Compound

Each ampoule contains ketorolac tromethamine 30 mg, as well as excipients: ethyl alcohol 95% 0.125 ml, sodium chloride 4.35 mg, disodium EDTA 1.0 mg, octoxynol 0.07 mg, sodium hydroxide 0.725 mg, propylene glycol 400 mg, water for injection up to 1 ml

Pharmacotherapeutic group

Nonsteroidal anti-inflammatory and antirheumatic drugs. ATX code: M01 AB15.

Description

Transparent, colorless or pale yellow liquid, in yellow ampoules, volume 1 ml, USP 1 type.

Pharmacological properties

Pharmacodynamics: ketorolac, being a non-steroidal anti-inflammatory drug, has an analgesic, antipyretic and anti-inflammatory effect. The mechanism of action at the biochemical level is inhibition of the cyclooxygenase enzyme, mainly in peripheral tissues, resulting in inhibition of the biosynthesis of prostaglandins - modulators of pain sensitivity, thermoregulation and inflammation. Ketorolac is a racemic mixture of [-]S and [-]P enantiomers, and the analgesic effect is due to the [-]S form. The drug does not affect opioid receptors, does not depress respiration, does not inhibit intestinal motility, does not have a sedative or anxiolytic effect, does not cause drug dependence, and does not affect the progression of the disease. Ketorolac inhibits platelet aggregation and increases bleeding time. The functional state of platelets is restored 24-48 hours after discontinuation of the drug.

Pharmacokinetics: the bioavailability of ketorolac after oral administration ranges from 80% to 100%. Maximum plasma concentration is achieved within 30-60 minutes. The pharmacokinetics of ketorolac under conditions of mid-therapeutic doses is a linear function. The equilibrium concentration of the drug in plasma is 50% higher than that determined after a single dose. More than 99% of the drug is bound to plasma proteins, resulting in an apparent volume of distribution of less than 0.3 l/kg.

Ketorolac is metabolized primarily to form conjugated forms of glucuronic acid, which are excreted through the kidneys. Metabolites do not have analgesic activity. The half-life of the drug averages 5 hours.

Indications for use

Short-term relief of moderate and severe acute pain in the postoperative period. Treatment should be started only in a hospital setting, the maximum duration of treatment is 2 days.

Directions for use and doses

Ketorol is intended for intramuscular injection; the drug should not be used for epidural or spinal administration. The solution is injected slowly intramuscularly (deep into the muscle). The onset of the analgesic effect is about 30 minutes with its maximum severity within 1-2 hours, the average duration of analgesia is 4-6 hours.

Administration of the drug several times a day for more than 2 days is not recommended, since in most cases patients do not require longer-term analgesic therapy, or can be switched to oral ketorolac. In this case, the duration of use of ketorolac parenterally and orally should not exceed 5 days in total.

To achieve maximum analgesic effect in the early postoperative period, it is possible to use ketorolac and narcotic analgesics together; the daily dose of the latter in this case is reduced. Ketorolac does not affect addiction to opioids and does not increase associated respiratory depression or sedation.

Dose selection and adjustment should be made in accordance with the intensity of pain and response to the drug. To minimize side effects, it is recommended to use the minimum effective dose for the shortest possible course of treatment.

Adults; The usually recommended initial dose of Ketorol is 10 mg, followed by 10-30 mg every 4-6 hours. In the early postoperative period, it is permissible to administer the drug every 2 hours, if necessary. The maximum daily dose is 90 mg/day. in patients weighing less than 50 kg - no more than 60 mg/day.

Elderly patients (over 65): It is recommended to use the drug in the lowest effective dose, the total dose should not exceed 60 mg/day. Due to the higher risk of side effects in this group of patients, the minimum possible duration of treatment and regular monitoring of the patient’s condition to exclude gastrointestinal bleeding are recommended. Children: The safety and effectiveness of ketorolac in children have not been confirmed; the drug is not recommended for use in children under 16 years of age.

Patients with impaired renal function: the use of ketorolac is contraindicated in patients with severe and moderate renal impairment. In case of mild renal dysfunction, it is permissible to use Ketorol in a dose of no more than 60 mg/day.

If it is necessary to combine parenteral and oral administration of Ketorol, the total daily dose should not exceed 90 mg (60 mg in persons over 65 years of age, with a body weight of less than 50 kg or impaired renal function), while the dose of the drug taken orally should not exceed 40 mg/ days It is recommended to quickly transfer the patient only to the oral form of the drug.

Side effect

From the gastrointestinal tract: anorexia, feeling of abdominal discomfort, feeling of fullness of the stomach, nausea, dyspepsia, gastrointestinal pain, epigastric pain, diarrhea, flatulence, belching, vomiting, constipation, erosive and ulcerative changes, bleeding and perforation of the gastrointestinal tract (sometimes fatal) , vomiting blood, blood in the stool, gastritis, peptic ulcer, pancreatitis, ulcerative stomatitis, esophargitis, exacerbation of Crohn's disease and colitis.

From the liver and biliary tract: liver dysfunction, liver failure, jaundice, hepatitis, hepatomegaly, increased activity of liver transaminases.

From the nervous system: headache, dizziness, fainting, increased fatigue, weakness, irritability, dry mouth, increased thirst, mood changes, anxiety, impaired concentration, euphoria, nervousness, confusion, paresthesia, unusual dreams, depression, drowsiness, disturbance sleep, insomnia, hallucinations, agitation, hyperkinesia, convulsions, pathological thoughts, aseptic meningitis, stiff neck, anxiety, vertigo, disorientation, thinking disorder.

From the senses: disturbance of taste, blurred vision, optic neuritis, tinnitus, decreased and loss of hearing.

From the musculoskeletal system: myalgia.

From the outsideurinarysystems: pain at the site of the kidney projection, dysuria, frequent urination, oliguria, hematuria, proteinuria, increased levels of urea and creatinine in the blood serum, hyponatremia, hyperkalemia, urinary retention, renal failure, interstitial nephritis, papillary necrosis, nephrotic syndrome, hemolytic uremic syndrome.

From the cardiovascular system: pallor, hyperemia, chest pain, palpitations, bradycardia, heart failure, arterial hypertension, edema. Data from clinical and epidemiological studies suggest that the use of certain NSAIDs, especially in high doses and for long periods of time, may be associated with an increased risk of arterial thromboembolic complications (myocardial infarction or stroke).

From the outside blood: purpura, leukopenia, eosinophilia, neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia, thrombocytopenia, a possible decrease in the rate of blood clotting, the occurrence of hemorrhages under the skin, hematomas, nosebleeds, prolongation of bleeding time, increased bleeding of postoperative wounds.

From the respiratory system: shortness of breath, tachypnea, bronchospasm, complication of asthma, pulmonary edema.

From the reproductive system: infertility (in women).

From the skin: itching, urticaria, photosensitivity, Lyell's syndrome, exfoliative dermatitis, toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome, skin rashes, including maculopapular and weeping, changes in facial skin color.

Allergic reactions: anaphylactic and anaphylactoid reactions, urticaria, bronchospasm, laryngeal edema, angioedema, eyelid edema, periorbital edema, exfoliative dermatitis, bullous dermatosis.

