Ketorol the highest single dose. Is it possible to give "Ketorol" to children? Terms and conditions of storage

Regardless of the cause of the pain, in many cases the first-line drugs for treatment are. Today, drugs in this group are represented by a wide range, and when choosing the most optimal option, the intensity of the pain syndrome, the presence of concomitant diseases, and some other factors are taken into account. Consider in which cases it is recommended to use one of these drugs - Ketorol in the form of injections.

The composition and properties of the drug Ketorol for injections

Ketorol for injections is available in ampoules containing 1 ml of solution. The active substance of the drug is ketorolac. Auxiliary substances of the solution:

• sodium chloride;
• ethanol;
• water;
• sodium hydroxide, etc.

The drug has the following effect:

• weak antipyretic;
• anti-inflammatory;
• pronounced analgesic.

The onset of analgesic action is observed already half an hour after the administration of Ketorol in the form of an injection. The maximum effect is noted after 1-2 hours, and the duration of the therapeutic effect is about 5 hours.

Indications for the use of Ketorol injections

The injection form of the drug Ketorol is recommended for use in moderate and severe pain syndrome of any localization to obtain a rapid analgesic effect. This form of the drug is prescribed in cases where taking Ketorol tablets is not possible. It is advisable to use Ketorol injections in the treatment of acute conditions, and not for the treatment of chronic pain syndromes.

So, Ketorol injections can be used for:

• postoperative pain;
• post-traumatic pains;
• pain associated with tumor diseases;
• muscle and joint pain;
• rheumatic diseases;
• migraines;
• renal and hepatic colic;
• etc.

Dosage of Ketorol injections

Ketorol painkillers are performed intramuscularly, less often intravenously. As a rule, the solution is injected into the outer upper third of the thigh, shoulder, buttock. It is necessary to inject deeply into the muscle, slowly.

The dosage of the drug is selected by the attending physician individually, but therapy should always be started with a minimum dose, and further guided depending on the patient's response and the effect achieved. For patients under 65 years of age, a single dose of Ketorol can be from 10 to 30 mg. Injections can be repeated every 4 to 6 hours, while the maximum daily dose should not exceed 30 ml.

Side effects of Ketorol injections

In the treatment of Ketorol in the form of injections, side effects from various organs and systems may occur, namely:

• stool disorders;
• nausea;
• abdominal pain;
• headache;
• bleeding;
• difficulty breathing;
• puffiness;
• skin rash;
• increased blood pressure;
• sweating;
• insomnia;
• urinary retention, etc.

Ketorol injections and alcohol

Injections of this drug are not compatible with the intake of alcoholic beverages. Drinking alcohol during treatment with Ketorol not only reduces the effectiveness of the drug (the duration of action decreases), but also increases the risk of side effects. Therefore, during the period of treatment should refrain from drinking alcohol.

Contraindications to Ketorol injections

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

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

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 the inhibition of the cyclooxygenase enzyme, 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 the [-]S and [-]P enantiomers, with the analgesic effect 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 and anxiolytic effect, does not cause drug dependence, does not affect the progression of the disease. Ketorolac inhibits platelet aggregation and increases bleeding time. The functional state of platelets is restored within 24-48 hours after discontinuation of the drug.

Pharmacokinetics: the bioavailability of ketorolac after oral administration ranges from 80% to 100%. The maximum plasma concentration is reached within 30-60 minutes. The pharmacokinetics of ketorolac under the conditions of prescribing medium 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 binds to plasma proteins, resulting in an apparent volume of distribution of less than 0.3 l / kg.

Ketorolac is metabolized mainly with the formation of conjugated forms of glucuronic acid, which are excreted through the kidneys. Metabolites do not have analgesic activity. The half-life of the drug is on average 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, the maximum duration of treatment is 2 days.

Dosage and administration

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.

The introduction of the drug several times a day for more than 2 days is not recommended, since in most cases patients do not need longer pain relief therapy, or can be transferred to oral ketorolac. In this case, the duration of the use of ketorolac parenterally and orally should not exceed a total of 5 days.

To achieve the maximum analgesic effect in the early postoperative period, the combined use of ketorolac and narcotic analgesics is possible, the daily dose of the latter in this case is reduced. Ketorolac has no effect on addiction to opioids and does not increase the respiratory depression or sedation associated with them.

Selection and dose adjustment should be made in accordance with the intensity of pain and the response to the administration of the drug. To minimize side effects, it is recommended to use the lowest 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, regular monitoring of the patient's condition to exclude gastrointestinal bleeding is recommended. Children: the safety and efficacy 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 the case of mild renal impairment, the use of Ketorol at a dose of not more than 60 mg / day is acceptable.

If necessary, joint 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 / day. day It is recommended that the patient be transferred to the oral form of the drug as soon as possible.

Side effect

From the gastrointestinal tract: anorexia, abdominal discomfort, stomach fullness, 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 of blood, blood in the stool, gastritis, peptic ulcer, pancreatitis, ulcerative stomatitis, esophagitis, exacerbation of Crohn's disease and colitis.

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

From the nervous system: headache, dizziness, fainting, fatigue, weakness, irritability, feeling of 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, neck stiffness, anxiety, vertigo, disorientation, thinking disorder.

From the sense organs: violation of taste sensations, blurred vision, optic neuritis, tinnitus, hearing loss and decrease.

From the musculoskeletal system: myalgia.

From the sideurinarysystems: pain at the site of the projection of the kidneys, 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 side of 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 some NSAIDs, especially at high doses and for a long time, may be associated with an increased risk of developing arterial thromboembolic complications (myocardial infarction or stroke).

From the side blood: purpura, leukopenia, eosinophilia, neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia, thrombocytopenia, a 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 side of the respiratory system: shortness of breath, tachypnea, bronchospasm, complication of asthma, pulmonary edema.

From the reproductive system: infertility (in women).

From the side of the skin: itching, urticaria, photosensitivity, Lyell's syndrome, exfoliative dermatitis, toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome, skin rashes, including maculopapular and weeping, discoloration of the skin of the face.

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, excessive 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 observe the established dosages and administration regimens, take into account the patient's condition (age, concomitant diseases, liver, kidney function, state of water-electrolyte metabolism and hemostasis system), as well as possible drug interactions. with combination therapy.

