Ketorol is a nonsteroidal anti-inflammatory drug (NSAID). Ketorol works by reducing hormones that cause inflammation and pain in the body.
Ketorol is used short-term (5 days or less) to treat moderate to severe pain.
Ketorol may also be used for purposes not listed in this medication guide.
Ketorol indications
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Carefully consider the potential benefits and risks of Ketorol and other treatment options before deciding to use Ketorol. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
Acute Pain in Adult Patients
Ketorol 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 Ketorol, and oral Ketorol is to be used only as continuation treatment, if necessary.
The total combined duration of use of Ketorol injection and oral Ketorol 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 Ketorol therapy is not to exceed 5 days.
Ketorol 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 Ketorol injection dosage range with low doses of narcotics prn, unless otherwise contraindicated. Ketorol injection and narcotics should not be administered in the same syringe.
How should I use Ketorol?
Use Ketorol spray as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Ketorol spray comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Ketorol spray refilled.
Do not take Ketorol 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 Ketorol spray for more than 5 days. Ketorol spray is not for the treatment of mild to moderate or chronic pain (eg, headache).
Avoid contact with the eyes. If you get Ketorol 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 Ketorol spray. Discard each bottle within 24 hours of opening it, even if it still contains some unused medicine.
If you miss a dose of Ketorol 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 Ketorol spray.
Uses of Ketorol in details
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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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 Ketorol may be beneficial for acute abortive treatment of migraine in patients with a history of episodic migraines for at least 1 year.
Ketorol 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. Ketorol 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)
Ketorol dosage
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Carefully consider the potential benefits and risks of Ketorol tablets and other treatment options before deciding to use Ketorol 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 Ketorol and Ketorol tablets is not to exceed 5 days. In adults, the use of Ketorol tablets is only indicated as continuation therapy to IV or IM dosing of Ketorol.
Transition from IV or IM dosing of Ketorol (single- or multiple-dose) to multiple-dose Ketorol 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 Ketorol and Ketorol tablets is not to exceed 5 days.
The following table summarizes Ketorol tablet dosing instructions in terms of age group:
Table 4: Summary of Dosing Instructions
Patient Population
Ketorol Tablets (following IV or IM dosing of Ketorol)
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
Ketorol slightly reduces the plasma protein-binding of warfarin. In vitro studies indicate that at therapeutic concentration of salicylate, the binding of Ketorol reduces from approximately 99.2-97.5%; representing a potential 2-fold increase in unbound plasma Ketorol levels. Ketorol has been reported to reduce the diuretic response to furosemide in normovolemic individuals by approximately 20%.
Concomitant administration of Ketorol and probenecid results in decreased clearance of Ketorol and significant increase in Ketorol 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 Ketorol also.
There have been reports of a possible interaction of Ketorol and nondepolarizing muscle relaxants, which lead to apnea. Concomitant use of Ketorol 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 Ketorol and antiepileptic drugs (phenytoin, carbamazepine). There have been reports of hallucinations when Ketorol is concomitantly used with psychoactive drugs (fluoxetine, thiothixene, alprazolam).
Laboratory Tests: Ketorol inhibits platelet aggregation and may prolong bleeding time.
Food: Food reduces the rate but not the extent of absorption.
Applies to Ketorol ophthalmic: ophthalmic solution
In addition to its needed effects, some unwanted effects may be caused by Ketorol 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 Ketorol 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
Rare
Blurred vision or other change in vision
eye irritation or redness
Minor Side Effects
Some of the side effects that can occur with Ketorol 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
Ketorol is contraindicated in patients with previously demonstrated hypersensitivity to Ketorol.
Ketorol 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.
Ketorol 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.
Ketorol is contraindicated as prophylactic analgesic before any major surgery.
Ketorol is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
Ketorol is contraindicated in patients with advanced renal impairment or in patients at risk for renal failure due to volume depletion.
Ketorol 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.
Ketorol 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.
Ketorol 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 Ketorol and probenecid is contraindicated.
The concomitant use of Ketorol and pentoxifylline is contraindicated.
Ketorol injection is contraindicated for neuraxial (epidural or intrathecal) administration due to its alcohol content.
Active ingredient matches for Ketorol:
Ketorolac in Bahrain, Georgia, India, Romania, Russian Federation, Venezuela.
Ketorolac (Argentina, Australia, Austria, Brazil, Canada, Chile, China, Colombia, Denmark, Finland, France, Germany, Greece, Hong Kong, India, Ireland, Italy, Kenya, Lithuania, Malta, Netherlands, New Zealand, Peru, Philippines, Singapore, South Africa, Spain, Switzerland, Taiwan, Thailand, Turkey, United Kingdom, United States, Venezuela)
Injectable; Injection; Ketorolac Tromethamine 15 mg / ml
Injectable; Injection; Ketorolac Tromethamine 30 mg / ml
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