From the body as a whole: general malaise, swelling, fever, increased sweating, weight gain; pain, swelling and hyperemia at the injection site. To prevent possible side effects, one should strive to use the minimum effective doses of the drug, strictly adhere to the established dosages and administration regimens, take into account the patient’s condition (age, concomitant diseases, liver function, kidney function, state of water-electrolyte metabolism and hemostatic system), as well as possible drug interactions with combination therapy.

Contraindications

Bronchial asthma, complete or partial syndrome of nasal polyps, bronchospasm, history of angioedema. Peptic ulcer of the stomach and duodenum during an exacerbation, as well as a history of ulcers or gastrointestinal bleeding, the presence or suspicion of gastrointestinal bleeding. History of blood coagulation disorders, conditions with a high risk of bleeding, hemorrhagic diathesis, coagulopathies, hemorrhagic stroke, intracranial bleeding, simultaneous use with anticoagulants (including warfarin, low doses of heparin). Surgical interventions with a high risk of bleeding or the risk of incomplete stopping of bleeding. Moderate and severe renal failure (plasma creatinine more than 50 mg/l), risk of renal failure, hypovolemia, dehydration. Pregnancy, childbirth and breastfeeding. Hypersensitivity to ketorolac, aspirin, other NSAIDs or any component of the drug. Concomitant use of other NSAIDs (risk of additive side effects) Age under 16 years Congestive heart failure The drug is not used for pain relief before and during surgery. Ketorolac is not used for epidural and intrathecal injections. Severe liver failure. Combined use with lithium preparations, pentoxifylline probenecid. Epidural or intrathecal administration of the drug is contraindicated.

Features of application

Prescription for patients with impaired function liver: prescribed with caution. While taking ketorolac, liver enzyme levels may increase. If there are functional abnormalities in the liver while taking ketorolac, a more severe pathology may develop. If signs of liver pathology are detected, treatment should be stopped.

Patients with renal failure or a history of kidney disease: ketorolac is prescribed with caution.

Purpose elderly patients: Since patients in this age group are more likely to develop adverse reactions, the minimum effective dose should be used (daily therapeutic dose of no more than 60 mg for patients over 65 years of age).

Pregnancy and lactation

Efficacy and safety have not been established. Drugs that affect the synthesis of prostaglandins, including ketorolac, can cause a decrease in fertility, and therefore are not recommended for use by women planning pregnancy. The safety of the drug in pregnant women has not been studied. A study on rats and rabbits at toxic doses did not reveal a teratogenic effect. In rats, prolongation of gestational age and delayed birth were noted. Due to the known negative effect of NSAID drugs on the cardiovascular system of the fetus (risk of occlusion of the ductus arteriosus), ketorolac is contraindicated in pregnant women. The use of ketorolac during labor is not recommended due to the increased risk of bleeding in mother and child. Ketorolac penetrates into milk, and therefore is not recommended for use during lactation.

Impact on laboratory test indicators: it is possible to increase bleeding time when studying coagulation parameters.

Impact on ability to driveand other mechanisms

Since a significant proportion of patients who are prescribed ketorolac develop side effects from the central nervous system (drowsiness, dizziness, headache), it is recommended to avoid performing work that requires increased attention and quick reaction.

Warnings and Precautions

Ketorolac can cause severe adverse reactions from the digestive tract at any stage of drug therapy after or without warning symptoms; such adverse reactions can be fatal. The risk of serious gastrointestinal bleeding is dose-related, but side effects can occur even with short-term therapy. In addition to a history of peptic ulcer disease, provoking factors are the simultaneous use of oral corticosteroids, anticoagulants, long-term therapy with non-steroidal anti-inflammatory drugs, smoking, drinking alcoholic beverages, and old age. If you suspect the development of adverse reactions from the gastrointestinal tract, ketorolac should be discontinued.

NSAIDs should be used with caution in patients with a history of Crohn's disease and ulcerative colitis due to the possibility of worsening the disease.

Ketorolac inhibits platelet aggregation and prolongs bleeding time; platelet function returns to normal within 24-48 hours after discontinuation of the drug. In patients receiving anticoagulant therapy, the use of ketorolac may increase the risk of bleeding. Patients already taking anticoagulants or requiring low-dose heparin should not receive ketorolac. In patients taking other drugs that affect hemostasis, ketorolac should be used with caution. In patients who have undergone surgery with a high risk of bleeding or incomplete hemostasis, ketorolac should not be used.

Like other NSAIDs, ketorolac inhibits prostaglandin synthesis and may cause kidney toxicity and should therefore be used with caution in patients with impaired renal function or a history of kidney disease. Risk groups include patients with impaired renal function, hypovolemia, heart failure, impaired liver function, patients using diuretics, and elderly patients.

Fluid retention, sodium chloride retention, hypertension, oliguria and peripheral edema have been observed in some patients taking NSAIDs, including ketorolac, so it should be used with caution in patients with hypertension, heart failure, and fluid and electrolyte imbalances should be corrected before administering the drug.

Clinical studies and epidemiological data suggest that the use of some NSAIDs, especially in high doses and for long periods of time, may be associated with an increased risk of arterial thrombotic complications such as myocardial infarction or stroke. Such a risk cannot be excluded for ketorolac. To minimize the potential risk of adverse cardiovascular complications in patients using NSAIDs, the lowest effective dose should be used for the shortest possible period of time. Ketorolac should be prescribed to patients with uncontrolled hypertension, congestive heart failure, established coronary artery disease, peripheral arterial and/or cerebrovascular disease only after a thorough assessment of all the advantages and disadvantages of such treatment.

Ketorolac should be administered with caution to patients with impaired liver function or a history of liver disease. Significant increases (more than three times normal) in serum ALT and AST were observed in less than 1% of patients in controlled clinical studies. In addition, isolated cases of severe hepatic reactions have been reported, including jaundice, fulminant hepatitis, liver necrosis and liver failure, in some cases leading to death. If signs of liver dysfunction appear, ketorolac should be discontinued.

Use of the drug in patients with systemic lupus erythematosus or connective tissue diseases may be associated with an increased risk of developing aseptic meningitis.

There have been reports of serious skin reactions such as exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis. The highest risk of these reactions exists at the beginning of treatment.

Serious anaphylactic and anaphylactoid reactions, such as bronchospasm, laryngeal edema, angioedema, and anaphylactic shock, have been reported. Ketorolac should not be used in patients with a history of bronchial asthma, nasal polyp syndrome, bronchospasm, or angioedema. If a rash or other manifestations of hypersensitivity appear, treatment with the drug should be discontinued.

This medicine contains a small amount of ethanol (ethyl alcohol), i.e. less than 100 mg in 1 ml the sodium content of the medicinal product is less than 1 mmol (23 mg) in 1 ml.

Interaction with other drugs

Ketorolac slightly reduces the degree of protein binding of warfarin.

In research in vitro the effect of therapeutic doses of salicylates on the degree of binding of ketorolac to plasma proteins is shown, downward from 99.2% to 97.5%. When combined with furosemide, its diuretic effect may be weakened by approximately 20%.