Contraindications

Bronchial asthma, Complete or partial syndrome of nasal polyps, bronchospasm, angioedema in history. 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. A history of blood clotting disorders, conditions with a high risk of bleeding, hemorrhagic diathesis, coagulopathy, 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 bleeding. Moderate and severe renal insufficiency (plasma creatinine more than 50 mg / l), risk of renal insufficiency, hypovolemia, dehydration. Pregnancy, childbirth and lactation. Hypersensitivity to ketorolac, aspirin, other NSAIDs or any component of the drug. Simultaneous use of other NSAIDs (risk of summation of side effects) Age up to 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. Joint use with lithium preparations, pentoxifylline probenecid. Epidural or intrathecal administration of the drug is contraindicated.

Application features

Administration to patients with impaired function liver: assigned with caution. While taking ketorolac, an increase in the level of liver enzymes is possible. In the presence of functional abnormalities in the liver while taking ketorolac, a more severe pathology may develop. If signs of liver pathology are detected, treatment should be discontinued.

Patients with kidney 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 not 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 reduced fertility, and therefore are not recommended for use by women planning pregnancy. The safety of the drug in pregnant women has not been studied. In a study on rats and rabbits at toxic doses, no teratogenic effect was detected. In rats, prolongation of the gestation period and delayed delivery were noted. In connection with the known negative effect of NSAIDs on the fetal cardiovascular system (risk of occlusion of the arterial duct), ketorolac is contraindicated in pregnant women. The use of ketorolac during childbirth is not recommended due to the increased risk of bleeding in the mother and child. Ketorolac penetrates into milk, and therefore is not recommended for use during lactation.

Impact on laboratory tests: possible increase in bleeding time in the study of coagulation parameters.

Influence on the ability to drive transportand other mechanisms

Since a significant proportion of patients with the appointment of 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 response.

Warnings and Precautions

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

NSAIDs should be used with caution in patients with Crohn's disease and a history of ulcerative colitis due to the possibility of worsening the course of 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 who are already taking anticoagulants or who require low-dose heparin should not receive ketorolac. In patients taking other drugs that affect hemostasis, ketorolac should be used with caution. In patients who underwent surgery with a high risk of bleeding or incomplete hemostasis, ketorolac should not be used.

Like other NSAIDs, ketorolac inhibits prostaglandin synthesis and may have a toxic effect on the kidneys, so it should be used with caution in patients with impaired renal function or a history of kidney disease. The risk group includes patients with impaired renal function, hypovolemia, heart failure, impaired liver function, patients who use diuretics, and elderly patients.

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

Clinical studies and epidemiological data suggest that the use of some NSAIDs, especially at high doses and for a long time, may be associated with an increased risk of arterial thrombotic complications such as myocardial infarction or stroke. It is impossible to exclude such a risk for Ketorolac. To minimize the potential risk of developing adverse cardiovascular events in patients using NSAIDs, the lowest effective dose should be used for the shortest possible period of time. Ketorolac should only be administered to patients with uncontrolled hypertension, congestive heart failure, established ischemic heart disease, peripheral arterial and/or cerebrovascular disease, after a thorough assessment of all the advantages and disadvantages of such treatment.

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

The 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.

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

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

Interaction with other drugs

Ketorolac slightly reduces the degree of warfarin protein binding.

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

Probenecid reduces plasma clearance and volume of distribution of ketorolac increases its plasma concentration and increases its half-life. Against the background of the use of ketorolac, a decrease in the clearance of methotrexate and lithium and an increase in the toxicity of these substances are possible.

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

It is possible that concomitant use with ACE inhibitors may increase the risk of impaired renal function.

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

Perhaps the occurrence of hallucinations against the background of the simultaneous administration of ketorolac and psychostimulant drugs (fluoxetine, thiothixene, alprazolam).

The simultaneous 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 the concentration of thromboxane and prolongs bleeding time. Platelet function returns to normal within 24-48 hours after discontinuation of ketorolac. Although studies do not indicate a significant interaction between ketorolac and anticoagulants, the 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 within 8 to 12 days of mifepristone administration due to a possible reduction in the effect of mifepristone.

The simultaneous use of ketorolac with pentoxifylline increases the risk of bleeding.

As with other NSAIDs, caution should be exercised when co-administered with corticosteroids due to an increased risk of gastrointestinal ulceration or bleeding.

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

Patients who take quinolines at the same time may be at increased risk of seizures.

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

There is an increased risk of nephrotoxicity when NSAIDs are co-administered with tacrolimus or cyclosporine.

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

Incompatibility

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

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 discontinuation of the drug. In these cases, gastric lavage, the introduction of adsorbents (activated charcoal) and symptomatic therapy are recommended. Ketorolac is not sufficiently eliminated by dialysis.

Manufactured

Dr. Reddy's Laboratories Ltd.

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

Ketorol - instructions, use, contraindications

Ketorol is an analgesic drug with anti-inflammatory and antipyretic effects.

pharmachologic effect

The active substance of Ketorol is ketorolac, which, by inhibiting the activity of the cyclooxygenase enzyme, helps to inhibit the biosynthesis of prostaglandins, which are modulators of inflammation, thermoregulation and pain sensitivity.

The analgesic effect of Ketorol injections can be observed within half an hour after administration, and the maximum effect is after 1-2 hours.

The therapeutic effect of Ketorol lasts for 4-6 hours.

Indications for use

The instruction recommends prescribing Ketorol for moderately or severe pain syndrome: pain in the muscles and back, pain from injuries in the joints, sprains, dislocations, postoperative pain, neuralgia, cancer, radiculitis, toothache, migraine, burns, etc.

Instructions for use Ketorol

For patients over 65 years of age, Ketorol injections are given according to the scheme described above, with the only difference being that the maximum single dose should be 15 mg, and the maximum daily dose should be 60 mg. Ketorol injections can be used for no longer than 5 days.

Side effects

Contraindications to the use of Ketorol

According to the instructions, Ketorol is not used to treat chronic pain. The use of Ketorol is contraindicated in:

• bronchospasm (narrowing of the bronchi as a result of muscle contraction);
• "Aspirin" asthma (suffocation attacks associated with taking salicylates);
• hypovolemia (decrease in blood volume);
• angioedema (limited deep swelling of the mucous membranes or subcutaneous tissue and skin);
• dehydration (dehydration);
• peptic ulcers (an expression of the mucous membrane of the esophagus as a result of exposure to gastric juice on one of its segments);
• erosive and ulcerative lesions of the digestive tract in the acute phase;
• hypocoagulation (reduced blood clotting);
• hemorrhagic diathesis (diseases of the blood system, which are characterized by a tendency to increased bleeding);
• hemorrhagic stroke (bleeding into the brain caused by rupture of blood vessels);
• liver or kidney failure;
• simultaneous use with other anti-inflammatory nonsteroidal drugs;
• violation of hematopoiesis;
• high risk of bleeding;
• hypersensitivity to ketorolac or other non-steroidal anti-inflammatory drugs.

