidol, Plusindol, Ranketo, Rapix, Rolodiquim, Rometran-K, Sebapain, Supradol, Toloran, Toral-Teva, Torkol, Trodorol, Tromedal, Ultilap, Zafidol.

Drug combinations

Chemistry

Ketorolac Tromethamine: C~15~H~13~NO~3~ C~4~H~11~NO~3~. Mw: 376.40. (1) 1H-Pyrrolizine-1-carboxylic acid, 5-benzoyl-2,3-dihydro, (±)-, compound with 2-amino-2-(hydroxymethyl)-1,3-propanediol (1:1); (2)(±)-5-Benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid, compound with 2-amino-2-(hydroxymethyl)-1,3-propanediol (1:1). CAS-74103-07-4; CAS-74103-06-3 (ketorolac)(1984).

Pharmacologic Category

Analgesics and Antipyretics; Other Nonsteroidal Anti-inflammatory Agents. (ATC-Code: M01AB15; S01BC05).

Mechanism of action

Inhibits prostaglandin synthesis by decreasing activity of enzyme cyclooxygenase, which results in decreased formation of prostaglandin precursors.

Therapeutic use

Short-term (≤5 days) management of moderate-to-severe acute pain requiring analgesia at opioid level. Temporary relief of ocular itching due to seasonal allergic conjunctivitis. Postoperative inflammation following cataract extraction. Reduction of ocular pain and photophobia following incisional refractive surgery. Reduction of ocular pain, burning, and stinging following corneal refractive surgery.

Pregnancy and lactiation implications

The drug may inhibit uterine contractions and adversely affect fetal circulation, therefore its use is contraindicated during labor and delivery. Use should be avoided during late pregnancy. Use of systemic ketorolac contraindicated in breast-feeding women.

Unlabeled use

Contraindications

Hypersensitivity to ketorolac, aspirin, other NSAIDs, or any component of the formulation. Peptic ulcer disease, GI bleeding or perforation, advanced renal disease or risk of renal failure. Prophylaxis before major surgery. Cerebrovascular bleeding. Hemorrhagic diathesis, incomplete hemostasis, or high risk of bleeding. With ASA or other NSAIDs, probenecid or pentoxifylline. Epidural or intrathecal administration. Perioperative pain in setting of CABG surgery. Labor and delivery. Breast-feeding.

Warnings and precautions

May inhibit platelet function. Contraindicated in cerebrovascular bleeding (suspected or confirmed), hemorrhagic diathesis, incomplete hemostasis and high risk for bleeding. Anemia might occur. Increased risk of adverse cardiovascular thrombotic events, including myocardial infarction, stroke, and new onset or worsening of pre-existing hypertension. Use caution with fluid retention, heart failure, or hypertension. May increase risk of GI irritation, inflammation, ulceration, bleeding, and perforation. Use caution with history of GI disease (bleeding, ulcers, inflammatory bowel disease), concurrent therapy with aspirin, anticoagulants and/or corticosteroids, smoking, use of alcohol, elderly or debilitated patients. Hypersensitivity, including bronchospasm and anaphylactic shock, might occur. Do not use in patients who experience asthma, bronchospasm, rhinitis, or urticaria with NSAID or aspirin therapy. Ketorolac injection contraindicated in prior hypersensitivity reaction to aspirin or NSAIDs. May cause serious skin adverse events including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Do not administer in aspirin-sensitive asthma (severe bronchospasm may occur). Use caution in other forms of asthma. Risk of MI and stroke may be increased with use following CABG surgery. Use with caution in hepatic impairment or history of liver disease. Ketorolac contraindicated in advanced renal impairment and in risk for renal failure due to volume depletion. Concurrent use of ketorolac with aspirin or other NSAIDs contraindicated due to increased risk of adverse reactions. The elderly are at increased risk for adverse effects (especially CNS effects, peptic ulceration, renal toxicity). Use contraindicated in labor and delivery and breast-feeding women. Dosage adjustment required for patients weighing <50 kg (<110 pounds). Oral ketorolac not indicated for use in children. Ophthalmic solution may increase bleeding time associated with ocular surgery (use with caution in known bleeding tendencies or patients receiving anticoagulants). Healing time may be slowed or delayed. Corneal thinning, erosion, or ulceration reported with topical NSAIDs. Use caution with complicated ocular surgery, corneal denervation, corneal epithelial defects, diabetes, rheumatoid arthritis, ocular surface disease, or ocular surgeries repeated within short periods of time; risk of corneal epithelial breakdown may be increased. Oral therapy only indicated for use as continuation treatment, following parenteral ketorolac and not indicated for minor or chronic painful conditions. Ketorolac injection contraindicated for epidural or intrathecal administration. Withhold for at least 4-6 half-lives prior to surgical or dental procedures.

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