Probenecid reduces the plasma clearance and volume of distribution of ketorolac, increasing its plasma concentration and increasing its half-life. With the use of ketorolac, the clearance of methotrexate and lithium may decrease and the toxicity of these substances may increase.

A possible interaction between ketorolac and non-depolarizing muscle relaxants has been noted, leading to the development of apnea.

It is possible that simultaneous use with ACE inhibitors may increase the risk of renal dysfunction.

Rare cases of the development of convulsive attacks have been described when ketorolac is combined with anticonvulsants (phenytoin, carbamazepine).

Hallucinations may occur during simultaneous use of ketorolac and psychostimulant drugs (fluoxetine, thiothixene, alprazolam).

Concomitant use of ketorolac and NSAIDs, including selective cyclooxygenase-2 inhibitors, should be avoided due to an increased risk of serious adverse reactions. Ketorolac inhibits platelet aggregation, reduces thromboxane concentrations and prolongs bleeding time. Platelet function returns to normal within 24-48 hours after stopping ketorolac. Although studies do not indicate a significant interaction between ketorolac and anticoagulants, concomitant use of ketorolac and therapeutic doses of warfarin, prophylactic doses of heparin (2500-5000 units over 12 hours) and dextrans may be associated with an increased risk of bleeding.

NSAIDs should not be used for 8 to 12 days after mifepristone administration due to the possible decreased effect of mifepristone.

Concomitant use of ketorolac with pentoxifylline increases the risk of bleeding.

As with other NSAIDs, caution should be used when coadministered with corticosteroids due to the increased risk of GI ulceration or bleeding.

Ketorolac has been shown to reduce the need for opioid analgesics when they are used to relieve postoperative pain.

Patients taking quinolines concomitantly may be at increased risk of seizures.

Concomitant use of NSAIDs with zidovudine leads to an increased risk of hematological toxicity.

There is an increased risk of nephrotoxicity when NSAIDs are used concomitantly with tacrolimus or cyclosporine.

NSAIDs may worsen heart failure, reduce glomerular filtration rate, and increase plasma levels of cardiac glycosides when used together.

Incompatibility

Ketorolac injection solution should not be mixed in small containers (for example, in the same syringe) with morphine sulfate, meperidine hydrochloride, promethazine hydrochloride or hydroxyzine hydrochloride, as ketorolac may precipitate.

Overdose

An overdose of ketorolac with a single or repeated use is usually manifested by pain in the abdomen, the occurrence of peptic ulcers of the stomach or erosive gastritis, impaired renal function, hyperventilation, metabolic acidosis, these symptoms are cured after stopping the drug. In these cases, gastric lavage, administration of adsorbents (activated carbon) and symptomatic therapy are recommended. Ketorolac is not sufficiently eliminated by dialysis.

Manufactured

Dr. Reddy's Laboratories Ltd.

Village Khol, Nalagarh Road, Baddi, Solan District, Himachal Pradesh, 173205, India.

Ketorol is a drug whose active substance is ketorolac. It is classified as an NSAID and has analgesic, anti-inflammatory and antipyretic effects.

It is used to eliminate pain of varying degrees of intensity and various etiologies (including postoperative pain and cancer pain).

On this page you will find all the information about Ketorol: complete instructions for use for this drug, average prices in pharmacies, complete and incomplete analogues of the drug, as well as reviews of people who have already used Ketorol. Would you like to leave your opinion? Please write in the comments.

Clinical and pharmacological group

NSAIDs with a pronounced analgesic effect.

Conditions for dispensing from pharmacies

Dispensed with a doctor's prescription.

Prices

How much do Ketorol tablets cost? The average price in pharmacies is 45 rubles.

Release form and composition

Ketorol is produced in the form of tablets coated with a special soluble green coating. The biconvex shape of the tablet makes it easier to swallow the medicine.

• All dosage forms of Ketorol contain ketorolac in varying concentrations as an active substance. So, the tablets contain 10 mg of ketorolac, the solution contains 30 mg per 1 ml, and the gel contains 20 mg per 1 g (2%).

Each tablet has a special embossing in the form of the Latin letter S. The tablets are packaged in 10 pieces in a plastic blister with a metal coating. The package may contain a different number of blisters, which makes the price of the drug radically different.

Pharmacological effect

Ketorol is a non-steroidal anti-inflammatory drug with a predominantly analgesic effect. The active ingredient of the drug is ketorolac (ketorolac tromethamine). Ketorolac has moderate antipyretic properties, an anti-inflammatory effect and a pronounced analgesic effect.

Ketorolac, predominantly in peripheral tissues, causes indiscriminate inhibition of the activity of cyclooxygenase enzymes types 1 and 2, resulting in inhibition of prostaglandin formation. Prostaglandins play an important role in pain, inflammatory reactions and the mechanism of thermoregulation. According to the chemical structure, the active substance of Ketorol is a racemic mixture of +R- and -S- enantiomers, and the analgesic effect of the drug is due precisely to the -S-enantiomers.

Ketorol does not affect opioid receptors, does not depress the respiratory center, does not have a sedative or antidepressant effect, and does not cause drug dependence. The analgesic effect of Ketorol is comparable in strength to morphine and is much more superior to non-steroidal anti-inflammatory drugs of other groups. The onset of analgesic action after intramuscular administration or oral administration begins after 0.5 and 1 hour, respectively. The maximum analgesic effect is observed after 1-2 hours.

Indications for use

In the form of a solution and tablets, Ketorol is used to relieve pain of various origins of medium and severe intensity:

1. Dislocations, sprains, other injuries and their consequences;
2. Rheumatic diseases;
3. Toothache;
4. Radiculitis, neuralgia;
5. Myalgia, arthralgia;
6. Pain in the postoperative and postpartum period;
7. Oncological diseases.

In the form of a gel, the drug is used topically for pain caused by the following diseases:

1. Bursitis, epicondylitis, tendonitis, synovitis;
2. Rheumatic diseases;
3. Radiculitis, neuralgia;
4. Arthralgia, myalgia;
5. Injuries (ligament damage, bruises and inflammation of soft tissues, including post-traumatic origin).

Contraindications

1. Hyperkalemia;
2. Lactase deficiency;
3. Patients' age is up to 16 years;
4. Pregnancy and lactation;
5. Gastrointestinal bleeding or suspicion of it;
6. Ulcerative colitis or in the acute phase;
7. History of asthma attacks, bronchospasms, frequent obstructive bronchitis;
8. Severe damage to the liver and kidneys, accompanied by disruption of the functioning of these organs;
9. Hereditary blood diseases accompanied by a violation of its coagulation function;
10. Individual intolerance to acetylsalicylic acid or drugs from the group of non-steroidal anti-inflammatory drugs;
11. Chronic diseases of the gastrointestinal tract with the presence of ulcerative-erosive surfaces

Relative contraindications include:

1. Coronary heart disease;
2. Diabetes mellitus;
3. Heart failure;
4. Cholestasis;
5. Patient age over 60 years;
6. Concomitant use of anticoagulants or antiplatelet agents.

Use during pregnancy and lactation

The solution and tablets are contraindicated during pregnancy and breastfeeding.