Ketorol, the use of which must be discussed with the attending physician, is not prescribed for pregnant and lactating women, as well as children and adolescents under 16 years of age.

The instruction recommends using Ketorol with caution for cholecystitis (inflammation of the gallbladder), arterial hypertension, chronic heart failure, bronchial asthma, impaired renal function, sepsis (infection with the bloodstream of infectious agents), active hepatitis, polyps (tissue outgrowths) of the mucous membrane of the nasopharynx and nose , systemic lupus erythematosus (connective tissue disease).

Additional Information

Source: http://www.neboleem.net/ketorol.php

Ketorol injections: instructions for use

Solution for parenteral administration Ketorol is a medicinal product of the clinical and pharmacological group of non-steroidal anti-inflammatory drugs. It is used to reduce the severity of pain in various inflammatory pathologies.

Release form and composition

The drug Ketorol is a clear, colorless liquid that should not contain visible impurities or inclusions.

The main active ingredient of the drug is ketorolac, its content in 1 ml of solution is 30 mg.

It also includes auxiliary components, which include:

• Ethanol.
• Denatria edetat.
• Sodium hydroxide.
• Sodium chloride.
• propylene glycol.
• Otoxinol.

The solution for parenteral administration of Ketorol is contained in dark glass ampoules with a volume of 1 ml, they are packaged in a blister pack in the amount of 10 pieces. The cardboard pack contains one blisters and instructions for the use of the drug.

pharmachologic effect

The mechanism of the analgesic effect of the active substance of the Ketorol injection solution is the non-selective blocking of the activity of the cyclooxygenase enzyme (COX 1 and 2), which catalyzes the process of chemical conversion of arachidonic acid into prostaglandins. These compounds are mediators of the inflammatory response, they are produced by cells of the immune system during tissue damage and cause a number of biological effects. The development of pain in this case is associated with direct irritation of sensitive nerve endings by prostaglandins. By reducing the concentration of prostaglandins in the area of ​​​​the inflammatory reaction, Ketorol injection reduces the severity of pain. Also, to a lesser extent, it reduces the severity of hyperemia and edema, and also reduces body temperature when it rises. The drug reduces the level of prostaglandins of the upper gastrointestinal tract, which perform a protective function and prostaglandins, which provide the process of aggregation (gluing) of platelets during the formation of a blood clot.

After parenteral administration of Ketorol injection solution, the active substance quickly accumulates in the tissues, and is also evenly distributed in them. Ketorolac is metabolized in hepatocytes (liver cells) with the formation of inactive decay products that are excreted from the body in the urine.

Indications for use

The use of a solution for parenteral administration of Ketorol is indicated for the symptomatic and pathogenetic treatment of inflammatory pathologies accompanied by the development of pain syndrome:

• Inflammation of the joints (arthritis) due to an infectious, autoimmune process, as well as degenerative-dystrophic destruction of articular cartilage (arthrosis).
• Pain in the muscles (myalgia) and peripheral nerves (neuralgia), which are caused by aseptic inflammation.
• Post-traumatic and postoperative pain of moderate severity.
• Rheumatic pathology associated with the production of antibodies to the body's own tissues and the development of specific autoimmune inflammation.

It can also be used for oncological pathology, accompanied by a pain syndrome of moderate intensity.

Contraindications for use

The introduction of Ketorol injection solution is contraindicated in a number of pathological and physiological conditions of the body, which include:

• Individual intolerance to ketorolac or auxiliary components of the drug.
• The presence of "aspirin asthma", which is accompanied by the development of bronchospasm (narrowing of the bronchi due to an increase in the tone of the smooth muscles of their walls) in response to the intake of nonsteroidal anti-inflammatory compounds.
• Severe liver or kidney failure.
• Dehydration (dehydration of the body) and hypovolemia (decrease in the volume of circulating blood), regardless of the causes of their occurrence.
• Decreased blood clotting (hemophilia).
• Confirmed or suspected hemorrhagic stroke (bleeding in the brain).
• Simultaneous use of other drugs of the group of non-steroidal anti-inflammatory drugs.
• Severe allergic reactions, in particular bronchospasm and angioedema angioedema (pronounced swelling of the tissues of the face or genitals, which develops due to increased permeability of the vascular wall).
• Pathological processes accompanied by impaired hematopoiesis.
• Hemorrhagic diathesis is a platelet disease that leads to increased bleeding from small vessels.
• Increased risk of bleeding, including those associated with surgery.
• Pregnancy at any stage of the course, childbirth and breastfeeding.
• Children's age up to 16 years.

The use of the drug is limited before performing surgical procedures due to the increased risk of bleeding during their implementation. Before starting the use of a solution for parenteral administration, you should make sure that there are no contraindications.

Dosage and administration

Solution for parenteral administration Ketorol is administered intramuscularly at the minimum therapeutically effective dose, which depends on the severity of the pain syndrome. A single dose can vary from 10 to 30 mg.

For persons with a violation of the functional activity of the kidneys of mild and moderate severity, as well as for people over 65 years old, the dose of the drug is reduced to 10-15 mg.

Several injections of the drug are allowed in this dosage with an interval of 4-6 hours. In this case, the maximum daily dose should not exceed 90 mg, for persons with impaired renal function and the elderly over 65 years of age - 60 mg.

The duration of the course of parenteral injection should not exceed 5 days.

Side effects

The beginning of treatment with a solution for parenteral administration can lead to the development of adverse reactions from various organs and systems:

• Digestive system - gastralgia (stomach pain), diarrhea, nausea, vomiting, flatulence (bloating), a feeling of full stomach, stomatitis (inflammation of the oral mucosa), the formation of erosions and ulcers of the stomach or duodenum, the development of the gastrointestinal bleeding, hepatitis (inflammation of the liver caused by damage to hepatocytes), cholestatic jaundice, provoked by a violation of the outflow of bile from the gallbladder.
• Nervous system - periodic dizziness, headache, drowsiness, very rarely develops aseptic meningitis (reactive inflammation of the meninges), increased activity of the nervous system, hallucinations, depression, psychosis.
• Sense organs - noise or ringing in the ears, decreased vision (blurring of visual perception).
• Respiratory system - bronchospasm, shortness of breath, laryngeal edema, rhinitis (inflammation of the nasal mucosa).
• Urinary system - acute renal failure (very rare), hematuria (the appearance of blood in the urine), increased urination with a change in the volume (increase or decrease) of urine output.
• Red bone marrow and blood system - anemia (anemia), eosinophilia (an increase in the number of eosinophils in the blood), leukopenia (a decrease in the number of leukocytes), a decrease in blood clotting.
• Skin - the development of small-pointed rash with itching, exfoliative dermatitis (skin thickening, development of peeling against the background of elevated body temperature with or without fever), Stevens-Johnson syndrome, Lyell (severe skin lesions with partial necrosis).

