Ketorolac

Indications
 Oral
Moderate to severe pain
Adult: 10 mg every 4-6 hr. Max: 40 mg/day. Max duration: 7 days.
Elderly: 10 mg every 6-8 hr. Max duration: 7 days.
Renal impairment: Contraindicated in moderate to severe impairment.
Parenteral
Moderate to severe pain
Adult: 60 mg as a single dose via IM inj or 30 mg as a single IV dose. Alternatively, 30 mg every 6 hr via IM or IV admin up to a max of 120 mg daily. Halve the doses in patients weighing <50 kg. Max duration: 2 days; patient should be transferred to oral therapy as soon as possible.
Elderly: 30 mg as a single dose via IM inj or 15 mg as a single IV dose. Alternatively, 15 mg every 6 hr via IM or IV admin up to a max of 60 mg daily.
Renal impairment: 30 mg as a single dose via IM inj or 15 mg as a single IV dose. Alternatively, 15 mg every 6 hr via IM or IV admin up to a max of 60 mg daily. Contraindicated in moderate to severe impairment.
Ophthalmic
Ocular itching associated with seasonal allergic conjunctivitis
Adult: As trometamol: Instil 1 drop of a 0.5% solution into the affected eye(s) 4 times daily.
Renal impairment: Contraindicated in moderate to severe impairment.
Ophthalmic
Prophylaxis and reduction of postoperative ocular inflammation
Adult: As trometamol: Instil 1 drop of a 0.5% solution into the appropriate eye(s) 4 times daily starting 24 hr after surgery. Continue for 2 wk.
Renal impairment: Contraindicated in moderate to severe impairment.
Ophthalmic
Cystoid macular oedema
Adult: As trometamol: Instil 1-2 drops of a 0.5% solution into the appropriate eye(s) every 6-8 hr starting 24 hr before surgery and continue for 3-4 wk after surgery.
Renal impairment: Contraindicated in moderate to severe impairment.
Ophthalmic
Pain and photophobia after incisional refractive surgery
Adult: As trometamol: Instil 1 drop of a 0.5% solution 4 times daily into the operated eye for up to 3 days after surgery.
Renal impairment: Contraindicated in moderate to severe impairment.

Special Populations: Renal impairment: Max dose for parenteral admin is 60 mg/day.

Incompatibility: Y-site incompatibility: Fenoldopam, azithromycin. Syringe incompatibility: Promethazine, hydroxyzine, nalbuphine, haloperidol, prochorperazine edisylate, triethylperazine. Admixture incompatibility: Promethazine, morphine, hydroxyzine, meperidine.
Contraindications
 Hypersensitivity to aspirin or other NSAIDs, asthma. Hypovolaemia or dehydration. Do not give postoperatively to patients with high risk of haemorrhage. History of peptic ulcer or coagulation disorders. Nasal polyps, angioedema, bronchospasm. Labour. Moderate to severe renal impairment. GI bleeding, cerebrovascular bleeding. As prophylactic analgesic before surgery. Pregnancy, lactation.
Warnings / Precautions
 Elderly, patients weighing <50 kg, hepatic dysfunction, heart failure, predisposition to reduced blood volume or renal blood flow. Mild renal impairment; monitor renal function closely.
Adverse Reactions
 GI ulcer, bleeding and perforation, drowsiness, rash, bronchospasm, hypotension, psychosis, dry mouth, fever, bradycardia, chest pain, dizziness, headache, sweating, oedema, pallor, liver function changes. Transient stinging and local irritation (ophthalmic).
Potentially Fatal: Anaphylaxis. Severe skin reactions. MI, stroke, GI bleeding.
Overdose Reactions
 Symptoms: Abdominal pain, nausea, vomiting, hyperventilation, peptic ulceration, erosive gastritis and renal dysfunction. Management: Supportive and symptomatic.
Drug Interactions
 May reduce effects of antihypertensives eg ACE inhibitors or angiotensin II receptor antagonists (AIIA). Increased risk of renal toxicity with ACE inhibitors, diuretics. Increased adverse effects with aspirin or other NSAIDs. Hallucinations may occur when used with fluoxetine, thiothixene, alprazolam.
Potentially Fatal: Increased risk of GI bleeding with warfarin. May increase toxicity of methotrexate (MTX) and lithium. Increased plasma concentrations with probenecid.
See Below for More ketorolac Drug Interactions
Mechanism of Actions
 Ketorolac inhibits prostaglandin synthesis by decreasing the activity of the cyclooxygenase enzyme.
Onset: 30-60 min (oral); 10 min (IM).
Duration: 6-8 hr (oral/IM).
Absorption: Well absorbed (oral/IM); peak plasma concentrations after 30-60 min.
Distribution: Protein-binding: 99%. Crosses the placenta; enters breast milk; poorly penetrates into CSF.
Metabolism: Hepatic via glucuronic acid conjugation.
Excretion: Via urine (90%, as unchanged drug and metabolites); via faeces (remaining dose). Terminal elimination half-life: 4-6 hr; 6-7 hr (elderly); 9-10 hr (renal impairment).
Storage Conditions
 Ophthalmic: Store at 15-25°C (59-77°F). Oral: Store at 15-30°C (59-86°F). Parenteral: Store at 15-30°C (59-86°F). Protect from light.
ATC Classification
 M01AB15 - ketorolac ; Belongs to the class of acetic acid derivatives and related substances of non-steroidal antiinflammatory and antirheumatic products.
S01BC05 - ketorolac ; Belongs to the class of non-steroidal antiinflammatory agents. Used in the treatment of inflammation of the eye.
Storage
 Ophthalmic: Store at 15-25°C (59-77°F). Oral: Store at 15-30°C (59-86°F). Parenteral: Store at 15-30°C (59-86°F). Protect from light.
Available As
  • Ketorolac Tromethamine 0.5 mg
  • Ketorolac 0.5%
  • Ketorolac Tromethamine 0.5%
  • Keterolac Tromethamine 0.5%
  • Ketorolac Tromethamine 0.5% w/v
  • Ketorolac 0.5% w/v
  • Ketorolac Tromethamine USP 0.5% w/v
  • Keterolac Tromethamine 0.5% w/v
  • Ketorolac Tromethamine 10 mg
  • Keterolac Tromethamine 10 mg
  • Ketorolac 10 mg
  • Ketorolac 15 mg
  • Keterolac Tromethamine 30 mg
  • Ketorolac 30 mg
  • Ketorolac Tromethamine 30 mg
  • Ketorolac Tromethamine 4 mg
  • Ketorolac 4 mg
  • Ketorolac Tromethamine USP 4 mg
  • Keterolac Tromethamine 5 mg
  • Ketorolac Tromethamine 5 mg
  • Ketorolac 5 mg
  • Ketorolac 5%
  • Ketorolac Tromethamine 5%

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