Ketorolac Tablet

Drug Reference 9 min 42

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Created On: 27/09/2019

Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) with analgesic properties. It is used for short term management (up to 5 days) of moderately severe acute pain.

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Introduction

Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) with analgesic properties. It is used for short term management (up to 5 days) of moderately severe acute pain.

Indications

Moderately severe acute pain
Headache
Acute pain requiring opioid-level analgesia

Pharmachologic action

Ketorolac inhibits prostaglandin synthesis by competitive blocking cyclooxygenase (COX) enzyme. The prostaglandins cause the redness, fever, swelling, pain, and inflammation.

Dosage

Patients aged 17 to 64 years require 20 mg PO once followed by 10 mg every 4 to 6 hours as recommended. Patients aged >65 years, those with renal impairment, and/or weight <50 kg require 10 mg PO once followed by 10 mg every 4 to 6 hours as recommended.

Pharmacokinetics

Ketorolac is rapidly absorbed, C_max (maximum peak concentration) being achieved between 20 to 60 minutes. Its bioavailability is estimated to range from 80 to 100%. The drug is extensively bound (>99%) to plasma proteins and has a volume of distribution (0.1 to 0.3 L/kg) comparable with those of other NSAIDs. Ketorolac is extensively metabolized through glucuronidation and oxidation; little if any drug is eliminated unchanged. The elimination half-life is between 4 and 6 hours.

Contraindications

Allergy to aspirin or other NSAIDs
Gastrointestinal bleeding
Kidney or Liver disease
Asthma
Dehydration
Pregnancy and lactation
Postoperatively in patients with high risk of bleeding

Drug interaction

Aliskiren
ACE 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 in 10 to 1 in 100)

Abdominal pain & dyspepsia
Nausea & vomiting
Drowsiness

Uncommon (affecting 1 in 100 to 1 in 1000)

Edema
Hypertension
Pruritus
Skin Reactions

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

Peptic ulcer
GI 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 is not confirmed in this population
Not be used by nursing mothers because it is excreted in breast milk

Clinical evidence

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with strong analgesic activity that has been evaluated in postoperative setting, in both hospital inpatients and outpatients. Ketorolac provides relief from mild to severe pain in patients after major abdominal, orthopedic or gynecological surgery or ambulatory laparoscopic or gynecological procedures and also provides a useful alternative, or adjuvant, to opioids¹.
Ketorolac tromethamine controls postoperative pain better than Hydrocodone and Acetaminophen after anterior cruciate ligament reconstruction. With an effective loading dose administered before the subsequent oral dosage, better reduction in pain is there with Ketorolac tromethamine as compare to Hydrocodone and Acetaminophen².