The development of side effects is the basis for the abolition of the use of the solution for parenteral administration of Ketorol.

special instructions

Before you start using the Ketorol injection solution, it is important to carefully read the instructions for it and pay attention to such special instructions:

• The effect on the ability of platelets to aggregate (glue) is significantly reduced 24-48 hours after discontinuation of the drug.
• The use of a solution for parenteral administration of Ketorol as an anesthetic in obstetric practice is excluded.
• A decrease in the volume of circulating blood (hypovolemia) significantly increases the risk of side effects from the kidneys during the use of the drug.
• Joint use of the drug with other non-steroidal anti-inflammatory drugs is excluded.
• Ketorol injection solution after its administration may interact with drugs of other clinical and pharmacological groups, therefore, if they are used, the attending physician should be warned about this.
• Due to the possible development of side effects from the central nervous system, it is not recommended to perform work associated with the need for increased concentration of attention and speed of psychomotor reactions during the use of the drug.

In the pharmacy network, a solution for parenteral administration of Ketorol is dispensed by prescription. You can not start its independent use or use it on the recommendation of third parties.

Overdose

Exceeding the recommended therapeutic dose of a solution for parenteral administration of Ketorol is accompanied by abdominal pain, nausea, vomiting, the development of gastric erosions, kidney damage and metabolic alkalosis (alkalinization of the blood). Overdose treatment consists in symptomatic therapy, since it is almost impossible to reduce the concentration of the active substance of the drug in the body with the help of hemodialysis (hardware blood purification).

Analogues of Ketorol injections

Structural analogues for the parenteral solution of Ketorol are the drugs Ketanov, Ketorolac. They contain the same active substance and have a similar therapeutic effect.

Terms and conditions of storage

The shelf life of Ketorol injection solution is 3 years. The drug should be stored in a dark place, out of the reach of children, at an air temperature not higher than +25º C.

Ketorol injections price

The average cost of Ketorol injection solution in Moscow pharmacies ranges from 134-149 rubles.

Source: http://bezboleznej.ru/ketorol-ukoly

What do Ketorol tablets help with?

Ketorol tablets, what does this analgesic drug with anti-inflammatory and antipyretic action help with? The medicine is intended for the relief of pain in various ailments.

Release form

• Produced in the form of tablets in p / o 10 mg. Ketorol tablets (INN - Ketorolac) are biconvex, round in shape, coated with a green shell (the core is white or close to white). On one side there is an imprint in the shape of the letter "S".
• A solution for intramuscular and intravenous administration of 30 mg / ml is released. Ketorol in injections is available in 1 ml ampoules, each of which has a breaking point and a ring in the upper part.
• They also use a 2% gel for external use, tubes of 30 g. Ketorol gel is a homogeneous, characteristically smelling, transparent (or translucent) substance.

Compound

Tablet composition: ketorolac (10 mg/tab.), MCC, lactose, corn starch, colloidal silicon dioxide, Mg stearate, Na carboxymethyl starch (type A).

The composition of the film shell includes: hypromellose, propylene glycol (additive E1520), titanium dioxide; dyes brilliant blue (22%) and quinoline yellow (78%) - olive green.

The composition of the solution: ketorolac (30 mg per milliliter), octoxynol, EDTA, Na chloride, ethanol, propylene glycol (additive E1520), Na hydroxide, water for injection.

Gel composition: ketorolac (20 mg per gram of gel), propylene glycol (additive E1520), dimethyl sulfoxide, carbomer 974P, sodium methyl and propyl parahydroxybenzoate, tromethamine (trometamol), Drymon Inde flavor, ethanol, glycerol, purified water.

pharmachologic effect

The active substance of Ketorol tablets (from which the remedy for pain of various organs helps) is ketorolac, which, by inhibiting the activity of the cyclooxygenase enzyme, helps to inhibit the biosynthesis of prostaglandins, which are modulators of inflammation, thermoregulation and pain sensitivity. The analgesic effect of Ketorol injections can be observed within half an hour after administration, and the maximum effect is after 1-2 hours. The therapeutic effect of Ketorol lasts for 4-6 hours.

Indications for use

Ketorol tablets: what helps the tablet form of the drug?

The drug helps to reduce moderate / severe pain and inflammation, but does not affect the progression of the disease.

Tablets are effective for toothache, headache, pain that occurs during menstruation, after trauma, in the postoperative and postpartum periods, against the background of oncological diseases, with damage to peripheral nerves, with radiculopathy, arthralgia, myalgia, sprains, dislocations, rheumatic diseases .

What helps the medicine in injections?

Ketorol in ampoules, as well as the tablet form of the drug, is used to relieve pain of moderate and severe intensity.

Parenteral administration of the drug is preferred in situations where it is necessary to quickly relieve pain, and also if the patient cannot take it orally (for example, with peptic ulcer or due to a gag reflex).

Indications for the use of Ketorol: what is the gel used for?

Topical application of the gel helps to reduce pain and inflammation in:

• injuries (inflammation and bruises of soft tissues, including after an injury;
• bursitis, synovitis, ligament injury, epicondylitis, tendinitis);
• myalgia;
• arthralgia;
• radiculitis;
• neuralgia;
• rheumatic diseases.

Medication Ketorol: instructions for use

Ketorol, the use of which is advisable only for acute pain syndrome, and not for the treatment of chronic pain, is available in the form of tablets and solution for intramuscular injection.

Depending on the severity of the pain syndrome, Ketorol tablets can be prescribed once or repeatedly.

The solution for injection should be administered by deep intramuscular route.

For patients under 65 years of age, Ketorol injections are prescribed at a dose of 10-30 mg once or the same dose every 4-6 hours, while the maximum daily dose should not exceed 90 mg.

Patients over 65 years of age are given injections according to the scheme described above, with the only difference being that the maximum single dose should be 15 mg, and the maximum daily dose should be 60 mg. Ketorol injections can be used for no longer than 5 days.

When switching from intramuscular administration to oral administration of Ketorol, the total daily doses of the drug should be taken into account: on the day of the transition - 30 mg, for patients over 65 years of age - 60 mg, for patients under 65 years of age - 90 mg.

