Ketorolac Injection

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DRUGS
Ketorolac Injection

Ketorolac injection is used for short-term relief of moderate to severe pain. It is generally used before or after medical procedures or after surgery.

 

Introduction

Ketorolac injection is used for short-term relief of moderate to severe pain. It is generally used before or after medical procedures or after surgery.

Indications

  • Moderate to severe pain
  • Acute pain requiring opioid-level analgesia

Pharamcological Action

Ketorolac inhibits prostaglandin synthesis by competitive blocking cyclooxygenase (COX) enzyme. Ketorolac reduces the prostaglandins synthesis, chemicals that cells of the immune system, that cause the redness, fever, swelling and pain of inflammation and also effective to reduce non-inflammatory pain.

Dosage

  • IV: 30 mg as single dose or 30 mg  every 6hour; not to exceed 120 mg/day

Pharmacokinetics

Ketorolac is rapidly absorbed and mean peak plasma concentration of 2.4μg/ml at an average of 5.4 minutes after dosing. More than 99% of the ketorolac in plasma is protein-bound over a wide concentration range. The terminal plasma elimination half-life was 5.1 hours, average volume of distribution 0.15 l/kg, and total plasma clearance 0.35ml/min/kg. The primary route of excretion of ketorolac and its metabolites is renal: 91.4% (mean) of a given dose being found in the urine and 6.1% (mean) in the faeces.

Contraindications

  • History or active Gastrointestinal diseases such as bleeding, ulceration or perforation
  • In patients who have previously shown hypersensitivity reactions (e.g. asthma, rhinitis, angioedema or urticaria) in response to non-steroidal anti-inflammatory drugs
  • In patients with suspected or confirmed cerebrovascular bleeding, hemorrhage or incomplete haemostasis and coagulation disorders.
  • Syndrome of nasal polyps, angioedema or bronchospasm
  • Concurrent treatment with aspirin or other NSAIDs including cyclooxygenase 2 specific inhibitors.
  • Probenecid or lithium salts
  • Moderate or severe renal impairment (serum creatinine> 160 micromol/l)
  • Asthma
  • Severe heart failure, hepatic failure and renal failure
  • Anti-coagulants including warfarin and low dose heparin (2500 - 5000 units twelve hourly)
  • During pregnancy, labour, delivery or lactation
  • Children under 16 years of age
  • For neuraxial (epidural or intrathecal) administration due to its alcohol content

Drug Interactions

  • Aliskiren
  • ACE (angiotensin converting enzyme) inhibitors (such as captopril, lisinopril)
  • Angiotensin II receptor blockers (such as valsartan, losartan),
  • Corticosteroids (such as prednisone)
  • Methotrexate
  • Probenecid
  • Cidofovir
  • Diuretics (such as furosemide).
  • Anti-platelet drugs such as clopidogrel and blood thinners such as dabigatran/enoxaparin/warfarin

Side effects

Common (affecting between 1- 10 to1 in 100)

  • Abdominal pain & Dyspepsia
  • Nausea & Vomiting
  • Drowsiness

Uncommon (affecting between 1-100 to 1 in 1000)

  • Edema
  • Hypertension
  • Pruritus
  • Skin Reactions
  • Headache

Very rare (affecting less than 1 in 10,000)

  • Peptic Ulcer
  • Gastro intestinal  bleed/perforation
  • Renal or Liver Failure
  • Anaphylaxis

Precautions

  • It may increase the risk of serious cardiovascular events, myocardial infarction and stroke.
  • Not to be used in children younger than 17 years old; safety and effectiveness in these children have not been confirmed.
  • Not be used by nursing mothers because it is excreted in breast milk.

Clinic Evidence

  • Ketorolac is nonsteroidal anti- inflammatory drugs (NSAID) that have the potential to replace opioids in the treatment of severe pain. Ketorolac trometamol if given intravenously is effective in the management of surgical pain and pain related to cancer and has fewer side-effects in comparison to morphine. The administration time of Ketorolac is much shorter than other drugs. Intravenous ketorolac can be used for severe pain in isolated limb injuries1.
  • Continuous intravenous administration of Ketorolac reduces pain and morphine consumption after total hip or knee arthroplasty. Less sedation and reduced requirement of antiemetic is seen in the patients receiving Ketorolac2.

References

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