What is Doloket?
Doloket is a nonsteroidal anti-inflammatory drug (NSAID). Doloket works by reducing hormones that cause inflammation and pain in the body.
Doloket is used short-term (5 days or less) to treat moderate to severe pain.
Doloket may also be used for purposes not listed in this medication guide.
Doloket indications
Carefully consider the potential benefits and risks of Doloket and other treatment options before deciding to use Doloket. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
Acute Pain in Adult Patients
Doloket is indicated for the short-term (≤5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting. Therapy should always be initiated with IV or IM dosing of Doloket, and oral Doloket is to be used only as continuation treatment, if necessary.
The total combined duration of use of Doloket injection and oral Doloket is not to exceed 5 days of use because of the potential of increasing the frequency and severity of adverse reactions associated with the recommended doses. Patients should be switched to alternative analgesics as soon as possible, but Doloket therapy is not to exceed 5 days.
Doloket injection has been used concomitantly with morphine and meperidine and has shown an opioid-sparing effect. For breakthrough pain, it is recommended to supplement the lower end of the Doloket injection dosage range with low doses of narcotics prn, unless otherwise contraindicated. Doloket injection and narcotics should not be administered in the same syringe.
How should I use Doloket?
Use Doloket spray as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Doloket spray comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Doloket spray refilled.
- Do not take Doloket spray by mouth. Use in your nose only.
- Before you use each bottle for the first time, you must prime it. Remove the clear plastic cover and the blue plastic safety clip. Hold the bottle at arm's length away from you. Using your index and middle fingers on the top of the bottle and your thumb on the bottom of the bottle, press down evenly and release the pump 5 times. The bottle is now ready to use.
- To use this nose spray, gently blow your nose. Sit up straight or stand and tilt your head forward slightly. Place the tip of the spray container into the nose. Be sure to point the container away from the center of your nose. Breathe gently through the nostril and squeeze the spray container. If your dose requires 2 sprays, repeat the process for your other nostril. Replace the clear plastic cover after each use.
- Do NOT use Doloket spray for more than 5 days. Doloket spray is not for the treatment of mild to moderate or chronic pain (eg, headache).
- Avoid contact with the eyes. If you get Doloket spray in your eyes, rinse it out with water. If eye irritation persists for more than 1 hour, contact your doctor.
- Each bottle contains 1 day's supply of Doloket spray. Discard each bottle within 24 hours of opening it, even if it still contains some unused medicine.
- If you miss a dose of Doloket spray and you are taking it regularly, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Doloket spray.
Uses of Doloket in details
Use: Labeled Indications
Pain, moderate to moderately severe: Short-term (up to 5 days) management of moderate to moderately severe pain in adults that requires analgesia at the opioid level.
Off Label Uses
Migraine
Data from a prospective, randomized, double-blind, double-dummy, placebo and active comparator, crossover, non-inferiority trial suggests that intranasal Doloket may be beneficial for acute abortive treatment of migraine in patients with a history of episodic migraines for at least 1 year.
Doloket description
A synthetic opioid that is used as the hydrochloride. It is an opioid analgesic that is primarily a mu-opioid agonist. It has actions and uses similar to those of morphine. It also has a depressant action on the cough center and may be given to control intractable cough associated with terminal lung cancer. Doloket is also used as part of the treatment of dependence on opioid drugs, although prolonged use of methadone itself may result in dependence. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1082-3)
Doloket dosage
Carefully consider the potential benefits and risks of Doloket tablets and other treatment options before deciding to use Doloket tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals. In adults, the combined duration of use of IV or IM dosing of Doloket and Doloket tablets is not to exceed 5 days. In adults, the use of Doloket tablets is only indicated as continuation therapy to IV or IM dosing of Doloket.
Transition from IV or IM dosing of Doloket (single- or multiple-dose) to multiple-dose Doloket tablets:
Patients age 17 to 64: 20 mg PO once followed by 10 mg q4 to 6 hours prn not > 40 mg/day
Patients age ≥ 65, renally impaired, and/or weight < 50 kg (110 lbs): 10 mg PO once followed by 10 mg q4 to 6 hours prn not > 40 mg/day
Note:
Oral formulation should not be given as an initial dose.