Contraindications

Prohibitions for parenteral administration and oral administration of Ketorol:

• hypersensitivity to the components of the solution / tablets;
• full or partial combination of clinical manifestations of aspirin bronchial asthma (NSAID intolerance, asthma attacks, polypous rhinosinusitis);
• the presence of erosions and ulcerative defects on the mucosa of the upper gastrointestinal tract;
• bleeding in the active phase (gastrointestinal, cerebrovascular or other);
• exacerbated inflammatory bowel disease;
• hemophilia and other pathologies of the hemostasis system;
• terminal stage of development of heart failure (decompensated HF);
• functional disorders or active liver disease;
• confirmed hyperkalemia;
• postoperative period after CABG;
• renal failure, in which the concentration of creatinine does not exceed 30 ml / min, progressive pathologies of the kidneys;
• pregnancy, childbirth, lactation;
• age up to 16 years.

Side effects

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

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

How much do Ketorol tablets, gel and ampoules cost?

In Russia, the average price of Ketorol in tablets is 50 rubles, the price of Ketorol in ampoules is 150 rubles, the cost of an ointment (gel) is 230 rubles.

Patient opinions

Reviews of Ketorol tablets, as well as reviews of injections and gel, are positive in 95-98% of cases. Ketorol for toothache, for pain in the back and muscles, for headaches has been helping for half an hour, and its effect lasts up to six hours.

Most patients note that when using the drug in accordance with the instructions, side effects are extremely rare. Sometimes the disadvantages of Ketorol are called a large number of contraindications and the impossibility of long-term use.

It was not so long ago that I had to resort to the “Ketorol” remedy, from which it helps us: my husband fell so unsuccessfully that I had to call an ambulance for him, because he was close to fainting due to pain shock.

The ER doctor gave him an injection of painkillers and advised him to take pills as the pain recurred. And again, Ketorol turned out to be very effective, it relieved pain perfectly and acted up to 8 hours.

In general, now we always keep Ketorol at hand, but we hope that we will not need to use it.

I didn’t have any side effects, although I had to take the pills for 3 or 4 days (I don’t remember now), because the pain would be very strong, especially on the first day after the operation.

I was pleased that “Ketorol” acts quickly, he even relieved severe pain 15-20 minutes after taking one tablet and anesthesia was enough for 4-6 hours on the first day of admission, for 8 hours on the second day of admission, and then I already managed one tablet a day in the morning and one tablet at night, i.e. the effect of the medicine was enough for 12 hours.

Source: http://remedy.ucoz.ru/index/ketorol_ot_chego_pomogaet/0-246

Ketorol: instructions for use - Yandex.Health

Coated tablets green, round, biconvex, embossed with the letter “S” on one side; cross-sectional view - green shell and white or almost white core.

Excipients: microcrystalline cellulose - 121 mg, lactose - 15 mg, corn starch - 20 mg, colloidal silicon dioxide - 4 mg, magnesium stearate - 2 mg, sodium carboxymethyl starch (type A) - 15 mg.

The composition of the film shell: hypromellose - 2.6 mg, propylene glycol - 0.97 mg, titanium dioxide - 0.33 mg, olive green (quinoline yellow dye 78%, brilliant blue dye 22%) - 0.1 mg.

10 pieces. - blisters (2) - packs of cardboard.

NSAIDs, has a pronounced analgesic effect, has an anti-inflammatory and moderate antipyretic effect.

The mechanism of action is associated with non-selective inhibition of the activity of COX (COX-1 and COX-2), which catalyzes the formation of prostaglandins from arachidonic acid, which play an important role in the pathogenesis of pain, inflammation and fever.

Ketorolac is a racemic mixture of [-]S- and [+]R-enantiomers, with the analgesic effect due to the [-]S-form. The strength of the analgesic effect is comparable to morphine, significantly superior to other NSAIDs.

The drug does not affect opioid receptors, does not depress breathing, does not cause drug dependence, does not have a sedative and anxiolytic effect.

After oral administration, the analgesic effect develops after 1 hour.

Suction

When taken orally, ketorolac is well and rapidly absorbed from the gastrointestinal tract. The bioavailability of ketorolac is 80-100%, Cmax after oral administration at a dose of 10 mg is 0.82-1.46 μg / ml, Tmax is 10-78 minutes. Food rich in fats reduces the Cmax of the drug in the blood and delays its achievement by an hour.

Distribution

Plasma protein binding is 99%, Vd is 0.15-0.33 l / kg. The time to reach Css when taken orally at a dose of 10 mg 4 times / day is 24 hours, Css - 0.39-0.79 μg / ml.

It is excreted in breast milk: when taking ketorolac at a dose of 10 mg, Cmax in breast milk is reached 2 hours after the first dose and is 7.3 ng / ml, 2 hours after the second dose of ketorolac (when using the drug 4 times / day) - 7.9 ng/l.

Metabolism

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-hydroxyketorolac.

breeding

It is excreted mainly by the kidneys - 91%, through the intestines - 6%, glucuronides are excreted in the urine. Not excreted by hemodialysis.

T1 / 2 in patients with normal renal function is on average 5.3 hours (2.4-9 hours after oral administration at a dose of 10 mg). When taken orally at a dose of 10 mg, the total clearance is 0.025 l / h / kg.

Pharmacokinetics in special groups of patients

T1 / 2 increases in elderly patients and shortens in young patients.

Impaired liver function does not affect T1 / 2.

In patients with renal insufficiency, the Vd of the drug can increase by 2 times, and the Vd of its R-enantiomer by 20%.

In patients with impaired renal function at a plasma creatinine concentration of 19-50 mg / l (168-442 μmol / l), T1 / 2 is 10.3-10.8 hours, with severe renal failure - more than 13.6 hours.

In patients with renal insufficiency (with a plasma creatinine concentration of 19-50 mg / l), the total clearance is 0.016 l / h / kg.

Pain syndrome of strong and moderate severity:

Toothache;

Pain in the postpartum and postoperative period;

Oncological diseases;

myalgia;

Arthralgia;

Neuralgia, sciatica;

Dislocations, sprains;

Rheumatic diseases.

It is intended for symptomatic therapy, reducing the intensity of pain and inflammation at the time of use, does not affect the progression of the disease.

It is taken orally in a single dose of 10 mg.

At severe pain syndrome the drug is taken repeatedly at 10 mg up to 4 times / day, depending on the severity of pain.

The maximum daily dose is 40 mg. The lowest effective dose should be used.

When taken orally, the duration of the course 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 the transition should not exceed 30 mg.

