Ketolac Dosage

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Dosage of Ketolac in details

The dose of a drug and dosage of the drug are two different terminologies. Dose is defined as the quantity or amount of medicine given by the doctor or taken by the patient at a given period. Dosage is the regimen prescribed by the doctor about how many days and how many times per day the drug is to be taken in specified dose by the patient. The dose is expressed in mg for tablets or gm, micro gm sometimes, ml for syrups or drops for kids syrups. The dose is not fixed for a drug for all conditions, and it changes according to the condition or a disease. It also changes on the age of the patient.
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Ketolac ampoules are for IM or bolus IV injection administration.

Bolus IV doses should be given over not less than 15 sec. Ketolac ampoules should not be used for epidural or spinal administration. The time to onset of analgesic effect following both IV and IM administration is similar and is approximately 30 min, with maximum analgesia occurring within 1-2 hrs. The median duration of analgesia is generally 4-6 hrs.

Dosage should be adjusted according to the severity of the pain and the patient response.

Duration of Treatment: The administration of continuous multiple daily doses of Ketolac IM or IV should not exceed 2 days because adverse events may increase with prolonged usage. There has been limited experience with dosing for longer periods since the vast majority of patients have transferred to oral medication, or no longer require analgesic therapy after this time.

Ketolac tablets are recommended for short-term use only (up to 7 days) and are not recommended for chronic use.

Adults: Tablet: Recommended

Oral Dose: 10 mg every 4-6 hrs for pain as required. Doses exceeding 40 mg/day are not recommended.

For patients receiving Ketolac ampoules, and who are converted to Ketolac tablets, the total combined daily dose should not exceed 90 mg (60 mg for the elderly, renally impaired patients and patients <50 kg) and the oral components should not exceed 40 mg on the day the change of formulation is made. Patients should be converted to oral treatment as soon as possible.

Ampoule: Recommended Initial Dose: 10 mg, followed by 10-30 mg every 4-6 hrs as required. In the initial postoperative period, Ketolac may be given as often as every 2 hrs if needed. The lowest effective dose should be given. A total daily dose of 90 mg for non-elderly and 60 mg for the elderly, renally impaired patients and patients <50 kg should not be exceeded. The maximum duration of treatment should not exceed 2 days.

Special Dosage Instructions: Renal Impairment: Since Ketolac trometamol and its metabolites are excreted primarily by the kidney, Ketolac is contraindicated in moderate to severe renal impairment (serum creatinine >160 micromole/L); patients with lesser renal impairment should receive a reduced dose (not exceeding 60 mg/day IV or IM), and their renal status should be closely monitored.

Elderly: Tablet: A longer dosing interval eg, 6-8 hrs, is advisable in the elderly. The lower end of the dosage range is recommended for patients >65 years.

Ampoule: For patients >65 years, the lower end of the dosage range is recommended; a total daily dose of 60 mg should not be exceeded.

Combination Treatment: See Incompatibilities under Interactions.

Opioid analgesics (eg, morphine, pethidine) may be used concomitantly and may be required for optimal analgesic effect in the early postoperative period when pain is most severe. Ketolac trometamol does not interfere with opioid binding and does not exacerbate opioid-related respiratory depression or sedation. When used in association with Ketolac ampoules, the daily dose of opioid is usually less than that normally required. However, opioid side effects should still be considered, especially in day-care surgery.

Compatibilities: Ketolac ampoules are compatible with normal saline, 5% Dextrose, Ringer's solution, Ringer-Lactate solution or Plasmalyte solution. Compatibility with other drug is unknown.

What other drugs will affect Ketolac?

Tell your doctor if you are taking an antidepressant such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor). Taking any of these drugs with Ketolac may cause you to bruise or bleed easily.

Before taking Ketolac, tell your doctor if you are taking any of the following drugs:

  • a blood thinner such as warfarin (Coumadin);
  • lithium (Eskalith, Lithobid);
  • methotrexate (Rheumatrex, Trexall);
  • thiothixene (Navane);
  • alprazolam (Xanax);
  • diuretics (water pills) such as furosemide (Lasix);
  • muscle relaxers;
  • steroids (prednisone and others);
  • seizure medications such as carbamazepine (Carbatrol, Tegretol) or phenytoin (Dilantin);
  • a heart or blood pressure medication such as candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro, Avalide), losartan (Cozaar, Hyzaar), valsartan (Diovan), telmisartan (Micardis), or olmesartan (Benicar); or
  • aspirin or other NSAIDs such as etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), Ketolac, mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others; or
  • an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace), and others.

This list is not complete and there may be other drugs that can interact with Ketolac. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Ketolac interactions

Interactions are the effects that happen when the drug is taken along with the food or when taken with other medications. Suppose if you are taking a drug Ketolac, it may have interactions with specific foods and specific medications. It will not interact with all foods and medications. The interactions vary from drug to drug. You need to be aware of interactions of the medicine you take. Most medications may interact with alcohol, tobacco, so be cautious.
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Ketolac is highly bound to human plasma protein (mean 99.2%).