Use minimum effective dose for the individual patient.
Do not shorten dosing interval of 4 to 6 hours.
Total duration of treatment in adult patients: the combined duration of use of IV or IM dosing of Doloket and Doloket tablets is not to exceed 5 days.
The following table summarizes Doloket tablet dosing instructions in terms of age group:
| Patient Population | Doloket Tablets (following IV or IM dosing of Doloket) |
| Age < 17 years | Oral not approved |
| Adult Age 17 to 64 years | 20 mg once, then 10 mg q4 to 6 hours prn not > 40 mg/day |
| Adult Age ≥ 65 years, renally impaired, and/or weight < 50 kg | 10 mg once, then 10 mg q4 to 6 hours prn not > 40 mg/day |
Doloket interactions
See also:
What other drugs will affect Doloket?
Doloket slightly reduces the plasma protein-binding of warfarin. In vitro studies indicate that at therapeutic concentration of salicylate, the binding of Doloket reduces from approximately 99.2-97.5%; representing a potential 2-fold increase in unbound plasma Doloket levels. Doloket has been reported to reduce the diuretic response to furosemide in normovolemic individuals by approximately 20%.
Concomitant administration of Doloket and probenecid results in decreased clearance of Doloket and significant increase in Doloket plasma levels (approximately 3-fold increase), and there is an increase of approximately 2-fold in terminal half-life.
Increase in plasma lithium concentration due to inhibition of renal lithium clearance has been reported with some NSAIDs. There have been some reports of increased lithium plasma levels with Doloket also.
There have been reports of a possible interaction of Doloket and nondepolarizing muscle relaxants, which lead to apnea. Concomitant use of Doloket and angiotensin-converting enzyme inhibitors may increase the risk of renal impairment, particularly in volume-depleted patients.
Very few cases of seizure have been reported with concomitant use of Doloket and antiepileptic drugs (phenytoin, carbamazepine). There have been reports of hallucinations when Doloket is concomitantly used with psychoactive drugs (fluoxetine, thiothixene, alprazolam).
Laboratory Tests: Doloket inhibits platelet aggregation and may prolong bleeding time.
Food: Food reduces the rate but not the extent of absorption.
Doloket side effects
See also:
What are the possible side effects of Doloket?
Applies to Doloket ophthalmic: ophthalmic solution
In addition to its needed effects, some unwanted effects may be caused by Doloket ophthalmic. In the event that any of these side effects do occur, they may require medical attention.
Major Side Effects
You should check with your doctor immediately if any of these side effects occur when taking Doloket ophthalmic:
More common:
- Itching, redness, tearing, or other sign of eye irritation not present before use of this medicine or becoming worse during use
- redness of the clear part of the eye
- sensitivity to light
- swelling of the eye
- tearing
- throbbing pain
- Blurred vision or other change in vision
- eye irritation or redness
Minor Side Effects
Some of the side effects that can occur with Doloket ophthalmic may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:
More common:
- Stinging or burning of the eye when medicine is applied
- Dry eyes
- headache
Doloket contraindications
See also:
What is the most important information I should know about Doloket?
Doloket is contraindicated in patients with previously demonstrated hypersensitivity to Doloket.
Doloket is contraindicated in patients with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or perforation and in patients with a history of peptic ulcer disease or gastrointestinal bleeding.
Doloket should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients.
Doloket is contraindicated as prophylactic analgesic before any major surgery.
Doloket is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
Doloket is contraindicated in patients with advanced renal impairment or in patients at risk for renal failure due to volume depletion.
Doloket is contraindicated in labor and delivery because, through its prostaglandin synthesis inhibitory effect, it may adversely affect fetal circulation and inhibit uterine musculature, thus increasing the risk of uterine hemorrhage.
Doloket inhibits platelet function and is, therefore, contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis and those at high risk of bleeding.
Doloket is contraindicated in patients currently receiving aspirin or NSAIDs because of the cumulative risks of inducing serious NSAID-related adverse events.
The concomitant use of Doloket and probenecid is contraindicated.
The concomitant use of Doloket and pentoxifylline is contraindicated.
Doloket injection is contraindicated for neuraxial (epidural or intrathecal) administration due to its alcohol content.