External use is allowed in the 1st and 2nd trimesters, however, after 27 weeks, the use of the gel may cause post-term pregnancy or complicated labor.

Instructions for use

The instructions for use indicate that Ketorol tablets are taken orally in a single dose of 10 mg.

• In case of severe pain, the drug is taken again at 10 mg up to 4 times a day, depending on the severity of the pain. The maximum daily dose is 40 mg. The minimum effective dose should be used. When taken orally, the duration of treatment 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 should not exceed 90 mg for patients aged 16 to 65 years and 60 mg for patients over 65 years of age or with impaired renal function. In this case, the dose of the drug in tablets on the day of transition should not exceed 30 mg.

Side effects

Ketorol tablets and injections can provoke such undesirable reactions in patients as:

• bronchospasm, laryngeal edema, rhinitis;
• increased blood pressure, fainting, pulmonary edema;
• rectal, nasal, bleeding from postoperative wounds;
• diarrhea, stomach pain, vomiting, constipation, flatulence, stomatitis, nausea, heartburn;
• weight gain, swelling of the feet, fingers, ankles, legs, face, tongue, increased sweating, fever;
• headache, drowsiness, dizziness, hyperactivity, depression, ringing in the ears, hearing loss, blurred vision.
• itching, urticaria, change in complexion, skin rash, swelling of the eyelids, difficulty breathing, wheezing, heaviness in the chest;
• lower back pain, acute renal failure, frequent urination, nephritis (inflammation of the kidneys), decreased or increased volume of urine;
• leukopenia (increase in white blood cells), eosinophilia (increase in the number of eosinophils), anemia (decrease in the number of red blood cells or hemoglobin);
• purpura, skin rash, urticaria, Lyell's syndrome (allergic dermatitis as a reaction to drugs), Stevens-Johnson syndrome (the appearance of blisters on areas of the skin and on the mucous membrane of various organs).

Overdose

Possible signs of an overdose of Ketorol: nausea, abdominal pain, vomiting, peptic ulcers or erosive lesions of the gastrointestinal tract, metabolic acidosis, impaired renal function.

Treatment: gastric lavage followed by administration of adsorbent drugs, symptomatic treatment. Not excreted to a significant extent by dialysis methods.

Special instructions

1. When using tablets for more than 5 days, the risk of side effects in the patient increases, therefore, if there is no expected therapeutic effect, you should consult your doctor again.
2. If the pain syndrome is significantly severe or there are contraindications for oral use of the drug, Ketorol is prescribed to the patient in the form of an injection solution.
3. To reduce the risk of developing a drug ulcer, the patient can be prescribed antacid or coating drugs simultaneously with Ketorol tablets, which will reduce the irritating effect of the main substance of the tablet on the mucous membranes of the digestive tract.
4. Patients with blood clotting disorders during treatment with the drug should constantly monitor the level of platelets in the blood, especially for postoperative patients.

During treatment with the drug, patients should be careful when driving vehicles and operating complex devices that require increased concentration.

Drug interactions

Ketorolac enhances the hypoglycemic effect of insulin and oral hypoglycemic drugs, so recalculation of their doses is necessary; reduces the effectiveness of antihypertensive and diuretic drugs.

When prescribing Ketorol with narcotic analgesics, their doses are significantly reduced.

Antacids do not affect the absorption of ketorolac.

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

Possible undesirable (including severe) reactions:

1. Methotrexate – hepato- and nephrotoxicity;
2. Valproic acid – platelet aggregation disorder;
3. Lithium preparations – decreased clearance and increased toxicity;
4. Paracetamol and other nephrotoxic drugs, including gold preparations – nephrotoxicity;
5. ASA, other NSAIDs, glucocorticosteroids, calcium preparations, corticotropin, ethanol – formation of gastrointestinal ulcers, development of gastrointestinal bleeding;
6. Indirect anticoagulants, antiplatelet agents, thrombolytics, heparin, pentoxifylline, cefotetan, cefoperazone - development of bleeding;
7. Verapamil and nifedipine - increase their concentration in blood plasma.

During the treatment period, other non-steroidal anti-inflammatory drugs should not be used.

Symptoms of physical pain can come unexpectedly and last for a short time. When the pain syndrome is prolonged, this is a signal of a serious illness that requires emergency treatment. However, until the doctor determines the cause of the debilitating syndrome, a special drug, ketorol, is prescribed to relieve pain, an injection which relieves suffering within 30 minutes, and the analgesic effect lasts about 5 hours.

Basic information about the medication

Ketorol belongs to the group of drugs NSAIDs (non-steroidal anti-inflammatory drugs), a class of derivatives of pyrrolysine-carboxylic acid. Any form of the drug has an analgesic and anti-inflammatory effect with signs of a moderate antipyretic effect. However, after using Ketorol injections, the analgesic effect is much stronger and occurs faster, unlike other types of medication.

1. Gel. A homogeneous transparent substance, used externally, has a characteristic odor, packaged in tubes of 30 g.
2. The tablets are greenish in color, biconvex in shape, packaged in packs of 20 pieces. A distinctive feature of Ketorol tablets is the presence of the letter “S” on one side.
3. Ampoules (glass) of 1 ml with a solution for intramuscular and intravenous administration are equipped with a recess for breaking and a ring. The package contains 10 ampoules.

Reference: Ketorol in tablet and injection form is used to relieve pain not only of moderate intensity, but also to relieve severe pain of various natures. The gel is prescribed to reduce pain and inflammation at the sites of application.

Composition of dosage forms

The active component of any type of drug is the substance ketorolac. The instructions for use indicate that ketorolac is present in varying degrees of concentration in each form of the drug:

• gram of gel contains 20 mg of active substance dissolved in a mixture of purified water, ethyl alcohol and glycerol with the addition of flavor and auxiliary substances;
• the tablet contains 10 mg of ketorolac with the addition of corn starch, cellulose, lactose and other components;
• The attached instructions indicate that the injection solution contains 30 mg of ketorolac, prepared on the basis of deionized water, ethyl alcohol, sodium chloride, and other additional substances.

Clarification: Ketorol injectable form is preferable to prescribe for quick relief of pain, as well as when it is impossible to take pills due to stomach diseases (ulcers, gastritis, gag reflex, etc.). The instructions indicate that Ketorol (ampoules and tablets) is available with a prescription.

Features of the drug's action

The basis for the therapeutic effect of the drug Ketorol, as a representative of the NSAID line, is considered to be the biochemical process of inhibition of a special substance. The enzyme cyclooxygenase promotes the conversion of arachidonic acid into components (prostaglandins) that trigger an inflammation reaction, the development of pain, and an increase in body temperature. Ketorolac, by blocking the action of cyclooxygenase, stops the synthesis of prostaglandins, resulting in the cessation of inflammation, pain syndrome, and increased temperature.

Due to its powerful analgesic effect, comparable to the analgesia of morphine, the drug is primarily used for pain relief; the anti-inflammatory and antipyretic effects are secondary. According to the instructions, one of the main advantages of the symptomatic use of Ketorol is the absence of the following consequences:

• anxiolytic and sedative effects;
• respiratory depression, as well as urinary retention;
• development of drug dependence;
• disorders of the cardiovascular system;
• effects on the functioning of opiate receptors.