Warfarin, Digoxin, Salicylate, and Heparin

The in vitro binding of warfarin to plasma proteins is only slightly reduced by Ketolac (99.5% control vs 99.3%) when Ketolac plasma concentrations reach 5 to10 m g/mL. Ketolac does not alter digoxin protein binding. In vitro studies indicate that, at therapeutic concentrations of salicylate (300 m g/mL), the binding of Ketolac was reduced from approximately 99.2% to 97.5%, representing a potential twofold increase in unbound Ketolac plasma levels. Therapeutic concentrations of digoxin, warfarin, ibuprofen, naproxen, piroxicam, acetaminophen, phenytoin andtolbutamide did not alter Ketolac protein binding.

In a study involving 12 adult volunteers, KetolacORAL was coadministered with a single dose of 25 mg warfarin, causing no significant changes in pharmacokinetics or pharmacodynamics of warfarin. In another study, KetolacIV/IM was given with two doses of 5000 U of heparin to 11 healthy volunteers, resulting in a mean template bleeding time of 6.4 minutes (3.2 to 11.4 min) compared to a mean of 6.0 minutes (3.4 to 7.5 min) for heparin alone and 5.1 minutes (3.5 to 8.5 min) for placebo. Although these results do not indicate a significant interaction between Ketolac and warfarin or heparin, the administration of Ketolac to patients taking anticoagulants should be done extremely cautiously, and patients should be closely monitored.

Furosemide

KetolacIV/IM reduced the diuretic response to furosemide in normovolemic healthy subjects by approximately 20% (mean sodium and urinary output decreased 17%).

Probenecid

Concomitant administration of KetolacORAL and probenecid resulted in decreased clearance of Ketolac and significant increases in Ketolac plasma levels (total AUC increased approximately threefold from 5.4 to 17.8 m g/h/mL) and terminal half-life increased approximately twofold from 6.6 to 15.1 hours. Therefore, concomitant use of Ketolac and probenecid is contraindicated.

Lithium

Inhibition of renal lithium clearance, leading to an increase in plasma lithium concentration, has been reported with some prostaglandin synthesis-inhibiting drugs. The effect of Ketolac on plasma lithium has not been studied, but cases of increased lithium plasma levels during Ketolac therapy have been reported.

Methotrexate

Concomitant administration of methotrexate and some NSAIDs has been reported to reduce the clearance of methotrexate, enhancing the toxicity of methotrexate. The effect of Ketolac on methotrexate clearance has not been studied.

Nondepolarizing Muscle Relaxants

In postmarketing experience there have been reports of a possible interaction between KetolacIV/IM and nondepolarizing muscle relaxants that resulted in apnea. The concurrent use of Ketolac with muscle relaxants has not been formally studied.

ACE Inhibitors

Concomitant use of ACE inhibitors may increase the risk of renal impairment, particularly in volume-depleted patients.

Antiepileptic Drugs

Sporadic cases of seizures have been reported during concomitant use of Ketolac and antiepileptic drugs (phenytoin, carbamazepine).

Psychoactive Drugs

Hallucinations have been reported when Ketolac was used in patients taking psychoactive drugs (fluoxetine, thiothixene, alprazolam).

Morphine

KetolacIV/IM has been administered concurrently with morphine in several clinical trials of postoperative pain without evidence of adverse interactions. Do not mix Ketolac and morphine in the same syringe.

There is no evidence in animal or human studies that Ketolac induces or inhibits hepatic enzymes capable of metabolizing itself or other drugs.


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References

  1. MeSH. "Cyclooxygenase Inhibitors". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
  2. European Chemicals Agency - ECHA. "5-benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid: The information provided here is aggregated from the "Notified classification and labelling" from ECHA's C&L Inventory. ". https://echa.europa.eu/information-o... (accessed September 17, 2018).
  3. PubMed Health. "Ketorolac (Into the eye): This section provide the link out information of drugs collectetd in PubMed Health. ". http://www.ncbi.nlm.nih.gov/pubmedhe... (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Ketolac 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 Ketolac. 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

2 consumers reported frequency of use

How frequently do I need to take Ketolac?
It was reported by ndrugs.com website users that Ketolac should ideally be taken 3 times in a day as the most common frequency of the Ketolac. You should you adhere strictly to the instructions and guidelines provided by your doctor on how frequently this Ketolac should be taken. Get another patient's view on how frequent the capsule should be used by clicking here.
Users%
3 times in a day1
50.0%
Once in a day1
50.0%


3 consumers reported doses

What doses of Ketolac drug you have used?
The drug can be in various doses. Most anti-diabetic, anti-hypertensive drugs, pain killers, or antibiotics are in different low and high doses and prescribed by the doctors depending on the severity and demand of the condition suffered by the patient. In our reports, ndrugs.com website users used these doses of Ketolac drug in following percentages. Very few drugs come in a fixed dose or a single dose. Common conditions, like fever, have almost the same doses, e.g., [acetaminophen, 500mg] of drug used by the patient, even though it is available in various doses.
Users%
1-5mg1
33.3%
6-10mg1
33.3%
11-50mg1
33.3%


Consumer reviews


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Information checked by Dr. Sachin Kumar, MD Pharmacology

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