Active ingredient matches for Doloket:
Ketorolac in Dominican Republic, India.
Ketorolac tromethamine in India.
| Unit description / dosage (Manufacturer) | Price, USD |
| 5 mg x 5ml | $ 0.38 |
| Doloket Eye 5 ml Drop | $ 0.08 |
| Doloket 5mg EYE-DPS / 5ml | $ 0.38 |
| DOLOKET 5MG EYE DROPS 1 packet / 5 ML eye drop each (FDC Ltd) | $ 0.44 |
| DOLOKET eye drops 5 mg x 5ml (FDC) | $ 0.38 |
| Doloket 5mg Eye Drop (FDC Ltd) | $ 0.44 |
List of Doloket substitutes (brand and generic names): | |
| Dolo Galen (Paraguay) | |
| Doloket Eye Drops | |
| Doloket Eye Drops 5mg EYE-DPS / 5ml | $ 0.38 |
| Doloket LS | |
| Doloket LS Eye 5 ml Drop (Spectra (FDC Limited)) | $ 0.09 |
| DOLOKET LS 4MG EYE DROPS 1 packet / 5 ML eye drop each (Spectra (FDC Limited)) | $ 0.48 |
| DOLOKET-LS (India) | |
| 4 mg x 1 mL x 5ml (FDC (Vista)) | $ 0.40 |
| Doloket-LS 4mg x 1mL EYE DPS / 5ml (FDC (Vista)) | $ 0.40 |
| DOLOKET-LS eye drops 4 mg x 1 mL x 5ml (FDC (Vista)) | $ 0.40 |
| Doloket-LS 4mg x 1mL EYE DPS / 5ml (FDC (Vista)) | $ 0.40 |
| Dolomedin (Paraguay) | |
| Dolomin (Georgia, Paraguay) | |
| Dolomine (Egypt) | |
| Tablet; Oral; Aspirin 325 mg; Caffeine 33 mg (Frega) | |
| Injectable; Injection; Ketorolac Tromethamine 30 mg / ml (Frega) | |
| DOLOMINE TABLET 1 strip / 10 tablets each (Frega) | $ 0.63 |
| Dolomine Tablet (Frega) | $ 0.06 |
| Dolomine 0.5% (Egypt) | |
| Doloren 10 (Paraguay) | |
| Doloren 20 (Paraguay) | |
| Doloren 60 (Paraguay) | |
| Dolostop 20mg (Paraguay) | |
| Dolostop 60mg (Paraguay) | |
| Dolotor (Mexico) | |
| Dolout (Peru) | |
| Dolten (Argentina) | |
| Dolten SL (Argentina) | |
| Doltrex (Peru) | |
| Dorixina forte NF (Argentina) | |
| Droal (Spain) | |
| Drometak (Mexico) | |
| Duopharma Ketorolac Trometamol (Philippines) | |
| Duprac (Argentina) | |
| Duprac SL (Argentina) | |
| Dylac (Pakistan) | |
| Dyrolac (Philippines) | |
| Dyrolac inj 30 mg/mL 10 x 1's (Yung Shin) | |
| E-Ket (Bangladesh) | |
| Efimerol (Mexico) | |
| Eleadol 10mg (Uruguay) | |
| Eleadol 20mg (Uruguay) | |
| Eleadol 30mg (Uruguay) | |
| Elipa (Portugal) | |
| Emodol (Bangladesh) | |
| Enfluat (Georgia, Turkey) | |
| Erphapain (Indonesia) | |
See 1099 substitutes for Doloket | |
References
- PubChem. "ketorolac". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "ketorolac". http://www.drugbank.ca/drugs/DB00465 (accessed September 17, 2018).
- MeSH. "Cyclooxygenase Inhibitors". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Doloket are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Doloket. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
Consumer reported useful
No survey data has been collected yetConsumer reported price estimates
No survey data has been collected yetConsumer reported time for results
No survey data has been collected yet1 consumer reported age
| Users | % | ||
|---|---|---|---|
| 30-45 | 1 | 100.0% | |
Consumer reviews
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Information checked by Dr. Sachin Kumar, MD Pharmacology