Despite the benefits, the instructions for use of the drug warn that Ketorol injections should be prescribed with caution to people suffering from pathologies with a risk of bleeding. The medicine helps to thin the blood while reducing the activity of its coagulation, but without exceeding the normal limit.

Body reaction

When treated with tablets, the active substance of the drug is quickly absorbed in the digestive tract (30-40 minutes). Regardless of the method of ketorol entering the body, the use of the drug ensures 100% bioavailability, but the parenteral form of administration (injections) promotes more complete and rapid absorption of the incoming components.

The method of intramuscular administration of the drug demonstrates its rapid integration into the bloodstream due to the complete absorption of the active substance from the injection sites. The speed of onset of the analgesic effect after Ketorol injections depends on the strength of the pain syndrome:

• mild pain – the drug will take effect in 20-40 minutes;
• average pain threshold – it will take 30-60 minutes for pain relief;
• High intensity pain will subside 1-2 hours after the injection.

Biotransformation of ketorolac (more than 50% of the administered dose) occurs in the liver with the formation of non-analgesic metabolites. Inactive substances are excreted by the kidneys (91%) and intestines (6%) within 5 hours, faster in young patients than in older people. In some kidney diseases, the half-life of metabolites can extend to 13 hours or more.

Important: the instructions warn that any form of medication should not be used for a long time, since the active substance has a detrimental effect on the gastric mucosa, ulcerating it. In addition, traces of Ketorol are detected in breast milk 2 hours later, even after taking one tablet.

When are injections prescribed?

The use of Ketorol is symptomatic therapy; the drug is prescribed intramuscularly for short-term relief of pain and inflammation during the postoperative period. Injections with minimally effective doses are relevant for the following problems:

• symptoms of arthritis associated with joint inflammation;
• signs of arthrosis caused by degenerative-dystrophic destruction of articular cartilage;
• myalgia (muscle pain) and neuralgia (pinched nerve roots), as a consequence of the inflammatory process.

Due to its rapid analgesic effect, intramuscular administration of Ketorol helps reduce pain and swelling in rheumatic pathology, after a bruise or injury. Courses of injections are prescribed to relieve cancer pain; tablets are used to eliminate dental, headache, and menstrual pain, but chronic pain syndrome is not treated with Ketorol.

Rules for the use of the drug

According to the instructions for the drug, Ketorol tablets should be swallowed whole and washed down with a sufficient amount of water. The tablets should not be crushed or chewed, but can be taken regardless of meals, taking into account the specific dosage:

• single dose - once a day, one Ketorol tablet containing 10 mg of the active substance;
• repeated use - a maximum of 4 times a day, focusing on the severity of the pain syndrome.

Important: do not exceed the maximum daily dose of a short-term course of 5 days. Failure to follow the instructions increases the risk of developing side effects and dangerous complications after treatment with a non-steroidal anti-inflammatory drug.

Solution in ampoules

The instructions indicate that ampoules with Ketorol solution are completely ready for use; the doctor prescribes their use in a certain dosage, which is prohibited from being exceeded. To relieve pain, intramuscular injections are usually indicated in the gluteal region, and less often in the thigh or shoulder. If the doctor has not determined the individual dosage, then for a single administration you can use from 1 to 3 ampoules, taking into account the severity of the pain.

The dosage of Ketorol solution for injections, as an NSAID, is designed for the age group up to 65 years. If a patient switches from injections to tablets, you should carefully consider the total daily dose:

When relieving pain with Ketorol solution, use small-volume disposable syringes for deep but slow injection of the drug into the muscle. The intravenous administration process will take at least 15 seconds.

Information: the contents of the ampoule can be added to the dropper with other medicinal solutions compatible with ketorolac. The duration of a continuous course of treatment with injections, which are cheaper than tablets, should not exceed 5 days. If the pain does not go away, you will have to go to the doctor for in-depth diagnostics to identify the cause of the pain.

When injections are contraindicated

The use of Ketorol injections is not prescribed for hypersensitivity to any component of the medicinal solution. The instructions warn that injections are contraindicated:

• for diseases of the bronchopulmonary system, accompanied by swelling of the mucous membranes, bronchospasm;
• with erosive and ulcerative lesions of the mucous organs of the gastrointestinal tract, severe diseases of the liver and kidneys;
• with hematopoietic disorders, high risk of bleeding, including postoperative bleeding;
• with dehydration, hemophilia, polyposis;
• for symptoms of hemorrhagic stroke with cerebral hemorrhage.

Medicines in tablets or ampoules do not relieve pain in pregnant or lactating women, and are not used to relieve pain during labor. The instructions inform you that Ketorol is not used to treat children under 16 years of age and is not combined with other types of NSAIDs. Attention: the appearance of side effects indicates immediate discontinuation of painkiller injections.

Threat of side effects

Most often, the gastrointestinal tract suffers from undesirable manifestations of NSAID treatment, even in injections. Treatment with Ketorol can provoke diarrhea, symptoms of gastralgia; less often, patients complain of constipation, vomiting, flatulence, and there is a possibility of developing focal ulcerations.

According to patient reviews, the drug in injections has a stable effect, but some experience nausea with heartburn after taking the painkiller. Sometimes patients complain of dizziness accompanied by headache, but the symptoms disappear after completing the course.

Infrequently, the response to the administration of Ketorol from the respiratory system is the development of bronchospasm, the appearance of rhinitis, edema of the larynx, even of the lungs. The possibility of ringing in the ears, deterioration of hearing and vision cannot be ruled out. The cardiovascular system may respond to the injection use of Ketorol by increasing blood pressure.

Important: the instructions warn that abuse of Ketorol solution can result in swelling and inflammation, an anemic state, even the development of psychosis, and the appearance of hallucinations.

Arthrosis, osteochondrosis, injuries, tooth extraction, painful menstruation, inflammatory processes - all these diseases and pathological processes can be accompanied by acute pain, from which traditional analgesics usually do not save. However, Ketorol, a powerful pain reliever from the group of non-steroidal anti-inflammatory drugs, can often help in such cases. How effective is this drug, when should it be taken, what contraindications and side effects does it have?

Operating principle

The active component of Ketorol is ketorolac, which is a derivative of acetic acid. Ketorolac is a relatively new drug that appeared in the late 1980s. However, he quickly gained recognition throughout the world. Currently, ketorolac is used for the symptomatic treatment of various diseases and is widely used in gynecology, surgery, and ophthalmology.

The mechanism of action of ketorolac is a non-selective effect on a special enzyme - cyclooxygenase, which, in turn, is responsible for the synthesis of prostaglandins from arachidonic acid in the body. It is prostaglandins that are responsible for such phenomena as pain, inflammation and fever. Ketorol acts mainly in peripheral tissues.

Unlike many other non-steroidal anti-inflammatory drugs (NSAIDs), Ketorol mainly has only an analgesic effect, and its antipyretic and anti-inflammatory effect is relatively weak. The analgesic effect of ketorolac, however, is quite strong and is comparable to the analgesic effect of morphine, which is considered in medicine to be a kind of standard among painkillers. The analgesic effect of ketorolac exceeds that of all other NSAIDs and is second only to the effect of some narcotic analgesics.