Determination of the frequency of side effects: often (1-10%), sometimes (0.1-1%), rarely (0.01-0.1%), very rarely (less than 0.01%), including individual messages.

From the digestive system: often (especially in elderly patients over 65 years of age with a history of erosive and ulcerative lesions of the gastrointestinal tract) - gastralgia, diarrhea; sometimes - stomatitis, flatulence, constipation, vomiting, feeling of fullness in the stomach; rarely - 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, coffee grounds vomiting, nausea, heartburn, and others), cholestatic jaundice, hepatitis, hepatomegaly, acute pancreatitis.

From the urinary system: rarely - acute renal failure, back pain with or without hematuria and / or azotemia, hemolytic-uremic syndrome (hemolytic anemia, renal failure, thrombocytopenia, purpura), frequent urination, increase or decrease in urine volume, nephritis, edema of renal origin.

From the sense organs: rarely - hearing loss, tinnitus, visual impairment (including blurred vision).

From the respiratory system: rarely - bronchospasm, shortness of breath, rhinitis, laryngeal edema.

From the nervous system: often - headache, dizziness, drowsiness; rarely - aseptic meningitis (fever, severe headache, convulsions, neck and / or back muscle stiffness), hyperactivity (mood changes, anxiety), hallucinations, depression, psychosis.

From the side of the cardiovascular system: sometimes - an increase in blood pressure; rarely - pulmonary edema, fainting.

From the hematopoietic system: rarely - anemia, eosinophilia, leukopenia.

From the side of hemostasis: rarely - bleeding from a postoperative wound, epistaxis, rectal bleeding.

From the side of the skin: sometimes - skin rash (including maculo-papular rash), purpura; rarely - exfoliative dermatitis (fever with or without chills, redness, thickening or peeling of the skin, swelling and / or soreness of the palatine tonsils), urticaria, Stevens-Johnson syndrome, Lyell's syndrome.

Allergic reactions: rarely - anaphylaxis or anaphylactoid reactions (discoloration of the skin of the face, skin rash, urticaria, itching of the skin, tachypnea or dyspnea, swelling of the eyelids, periorbital edema, shortness of breath, shortness of breath, heaviness in the chest, wheezing).

Others: often - edema (face, shins, ankles, fingers, feet, weight gain); sometimes - increased sweating; rarely - swelling of the tongue, fever.

Complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose or paranasal sinuses and intolerance to acetylsalicylic acid and other NSAIDs (including history);

Erosive and ulcerative changes in the mucous membrane of the stomach and duodenum;

Active gastrointestinal bleeding;

Cerebrovascular or other bleeding;

Inflammatory bowel disease (Crohn's disease, ulcerative colitis) in the acute phase;

Blood clotting disorders, incl. hemophilia;

Decompensated heart failure;

liver failure or active liver disease;

Severe renal failure (CK

The drug has become in demand due to its strong analgesic, moderate anti-inflammatory and antipyretic effects. Ketorol helps with joint, headache, muscle pain. The tool is used in surgery, dentistry, orthopedics, neurology, gynecology, oncology.

The main substance of the drug Ketorolac tromethamine is one of the derivatives of pyrrolysinecarboxylic acid. The pharmaceutical composition appeared in 1980. A relatively new drug belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs or NSAIDs).

Ketorol tablets are intended for oral administration. Under the green membranous shell is a compressed white powder. The content of ketorolac in this dosage form is 10 mg. Auxiliary components are lactose, cellulose and other compounds.

Ketorol injections are called in everyday life a solution for intramuscular and intravenous injections. The volume of the ampoule is 1 ml, the concentration of ketorolac in the liquid is 30 mg/ml. Auxiliary components: sodium chloride and hydroxide, ethanol, etc.

The concentration of the active ingredient in the gel is 2%, which is 2 g in every 100 g of the drug. The total content of ketorolac in a tube weighing 30 g is 600 mg. In the drug reference books (RLS and Vidal) there are no Ketorol suppositories among the Ketorolac release forms. The same situation in Belarus, Ukraine.

Pharmacological action, pharmacodynamics and pharmacokinetics

Ketorolac inhibits cyclooxygenase, an enzyme necessary for the synthesis of prostaglandins. These are mediators responsible for the development of the inflammatory process, accompanying pain and fever. The action on COX is due to the analgesic and anti-inflammatory effects of NSAIDs.

The pharmacological action of ketorolac determined the scope of its use - the symptomatic treatment of pain.

Ketorol is a non-narcotic analgesic. However, the strong analgesic effect of the drug is often compared to opioids. Unlike the latter, ketorolac does not affect the central nervous system, it is not a tranquilizer.

After 4-10 minutes after the absorption of the active substance into the blood, the pain syndrome is weakened. The therapeutic effect lasts from 6 to 8 hours.

The absorption of Ketorolac does not depend on the intake or presence of food in the gastrointestinal tract. Over 50% of the active substance that enters the body is converted in the liver into metabolites that do not have physiological activity. Excretion in the urine is more than 90%, less than 10% is excreted through the intestines.

What helps Ketorol?

The causes of the pain syndrome in which this drug is prescribed may be different. Acute pain most often develops with inflammation, trauma, surgery, swelling, muscle spasms.

Ketorol is used for the short-term treatment of pain of moderate intensity:

• with traumatic lesions, including bruises, dislocations, ligament injuries, tendinitis, bursitis, synovitis;
• with osteochondrosis, radiculitis;
• myalgia, arthralgia, neuralgia;
• with rheumatic diseases;
• with oncology.

The drug helps in case of moderate and severe postoperative pain in patients in combination with low doses of narcotic analgesics. Ketorol is prescribed to reduce inflammation of the eye after cataract removal in adults.

What helps Ketorol gel:

• pain in injuries, damage to ligaments;
• rheumatic diseases;
• post-traumatic pain;
• myalgia and arthralgia;
• radiculitis;
• neuralgia.

Ketorol does not affect the course of the causative disease. A symptomatic remedy only reduces the intensity of the inflammatory process, pain syndrome caused by injuries, inflammation.

Instructions for use and dosage

The choice of the form of release of the drug is dictated by the main indication and concomitant circumstances. Pain relief is achieved faster with intramuscular and intravenous administration. The latter method is used mainly in hospitals and nursing homes.

Tablets Ketorol

Usually, one tablet is taken for toothache, which corresponds to 10 mg of ketorolac. For injuries, myalgia and other indications, an increase in dosages may be required. Take one tablet every 4-6 hours. The maximum allowable daily dose is 40 g.

