Ketorolac; Uses, Dosage, Side Effects, Interactions

Ketorolac
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Ketorolac is a potent, short-acting nonsteroidal anti-inflammatory drug (NSAID) that is available in both parenteral and oral forms. Ketorolac is generally given for a few days only and has not been linked to instances of idiosyncratic drug-induced liver disease in the published literature.

Mechanism of Action of Ketorolac

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) chemically related to indomethacin and tolmetin. Ketorolac tromethamine is a racemic mixture of [-]S- and [+]R-enantiomeric forms, with the S-form having analgesic activity. Its anti-inflammatory effects are believed to be due to inhibition of both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) which leads to the inhibition of prostaglandin synthesis leading to decreased formation of precursors of prostaglandins and thromboxanes from arachidonic acid. The resultant reduction in prostaglandin synthesis and activity may be at least partially responsible for many of the adverse, as well as the therapeutic, effects of these medications. Analgesia is probably produced via a peripheral action in which blockade of pain impulse generation results from decreased prostaglandin activity. However, inhibition of the synthesis or actions of other substances that sensitize pain receptors to mechanical or chemical stimulation may also contribute to the analgesic effect. In terms of the ophthalmic applications of ketorolac – ocular administration of ketorolac reduces prostaglandin E2 levels in aqueous humor, secondary to inhibition of prostaglandin biosynthesis.

Indications of Ketorolac

Contra-Indications of Ketorolac

 Dosage of Ketorolac

Strengths: 10 mg; 15 mg/mL; 30 mg/mL; 60 mg/2 mL

Dose for Pain

The combined duration of use of parenteral, oral, and intranasal ketorolac should not exceed 5 days; the oral formulation is only to be used as the continuation to IV or IM therapy.

Intranasal

  • Weight 50 kg or more: 31.5 mg every 6 to 8 hours (1 spray in each nostril)
  • Weight less than 50 kg: 15.75 mg every 6 to 8 hours (1 spray in 1 nostril)
  • Maximum dose: 4 doses per day

Parenteral, Single-Dose Treatment

  • Weight 50 kg or more: 60 mg IM or 30 mg IV
  • Weight less than 50 kg: 30 mg IM or 15 mg IV

Multiple-Dose Treatment

  • Weight 50 kg or more: 30 mg IM/IV every 6 hours as needed
  • Maximum dose: 120 mg/day
  • Weight less than 50 kg: 15 mg IM/IV every 6 hours as needed
  • Maximum dose: 60 mg/day

Oral, as the continuation to parenteral therapy

  • Weight 50 kg or more: 20 mg orally once followed by 10 mg every 4 to 6 hours as needed
  • Weight less than 50 kg: 10 mg orally once followed by 10 mg every 4 to 6 hours as needed
  • Maximum dose: 40 mg/day

Geriatric Pain

The combined duration of use of parenteral, oral, and intranasal ketorolac should not exceed 5 days; the oral formulation is only to be used as the continuation to IV or IM therapy.

Intranasal

  • Dose: 15.75 mg every 6 to 8 hours (one spray in 1 nostril)
  • Maximum dose: 4 doses per day

Parenteral

  • Single-Dose Treatment: 30 mg IM or 15 mg IV
  • Multiple-Dose Treatment: 15 mg IM/IV every 6 hours as needed
  • Maximum dose: 60 mg/day

Oral, as the continuation to parenteral therapy

  • Dose: 10 mg orally once followed by 10 mg every 4 to 6 hours as needed
  • Maximum dose: 40 mg/day

Pediatric Pain

The combined duration of use of parenteral, oral, and intranasal ketorolac should not exceed 5 days; the oral formulation is only to be used as continuation therapy to IV or IM.

Intranasal Age: Greater than 17 years

  • Weight 50 kg or more: 31.5 mg every 6 to 8 hours (1 spray in each nostril)
  • Weight less than 50 kg: 15.75 mg every 6 to 8 hours (1 spray in 1 nostril)
  • Maximum: 4 doses per day

Oral, as the continuation of parenteral therapy, Age: 17 years or older

  • Weight 50 kg or more: 20 mg orally once followed by 10 mg every 4 to 6 hours as needed
  • Weight less than 50 kg: 10 mg orally once followed by 10 mg every 4 to 6 hours as needed
  • Maximum dose: 40 mg/day

Parenteral Age: 17 years or older

  • Single-Dose Treatment:
  • Weight 50 kg or more: 60 mg IM or 30 mg IV
  • Weight less than 50 kg: 30 mg IM or 15 mg IV

Multiple-Dose Treatment

  • Weight 50 kg or more: 30 mg IM/IV every 6 hours as needed
  • Maximum dose: 120 mg/day
  • Weight less than 50 kg: 15 mg IM/IV every 6 hours as needed
  • Maximum dose: 60 mg/day

Age: 2 to 16 years, Single-Dose Treatment

  • IM: 1 mg/kg up to a maximum of 30 mg
  • IV: 0.5 mg/kg up to a maximum of 15 mg
  • Maximum dose: 1 dose

Side Effects of Ketorolac

The most common

More common

Rare

Drug Interactions of Ketorolac

Ketorolac may interact with following drugs, supplements & may change the efficacy of drugs

Pregnancy & Lactation of Ketorolac

FDA Pregnancy Category C

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. It must not be used during the last 3 months of pregnancy as it may cause heart and kidney problems for the developing baby and cause prolonged labor with excessive bleeding during delivery.

Breastfeeding

This medication passes into breast milk. If you are a breastfeeding mother and are taking ketorolac, it may affect your baby. Breastfeeding is not recommended while you are taking ketorolac.

References

  1. https://pubchem.ncbi.nlm.nih.gov

  2. https://pubchem.ncbi.nlm.nih.gov/compound/Ketorolac_tromethamine

Ketorolac

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