Ketorol does not affect opioid receptors and the central nervous system, does not cause drug dependence, sedative and anxiolytic effects, does not depress respiration (unlike opioid analgesics), does not affect intestinal motility, does not lead to urinary retention, bradycardia, tachycardia or changes in blood pressure .

Ketorol, like almost all other NSAIDs, affects blood clotting and prolongs bleeding time, although these changes do not exceed dangerous limits. However, it is worth remembering this for people who have diseases that impair blood clotting or may cause severe internal bleeding (for example, hemophilia or stomach ulcers).

Release form

Ketorol can be purchased in pharmacies in three main forms. Firstly, these are tablets intended for oral administration. Ketorol tablets are round, biconvex, covered with a green coating, white inside. On one side there is the Latin letter S. Each Ketorol tablet contains 10 mg of active ingredient.

Secondly, this is a solution intended for parenteral (intravenous or intramuscular) administration. The solution is contained in ampoules, and 1 ml of solution contains 30 mg of the active substance.

In addition, there is a 30 g gel for external use. Each tube of gel contains 600 mg of ketorolac. The concentration of the active substance in the gel is 2% (20 mg per 1 g).

Excipients in the tablet:

• microcrystalline cellulose,
• lactose monohydrate,
• corn starch,
• silicon dioxide,
• magnesium stearate,
• hypromellose,
• titanium dioxide

Excipients in Ketorol solution:

• octoxynol,
• disodium edetate,
• sodium chloride,
• ethanol,
• sodium hydroxide,
• water.

The solution is produced in packs of 10 ampoules, tablets - in packs of 20 pcs. Ketorol is produced by the Indian pharmaceutical company Dr. Reddy's Laboratories.

The shelf life of tablets and solution is 3 years, gel – 2 years. Tablets and solution for parenteral administration are available with a prescription; a prescription is not required for the gel.

Analogs

Structural analogues of the drug, that is, medicines containing ketorolac as an active substance, are:

• Ketanov,
• Adolor,
• Dolak,
• Dolomin,
• Ketalgin,
• Ketolak,
• Ketofril,
• Ketokam,
• Ketonal (gel only).

You can also find other NSAIDs in pharmacies, but it should be remembered that most of them differ significantly from Ketorol in their principle of action and indications.

Pharmacokinetics

Ketorol is quickly absorbed into the blood when taken orally. Fat-rich foods reduce the maximum concentration of the drug in the blood and slow down its onset. Ketorol is able to pass into breast milk, partially (approximately 10% of the drug) penetrates the placental barrier. Moreover, the bioavailability of the drug is about 100%, regardless of the dosage form. When administered parenterally, Ketorol begins to act faster than when taking tablets. The maximum concentration of the drug in the blood when taking tablets is observed after 1 hour, and the maximum therapeutic effect occurs a little later and lasts 4-6 hours. When administered parenterally, the maximum concentration depends on the route of administration (intramuscular or intravenous), as well as on the dose.

The highest concentration in the blood and the time of the highest concentration after intramuscular administration:

Maximum concentration in the blood and time of maximum concentration after intravenous administration:

Ketorol is metabolized 50% in the liver. Excreted from the body mainly by the kidneys (91%) and intestines (6%).

The half-life in patients with unimpaired renal function is on average 5.3 hours. This value is slightly higher for young patients and lower for elderly patients. In patients with impaired renal function (creatinine clearance 19-50 ml/min), the half-life rate increases to 10.3-10.8 hours. With even lower creatinine clearance, the time is extended to 13.6 hours. Liver function does not affect the half-life.

Indications

Indications for use of tablets and solution are almost the same. The choice of a particular dosage form is dictated by considerations such as speed of action and the patient's condition. The solution is indicated for use where the fastest effect is needed. In addition, sometimes the patient for some reason cannot take the pills (unconsciousness, vomiting, stomach ulcers, problems with swallowing). In this case, it is also worth using injections. In all other cases, tablets are indicated for use.

Ketorol is indicated for use, first of all, if it is necessary to get rid of pain of various origins:

• toothache;
• injuries;
• dislocations and muscle strains;
• bruises and inflammation of soft tissues;
• ligament damage;
• pain due to bursitis, tendonitis, epicondylitis, synovitis;
• myalgia;
• neuralgia;
• radiculitis;
• arthrosis;
• oncological diseases;
• headaches;
• pain due to various inflammatory processes;
• postoperative pain;
• postpartum pain;
• wounds;
• joint and bone pain;
• pain due to rheumatism.

Ketorol is more suitable for relieving pain of severe and moderate severity. For relatively mild pain, other drugs are indicated for use. In addition, Ketorol should not be used for a long time, more than 5 days. This means that for chronic pain it is also necessary to use other drugs.

Reviews

Reviews about the drug are mostly positive. Patients and doctors note the high effectiveness of the product and its reasonable price. However, there are also patients in whom the drug caused adverse reactions, and doctors point out that the drug is not intended for long-term use and cannot be used during pregnancy.

Contraindications

Ketorol has a number of contraindications. First of all, this is hypersensitivity to the components of the drug. In addition, it should not be given to children under 16 years of age (in tablet or injection form). This is due to the fact that when children take the drug, there is a high probability of developing side effects, such as nephritis, depression, hearing impairment, and pulmonary edema.

Therefore, for parents who want to relieve their children from the unpleasant symptoms of acute respiratory infections, flu and colds, Ketorol is not suitable. It is better to use ibuprofen and paracetamol, which are more effective and safe in this case. Adolescents over 16 years of age can use the drug for the same indications as adults.

Ketorol gel can be used from 12 years of age. In addition, Ketorol is prohibited in the form of tablets and injections for pregnant women. In the form of a gel, Ketorol is approved for pregnant women during the 1st and 2nd trimesters. In the third trimester, Ketorol should not be used even in the form of a gel, as this can lead to post-term pregnancy or complications of labor. Ketorol during lactation is prohibited in all forms.

Other contraindications when taken in the form of tablets and injections:

• • history of bronchospasms and angioedema;
  • dehydration;
  • ulcers and erosions of the gastrointestinal tract;
  • decreased blood clotting;
  • insufficiency of liver functions;
  • hemorrhagic diathesis;
  • history or current cerebral hemorrhage;
  • hematopoietic disorders;
  • risk of major bleeding;
  • decompensated heart failure;
  • high concentration of potassium in the blood.

recent coronary artery bypass surgery;

• milk sugar intolerance;
• acute phases of Crohn's disease, ulcerative colitis.

Ketorol is taken with caution when:

• bronchial asthma;
• hypersensitivity to NSAIDs;
• congestive heart failure;
• damage to peripheral arteries;
• systemic lupus erythematosus;
• coronary heart disease;
• arterial hypertension;
• stagnation of bile;
• hepatitis;
• sepsis;
• history of gastrointestinal ulcers;
• simultaneous use of anticoagulants and antiplatelet agents, NSAIDs, selective serotonin reuptake inhibitors, corticosteroids;
• in old age (over 65 years old);
• alcoholism;
• polyps of the nasal and nasopharyngeal mucosa;
• renal failure (creatinine clearance less than 60 ml/min);
• other severe somatic diseases.