The duration of treatment for most NSAIDs is 3-7 days.

Ketorol is not prescribed for children under 12 years of age. Older people may need to reduce the dose recommended for adults to avoid the adverse effect of the drug on the gastrointestinal tract.

Solution for intramuscular and intravenous administration

One ampoule of Ketorol contains 30 mg of the active ingredient. Experts suggest parenteral administration to start with a dose of 10 mg, then use 10-30 mg every 4-6 hours. The maximum single dose for the treatment of patients from 16 to 64 years old is 60 mg of Ketorolac (2 ampoules of Ketorol), the highest daily dose is 90 mg (3 ampoules).

If the patient's body weight is less than 50 kg and / or he is over 65 years old, then use a single dose of 15 or 30 mg (½ or 1 ampoule). A maximum of 2 ampoules can be administered per day.

Gel for external use

A single dose of ketorolac corresponds to a column of gel about 1.5-2 cm long. The agent is applied to clean, dry, intact skin within the area of ​​​​soreness, evenly distributed with fingertips, rubbed with soft massaging movements. Apply the gel no more than 4 times a day. The course of treatment is from 3 to 10 days.

During pregnancy and breastfeeding

The drug is not prescribed to women who are expecting a baby, as well as during childbirth. Ketorolac has an undesirable effect on the contractile functions of the uterus, passes through the placenta (10% of the dose taken by the expectant mother). The use of the drug can lead to intrauterine pulmonary hypertension in newborns. If the doctor deems it necessary, he will prescribe Ketorol tablets or injections in the I and II trimesters of pregnancy.

Ketorolac is strictly contraindicated in the last three months of pregnancy and lactation.

If a nursing mother takes a Ketorol tablet, the active ingredient passes into breast milk. The drug reaches its maximum concentration after 2 hours. Before using the gel, pregnant or lactating women should consult a gynecologist or pediatrician.

drug interaction

Simultaneous administration can enhance the negative effect of drugs on the gastrointestinal mucosa. Concomitant oral or parenteral use of Ketorol with other NSAIDs should be avoided, as this increases the risk of gastrointestinal bleeding.

And also the combination of ketorolac with the following drugs is undesirable:

• anticoagulants such as heparin and warfarin;
• platelet aggregation inhibitors;
• corticosteroids (GCS);
• calcium preparations;
• penoxifylline.

The combined use of ketorolac with methotrexate, lithium salts leads to an increase in the concentration and toxicity of the latter. With simultaneous treatment, Ketorol reduces the effectiveness of antihypertensive drugs and diuretics. Paracetamol and ketorolac can be used together for no longer than 2 days. The combination of Ketorol with narcotic painkillers can significantly reduce the dose of opioids.

Compatibility of Ketorol with alcohol

Ketorolac is not taken with ethanol. Both substances irritate the gastrointestinal mucosa to varying degrees, which creates a risk of gastrointestinal bleeding.

Alcohol increases the rate of absorption and elimination of NSAIDs. The analgesic effect, for which Ketorol is taken, develops and ends faster. There is a need to increase the dose, and this is fraught with increased side effects and overdose.

It is dangerous to combine ketorolac treatment with alcoholic beverages for a number of other reasons. For example, the combination is dangerous for the liver, which is responsible for the metabolism of drugs and ethanol. At the same time, the load on the kidneys increases, through which the excretion of decay products occurs.

Contraindications, side effects and overdose

Ketorol is not usually used for mild pain. The medicine is used under medical supervision. Treatment with Ketorol is contraindicated in case of hypersensitivity to the main and auxiliary components, allergies to other NSAIDs, in the last trimester of pregnancy, during childbirth, lactation. Tablets and injections are not prescribed for children under 16 years of age, gel - for adolescents under 12 years of age. Contraindications are predominantly severe lesions of the gastrointestinal tract, other systems and organs, renal failure.

Like other NSAIDs, ketorolac has side effects. Typical negative manifestations of treatment are nausea, abdominal pain, dyspepsia (12-13%), diarrhea (9%). Less common are more dangerous side effects: gastric ulcers and bleeding, swelling of the larynx, anaphylaxis.

Prolonged uncontrolled intake of Ketorol can contribute to the development of an allergic disease, dermatosis, asthma, pancreatitis, hepatitis. If any of the listed side effects occur, stop treatment and consult a doctor.

Exceeding the dose of ketorolac may be accompanied by nausea, abdominal pain, abdominal cramps, and vomiting. An overdose of Ketorol is one of the causes of blood pressure surges, ulcerations, gastric perforations, gastroduodenal bleeding, renal failure, anaphylaxis, and respiratory depression. You should immediately seek medical attention.

Drug analogues

Ketorolac is a part of domestic and foreign preparations. In pharmacies, you can find cheap analogues with almost identical composition - generics. The cost of Indian drugs manufactured under the general trade name Ketorol: solution in ampoules - 120 rubles. (10 pcs.), tablets - 36 rubles. (20 pcs.), gel - 255 rubles. (30 g).

Complete structural analogues, price (rub.):

• Ketorolac (Russia), tablets - from 15 to 40, ampoules - 80;
• Ketanov (Romania), tablets - 70, ampoules - 125;
• Ketorolac Romofarm (Romania), ampoules - 105;
• Dolak (India), tablets - 35, ampoules - 85.

In some cases, it is necessary to determine the benefits of Ketanov or Ketorol, which is best used for pain. The preparations are complete structural analogues - they contain the same active ingredient in identical dosages. This means that indications and contraindications, methods of application do not have serious differences. All characteristics of Ketorol and Ketanov are basically the same, so the funds are interchangeable.

A similar mechanism of action is found in group analogs of ketorolac. Indomethacin is closest in properties to Ketorol. Candles, various versions of tablets and gels have provided a great demand for another related compound with a similar mechanism of action - diclofenac. However, this particular representative of NSAIDs has been subjected to additional tests in recent years due to increased reports of negative effects on the gastrointestinal tract, cardiovascular system, and hematopoiesis.

Ketorolac has analgesic properties. Less pronounced anti-inflammatory and antipyretic effects. Therefore, Ketorol is not a full replacement for paracetamol, ibuprofen, aspirin and vice versa.

Doctor of Medicine, NSAID treatment safety researcher A. Karataev believes that there are more pros than cons for using this group of drugs. The scientist notes the high bioavailability of ketorolac, the ability to quickly accumulate in plasma.

Ketorol and analogues in composition develop an analgesic effect comparable to the use of small doses of morphine or promedol. However, the action of ketorolac lasts longer than narcotic painkillers. Ketorol is not a sedative, is not addictive, rarely provokes undesirable effects in a short course of treatment.

