ketorolac (Toradol, Acular, Acuvail)
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Introduction
Tradenames: Toradol, Acular. ketorolac tromethamine.
Indications
- management of moderate to severe acute pain-related syndrome
- renal colic
- not for chronic pain
- ophthalmic
Contraindications
- concurrent administration of probenecid
- patients who have developed nasal polyps, angioedema or bronchospastic reactions to NSAIDs
- cerebrovascular hemorrhage
- hemorrhagic diathesis
- high risk of bleeding
- pre-operative prophylaxis
- intra-operative use when hemostasis is critical
- severe renal insufficiency
- active peptic ulcer disease
- history of gastrointestinal bleeding
- chronic pain
Dosage
- 15-60 mg IM/IV every 6 hours, max 120 mg/day
- administer IV over at least 15 seconds
- patients > 65 years or patients with renal insufficiency
- 10 mg PO QID, max 40 mg/day
- should NOT be used for > 5 days
- do NOT administer intrathecally or epidurally
Tabs: 10 mg.
Injection: 15 mg, 30 mg, 60 mg (single-dose syringes).
Ophthalmic: (Acular) 1 drop QID (0.5%)
Pharmacokinetics
- rapidly absorbed with IM administration
- peak levels 30-60 minutes after IM administration
- peak levels 1-3 minutes after IV administration
- metabolized by liver
- excreted by kidneys
- terminal 1/2life is approximately 6 hours, prolonged with renal impairment
elimination via liver
elimination via kidney
1/2life = 4-10 hours
protein binding = >99 %
elimination by hemodialysis = -
elimination by peritoneal dialysis = -
Monitor
- liver function tests periodically[5]
Adverse effects
- not common (1-10%)
- drowsiness, bruising or burning at site of injection, dyspepsia, abdominal pain, edema, diarrhea, dizziness, headache, increased sweating
- uncommon (< 1%)
- other[2]
Drug interactions
- warfarin in combination prolong bleeding times
- ketorolac decreases clearance & increases toxicity of:
- probenecid
- competes for elimination
- contraindicated
- glucocorticoids in combination increases risk of GI & renal damage
- salicylates
- ketorolac may enhance activity of non-depolarizing muscle relaxants
- drug interaction(s) of direct oral anticoagulants (DOAC) with NSAIDs
- drug interaction(s) of cholinesterase inhibitors with NSAIDs
- drug interaction(s) of lithium carbonate with NSAIDs
- drug interaction(s) of NSAIDs with oral contraceptive
- drug interaction(s) of NSAIDs with SSRIs
- drug interaction(s) of NSAIDs with antidepressants
- drug interaction(s) of aspirin with NSAIDs
- drug interaction(s) of apixaban with NSAIDs
- drug interaction(s) of warfarin with NSAIDs
- drug interaction(s) of NSAIDs with beta blockers
- drug interaction(s) of NSAIDs with ARBs
- drug interaction(s) of NSAIDs with aldosterone antagonis
- drug interaction(s) of NSAIDs with glucocorticoid
- drug interaction(s) of NSAIDs, diuretics & angiotensin II receptor antagonists
- drug interaction(s) of NSAIDs, diuretics & ACE inhibitors
- drug interaction(s) of NSAIDs with ACE inhibitors
- drug interaction(s) of NSAIDs & antihypertensives
- drug interaction(s) of NSAIDs & loop diuretics
- drug interaction(s) of NSAIDs & aspirin
Laboratory
Mechanism of action
- acetic acid class NSAID with anti-inflammatory, analgesic & antipyretic properties
- inhibits prostaglandin synthesis
More general terms
Component of
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ 2.0 2.1 Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Clinical Guide to Laboratory Tests, NW Tietz (ed) 3rd ed, WB Saunders, Philadelpha 1995
- ↑ 5.0 5.1 Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Liver Function Test Scheduling Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260704&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 19(6): 2012 COMMENTARY: Common Questions About Ketorolac GUIDELINES: Guidelines for Prevention of NSAID-Related Ulcer Complications (2009) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280607&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 Deprecated Reference