Contraindications for use in gel form are:

• weeping dermatoses,
• eczema,
• wounds and abrasions at the site of application,
• "aspirin" bronchial asthma,
• third trimester of pregnancy.

The gel is prescribed with caution in old age (over 65 years), in childhood (under 16 years), with bronchial asthma, during the 1st and 2nd trimester of pregnancy.

Also, the drug should not be used if the patient suffers from intolerance to other NSAIDs or renal failure (creatinine clearance less than 30 ml/min). If creatinine clearance is less than 60 ml/min, the dose should be reduced.

Ketorol should not be used for preventive pain relief before operations, as well as in obstetric practice due to possible blood clotting disorders.

Side effects

When taking Ketorol orally, a number of side effects may occur. However, most of them are not life-threatening.

The most common side effects are abdominal pain and diarrhea (in more than 3% of cases). These side effects are usually observed in older people who have gastrointestinal ulcers. Also, a number of patients experience swelling (of the face, legs, ankles, fingers, feet), dizziness, and headaches. Less commonly (in 1-3% of cases), side effects such as increased blood pressure, stomatitis, flatulence, vomiting, constipation, and skin reactions may occur.

Ketorol may also cause other types of rare side effects:

Body systems that are affected by effects	types of effects
Gastrointestinal tract	constipation, flatulence, nausea, hepatitis, pancreatitis (inflammation of the pancreas)
urinary system	acute pain in the kidney area, blood in the urine, frequent urination, decreased or increased amount of urine, nephritis
respiratory organs	bronchial spasm, rhinitis, breathing problems, laryngeal edema
central nervous system	drowsiness, hyperactivity, aseptic meningitis (stiff neck muscles, severe headaches, convulsions), hallucinations, hearing impairment, ringing in the ears, visual disturbances, fainting
blood system	anemia, eosinophilia, leukopenia, nosebleeds
allergic and skin reactions	urticaria, anaphylactic shock, maculopapular rash, purpura, exfoliative dermatitis (expressed as fever, redness, thickening or peeling of the skin, swelling or tenderness of the tonsils), urticaria, Lyell-Johnson syndrome, eyelid edema, periorbital edema.

Sometimes there may be an increase in temperature and increased sweating.

Skin reactions are more common when using the drug in gel form. However, when applying the drug to a significant surface of the body, systemic side effects cannot be excluded:

• ulcerative pathologies of the gastrointestinal tract,
• heartburn,
• diarrhea,
• stomach pain,
• hematuria,
• vomit,
• nausea,
• fluid retention,
• anemia,
• agranulocytosis,
• leukopenia,
• thrombopenia.

If any side effects occur, you should interrupt treatment with the drug and seek medical advice.

Overdose

When using the gel, an overdose is impossible. Although sometimes the gel can get into the oral cavity, for example, from the lips. In this case, the oral cavity must be rinsed, and if the gel gets into the stomach, enterosorbents should be taken. An overdose when taking tablets orally can manifest itself in symptoms such as stomach pain, nausea, vomiting, urinary retention, renal dysfunction, and acidosis. The formation of ulcerative lesions in the stomach may also occur.

If an overdose occurs, it is recommended to do the standard gastric lavage procedures for such cases, take sorbents, and carry out symptomatic therapy, that is, therapy aimed at maintaining the performance of the main body systems. Hemodialysis in case of an overdose of the drug is usually not carried out, since it is ineffective.

Instructions for use

When using Ketorol in tablet form, they should be taken as needed, but no more than 4 tablets per day. The maximum dose is 40 mg per day. The course of treatment is 5 days, unless otherwise prescribed by the attending physician. The tablets must be swallowed without chewing and washed down with enough water. The effectiveness of Ketorol is not associated with food intake, however, when taking the drug immediately after a meal, the substance is absorbed into the blood more slowly and the analgesic effect appears later in this case. On the other hand, taking Ketorol before meals increases irritation of the gastric mucosa. Therefore, the most optimal time to take is 2 hours after meals.

Ketorol injections

Injections are preferable if the fastest possible analgesic effect is required, or the patient cannot take pills for any reason.

The solution is injected deep into the muscle. The injection site should be the outer upper third of the thigh, shoulder, buttock, or other area of ​​the body where the muscles come close to the skin. Small disposable syringes with a capacity of 0.5-1 ml are suitable for injections. Single dosage – 10-30 mg (0.3-1 ml). The largest single dose for intramuscular administration is 2 ml. A second injection can be given after 4-6 hours. No more than 90 mg of ketorolac (3 ml of solution) can be administered per day.

For people over 65 years of age, or weighing less than 50 kg, or having impaired renal function, the maximum single dose should not exceed 15 mg (0.5 ml). The maximum daily dose in this case is 60 mg. The solution must be administered slowly - this reduces the risk of developing negative reactions. The time for intravenous jet administration of the solution should not be less than 15 s.

The duration of treatment for parenteral administration should not exceed 5 days. When administered intravenously, the total dose for the entire course of treatment should not exceed 15 ml. For patients with reduced renal function, elderly people (over 65 years of age) or patients weighing less than 50 kg, this value is 10 ml.

If necessary, you can switch from the parenteral form of administration to taking tablets within 1 day. In this case, the maximum daily dose of both forms of the drug should not exceed 90 mg, and the dose of the drug in tablet form should not exceed 30 mg.

Instructions for intramuscular injections

The syringe and needle should be removed from the package immediately before injection. Use a syringe to draw the required amount of solution from the ampoule. Then the syringe should be raised with the needle up and tapped in the direction from the piston to the needle. This is necessary so that the air bubbles separate from the walls and rise up. To remove air, you need to lightly press the piston so that a drop appears on the needle. After this, the syringe is put aside and the injection site is treated with an antiseptic. The needle is inserted into the injection site perpendicularly and over its entire length, and then the contents of the syringe are squeezed out slowly and carefully. After the injection, the injection site is again treated with an antiseptic.

Ketorol infusions

Ketorol from an ampoule can be added to a dropper and used together with other saline solutions. Ketorol is compatible with the following solutions:

Physiological
dextrose 5%
lidocaine
dopamine
Ringer
Ringer-Locke
Plasma-lit
aminophylline
short-acting human insulin
heparin

Instructions for applying the gel (ointment)

The gel should be applied to an intact skin surface free of wounds, burns and abrasions. You should also avoid getting the gel in the eyes, mucous membranes of the mouth and nose.
Before applying the gel, the skin should be washed and dried.

From a 30 g tube of gel, squeeze out 1-2 cm of gel and apply it evenly to the surface of the skin. If the surface area to be treated is large, the amount of gel can be increased. The ointment must be rubbed into the skin several times in a circular motion until the composition is completely absorbed. The surface of the skin on which the gel was applied can be covered with a cotton or gauze bandage. However, it should not be tightly closed and should allow some air to pass through.

Do not apply the gel to the skin too often. It is enough to do this 4 times a day. In this case, the intervals between episodes of using the gel should not be less than 4 hours. The course of treatment with gel is no more than 10 days. If the desired improvement does not occur or if longer use of the drug is necessary, you should consult your doctor.