Compound

Ketorol solution for intramuscular injection
Active substance: tromethamine ketorolac.
Inactive substances: ethanol, sodium chloride, octoxynol, disodium edetate, sodium hydroxide, propylene glycol, water for injection.

pharmachologic effect

Indications for use

Mode of application

Ketorol for intramuscular injection
The minimum effective dose is selected individually, which depends on the therapeutic response of the patient and the intensity of the pain syndrome. If necessary, reduced doses of opioid analgesics can be given in parallel.
At the age of up to 65 years, 10-30 mg of the drug is used intramuscularly once or repeatedly (every 4-6 hours) at 10-30 mg. Patients over 65 years old, as well as in case of impaired renal function, Ketorol is prescribed intramuscularly once 10-15 mg or repeatedly 10-15 mg every 4-6 hours, depending on the severity of the pain syndrome.
The maximum allowable dose for patients under 65 years of age is 90 mg / day. In case of impaired renal function or age over 65 years, the maximum allowable dose is 60 mg / day. The course of therapy is no more than 5 days.

Switching from intramuscular to internal use
On the day of transition, the oral dose of Ketorol should not exceed 30 mg. The daily total dose of tablets and solution when switching from intramuscular administration to oral administration should be no more than 90 mg / day for patients 65 years of age or less, for patients with impaired renal function or over 65 years of age - 60 mg / day.

Side effects

From the urinary system: back pain without or with azotemia and / or hematuria, acute renal failure, uremic hemolytic syndrome (renal failure, thrombocytopenia, hemolytic anemia, purpura), decrease or increase in the volume of urine excreted, renal edema, frequent urination, jade (rare).

On the part of the digestive system: diarrhea and gastralgia, especially in patients over the age of 65 who had a history of erosive and ulcerative diseases of the gastrointestinal tract (often); flatulence, feeling of fullness in the stomach, constipation, stomatitis, vomiting (less often); erosive and ulcerative lesions of the gastrointestinal tract, including bleeding (burning or spasm in the epigastric region, abdominal pain, coffee grounds vomiting, heartburn, melena, nausea) and perforation of the gastrointestinal tract wall, hepatitis, acute pancreatitis, cholestatic jaundice, hepatomegaly (rare).

From the side of the central nervous system: headache, drowsiness, dizziness (often); depression, hallucinations, psychosis, tinnitus, hearing impairment, visual impairment (including blurred visual perception), hyperactivity (anxiety, mood changes), aseptic meningitis (severe headache, fever, stiffness of the muscles of the back and / or neck, convulsions) - rarely.

From the respiratory system: laryngeal edema (difficulty breathing, shortness of breath), dyspnea or bronchospasm, rhinitis (rarely).

Allergic reactions: anaphylactoid reactions or anaphylaxis (skin rash, discoloration of the skin of the face, skin itching, urticaria, dyspnea or tachypnea, periorbital edema, swelling of the eyelids, shortness of breath, shortness of breath, wheezing, heaviness in the chest) - rarely.
From the blood coagulation system: epistaxis, bleeding from a postoperative wound, bleeding from the intestines (rarely).

On the part of the hematopoietic organs: eosinophilia, anemia, leukopenia (rarely).

Skin reactions: purpura and skin rash, including maculo-papular rash (less often); urticaria, exfoliative dermatitis (fever with or without chills, peeling or thickening of the skin, redness, soreness and / or swelling of the tonsils), Lyell's syndrome, Stevens-Johnson syndrome (rarely).

From the side of the cardiovascular system: a slight increase in blood pressure (less often); pulmonary edema, loss of consciousness (rare).

Local reactions when injected into the muscle: pain or burning at the injection site (less often).

Others: swelling of the legs, face, ankles, feet, fingers, weight gain (often); excessive sweating (less often); fever, swelling of the tongue, (rare).

Contraindications

Pregnancy

drug interaction

Simultaneous use with indirect anticoagulants, thrombolytics, heparin, cefoperazone, antiplatelet agents, pentoxifylline and cefotetan increases the possible risk of bleeding.
Ketorol reduces the effect of antihypertensive and diuretic drugs, as it causes a decrease in the formation of prostaglandins in the kidneys.
Probenecid reduces the volume of distribution and plasma clearance of Ketorol, increases its content in the blood serum and increases the half-life of Ketorolac tromethamine.
The combined use of methotrexate and ketorolac is possible only with the appointment of small doses of methotrexate (in this case, it is necessary to carefully monitor the plasma concentration of methotrexate).

The absorption of Ketorolac tromethamine is not affected by the use of antacids.
Ketorol increases plasma levels of nifedipine and verapamil.
With the simultaneous use of Ketorol, the hypoglycemic effect of oral hypoglycemic drugs and insulin increases, which requires a change in the dose of the latter. When prescribing the drug with other drugs that have a nephrotoxic effect (including gold-containing drugs), the risk of nephrotoxicity increases.
Drugs that inhibit tubular secretion reduce the clearance of ketorolac tromethamine and increase its serum concentration.
When the drug is combined with opioid analgesics, a significant reduction in the dosage of the latter is possible.
The joint appointment of sodium valproate and Ketorol leads to a violation of platelet aggregation.
Pharmaceutically, tromethamine ketorolac is incompatible with lithium preparations and tramadol solution.

Do not mix the solution for intramuscular injection of Ketorol in the same syringe with promethazine, morphine sulfate and hydroxyzine, as they interact chemically with precipitation.
Solution for intramuscular injection Ketorol is compatible with 5% dextrose solution, isotonic sodium chloride solution, plasmalite, Ringer's lactate solution and Ringer's solution, as well as infusion solutions that include lidocaine hydrochloride, dopamine hydrochloride, aminophylline, heparin sodium salt and human insulin short action.

Overdose

Release form

Ketorol - solution for intramuscular injection in dark glass ampoules containing 1 ml of Ketorol (30 mg of ketorolac tromethamine). There are 10 ampoules in a blister.

Storage conditions

Additionally

The risk of developing side effects from the urinary system increases with hypovolemia.
Ketorol, if necessary, can be used in combination with opioid analgesics.
Ketorol is not recommended to be taken simultaneously with paracetamol for more than 5 days.
When using Ketorol, a significant number of patients develop side effects from the central nervous system (for example, drowsiness, headache, dizziness), so it is better to avoid performing activities that require a quick reaction and increased attention (working with mechanisms, driving vehicles).
Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide on the appointment of the drug, as well as determine the dose and methods of its use.