Interaction with other drugs

Interaction with other drugs that compete for binding to blood proteins cannot be ruled out.

When used with drugs that have a toxic effect on the kidneys (for example, gold preparations), Ketorol enhances their negative effect. The combination of Ketorol with some antihypertensive drugs may reduce their effect due to a decrease in the production of prostaglandins in the kidneys. When using Ketorol simultaneously with other NSAIDs or steroidal anti-inflammatory drugs, ethyl alcohol, the risk of gastric bleeding increases. Use with NSAIDs can lead to fluid retention in the body and increased blood pressure.

You should not use Ketorol simultaneously with paracetamol for more than 5 days, as this increases the risk of developing kidney pathologies. The same can be said about the simultaneous use of the drug with ACE inhibitors - in such a case, a negative effect on the kidneys is also manifested. Since the drug does not affect the effect of narcotic analgesics when used simultaneously with them, the dosage of the latter can be reduced to reduce the number of negative effects. Antacids do not affect the absorption of the drug from the gastrointestinal tract. Caution must be exercised when used with cyclosporine and lithium preparations.

Ketorol in the form of a solution cannot be mixed in the same syringe with certain medications due to drug incompatibility, for example, with morphine and tramadol.

Ketorol increases the effect of insulin and other hypoglycemic drugs, but at the same time reduces the effectiveness of antihypertensive drugs and furosemide, anti-epileptic drugs. Thrombolytic drugs and anticoagulants may promote bleeding.

Use with antidepressants may lead to the development of hallucinations.

If you use the drug simultaneously with all of the above drugs, you should consult your doctor.

Special instructions

Ketorolac affects blood clotting, but this effect is limited in time and lasts no more than 1-2 hours. Ketorol is not able to replace the preventive effect of acetylsalicylic acid on platelet aggregation. Therefore, patients taking acetylsalicylic acid drugs in moderate doses as anticoagulants should not refuse them. If there is a risk of gastropathy, proton pump inhibitor drugs and antacids are simultaneously prescribed. While using the drug, it is necessary to monitor hemostasis parameters once a week. Elderly people have a higher risk of developing side effects, so they should use Ketorol in minimal doses. Patients with renal failure who regularly use the drug should monitor their kidney parameters by taking urine tests. For liver diseases, Ketorol should be used with caution and in short courses.

Due to the risk of adverse reactions, the first dose of the drug should be administered under close medical supervision.

Ketorol is often prescribed to adults for severe pain, but its use in children is limited. Not everyone knows at what age such a medication can be given to a child, in what form it is used and how it acts on the human body.

Release form and composition

“Ketorol” is presented in several dosage forms, but they have one main ingredient – ​​ketorolac. The medicine is produced:

• In tablets. They have a biconvex round shape and a green shell. They include ketorolac in the form of tromethamine at a dose of 10 mg per 1 tablet, MCC, hypromellose, lactose, dyes, corn starch and other substances. The tablets are sold in packs of 20 per prescription and stored at room temperature for up to 3 years from the date of manufacture. This form of Ketorol is not prescribed to children under 16 years of age.
• In 2% gel form. One gram of such a translucent or transparent homogeneous mass contains 20 mg of the active compound, supplemented with glycerol, propylene glycol, dimethyl sulfoxide and other substances. This “Ketorol” is produced in tubes of 30 g and is sometimes called ointment. It is used only for local treatment, purchased without a prescription, and the shelf life of the gel is 2 years. This form of medication is prescribed to children from the age of 12.
• In solution for injection. It is presented as a yellowish or colorless liquid in 1 ml ampoules, packaged in packs of 5-10 pieces. Each ampoule contains 30 mg of ketorolac, to which ethanol, sodium chloride, disodium edetate and some other auxiliary compounds are added. The shelf life of such drugs is 3 years, and a prescription is required to purchase the product at the pharmacy. It is usually not prescribed in childhood. For adults, injections are given both intramuscularly and into a vein.

How does it work and when is it used?

Ketorolac has an analgesic effect that is superior in strength to the effect of most other non-steroidal anti-inflammatory drugs. The reason for the analgesic effect when taking Ketorol is the ability of its active substance to block the formation of compounds that cause pain and activate inflammation (prostaglandins). That is why Ketorol is most often used for pain, although it, like other drugs from the NSAID group, has both anti-inflammatory and some antipyretic effects.

The medication is in demand after operations, since most patients experience severe pain after surgical treatment. In addition, it is prescribed:

• for dislocation, sprain, fracture and other injury;
• for neuralgia;
• for toothache;
• for muscle pain;
• for arthralgia;
• in oncological pathology.

Contraindications

Side effects

One of the reasons why Ketorol is not used in childhood is its frequent side effects, which include abdominal pain, constipation, nausea, stomatitis, kidney damage, bronchospasm, nosebleeds, drowsiness and other negative symptoms. Due to the high risk of their occurrence, drugs containing ketorolac are prescribed with caution even to adults.

When treated with gel, negative local reactions may appear in the form of peeling skin, rash or severe itching. If they occur, you should stop using the drug and consult a doctor to change treatment.

Instructions for use

Ketorol tablets are taken as needed when the patient is experiencing severe pain. A single dosage of the drug for those aged 16 years and older is one tablet. If a single dose of the drug does not relieve the pain, then the tablet can be taken again. In this case, the drug should not be taken more than 4 times a day and for more than 5 days in a row.

Ketorol gel is applied to children over 12 years of age for injuries, pain in joints, muscles or neuralgia in a thin layer up to 4 times a day. The drug is used to treat cleansed skin (washed and dried, without damage) - only in the place of maximum pain. For one treatment, use a strip of gel 1 to 2 cm long. The duration of treatment with this form should not exceed 10 days.

Analogs

Other preparations of ketorolac can serve as a replacement - for example, “Ketanov”, “Dolak”, “Ketokam” or “Ketalgin”.

However, all of these drugs have contraindications for children, so if a child has pain, painkillers with other active compounds are often prescribed, for example:

• "Nurofen". This drug containing ibuprofen is approved from the age of three months. For the youngest children it is prescribed in a suspension or rectal suppositories, and for patients over 6 years old - in tablets.
• "Paracetamol". This drug is considered the safest for children and is prescribed to infants older than 1 month. It is produced in different forms (suppositories, syrup, tablets, suspension) and is more often used at high temperatures, but is often recommended for children for toothache or other pain.
• "Nimesil". This medication in the form of granules packaged in portioned sachets is used from the age of 12. It effectively relieves pain and helps reduce inflammation.
• "Analgin." They try to prescribe this remedy to children less often, but in emergency cases, for pain or fever, it can be used both in injections (from 3 months), and in suppositories (from 1 year) or tablets (from 6 years).

At the same time, parents need to remember that any drug with an analgesic effect only briefly eliminates pain, but does not in any way affect the cause of the pain. In addition, pain relief sometimes prevents treatment from starting on time, which leads to complications. And therefore, if a child is in severe pain, you should not give him any medications before consulting a doctor.

For more information about painkillers, see Dr. Komarovsky’s program.