Ketrolac (Toradol)

A non-steroidal anti-inflammatory drug (NSAID) in the family of heterocyclic acetic acid derivatives.

Oral, IV, IM, ophthalmic and intranasal formulation.

Brand name Toradol.

A non-steroidal anti-inflammatory drug (NSAID) in the family of heterocyclic acetic acid derivatives, used as an analgesic.

A first-generation NSAID.

Available as an eye drop is available and is used to treat eye pain.

Pregnancy in US: C

Routes of administration by mouth, I.M., I.V., intranasal, and ocular.

Bioavailability is 100% for all routes.

Metabolism is by the liver.

Biological half-life 3.5 h to 9.2 h, young adults, 4.7 h to 8.6 h in the elderly.

Excretion by the Kidney> 91%.

Biliary excretion >6%.

Inhibits the synthesis of prostaglandins.

An intranasal formulation is used for short-term management of moderate to moderately severe pain requiring analgesia at the opioid level.

Used for short-term management of moderate to severe pain.

It is usually not prescribed for longer than five days.

Effective when administered with acetaminophen to control pain in neonates because it does not depress respiration as do opioids.

Also used an adjuvant to opioids improving pain relief.

Ca be used to treat dysmenorrhea.

In idiopathic pericarditis it reduces inflammation.

Ketorolac is used for short-term pain control not lasting longer than five days.

Can be administered orally, by intramuscular injection, intravenously, and by nasal spray.

It is initially administered by intramuscular injection or intravenously, while oral therapy is only used as a continuation of the intramuscular or intravenous route.

Can be is used during eye surgery to maintain mydriasis, relaxing the iris muscles that will allow surgeons to perform cataract surgery.

Effective in treating ocular itching.

The ophthalmic formulation is associated with a decreased development of macular edema after cataract surgery.

Used to manage pain from corneal abrasions.

Contraindicated in those with hypersensitivity, allergies to the medication, cross-sensitivity to other NSAIDs, prior to surgery, history of peptic ulcer disease, GI bleeding, alcohol intolerance, renal impairment, cerebrovascular bleeding, nasal polyps, angioedema, and asthma.

Cautious use in patients who have experienced cardiovascular disease, myocardial infaction, stroke, heart failure, coagulation disorders, renal impairment, and hepatic impairment.

Uncommon, potentially fatal adverse effects are stroke, myocardial infarction, GI bleeding, Stevens-Johnson Syndrome, toxic epidermal necrolysis and anaphylaxis.

Greater than 10% experience drowsiness.

Infrequent side effects are paresthesia, prolonged bleeding time, injection site pain, purpura, sweating, abnormal thinking, increased tearing, edema, pallor, dry mouth, abnormal taste, urinary frequency increased liver enzymes, and itching.

Can cause premature constriction of the ductus arteriosis during the third trimester of pregnancy.

Potential to cause kidney damage.

Platelet function is decreased.

Probenecid can increase the probability of having a side effect when taken with ketorolac.

The use of Pentoxifylline and ketorolac can increase the risk of bleeding.

Its effectiveness is decreased when taken with aspirin.

GI complaints are additive with ingested with potassium supplements, aspirin, other NSAIDS, corticosteroids, or alcohol.

Can reduce effectiveness of antihypertensives and diuretics can be lowered.

Can increase serum lithium levels to the point of toxicity.

Increases toxicity to methotrexate exposure when used concurrently.

Bleeding risks increase with use of concurrent clopidogrel, cefoperazone, valproic acid, cefotetan, and eptifibatide,

Use of concurrent anticoagulants and thrombolytic medications also increase the likelihood of bleeding.

Chemotheray used to treat cancer can interact with ketorolac along with radiation therapy.

Renal toxicity increases when the drug is taken with cyclosporine.

Interactions exist with some herbal supplements, ginseng, clove, ginger, arnica, feverfew, dong quai, chamomile, and Ginkgo biloba, increasing the risk of bleeding.

Its primary mechanism of action responsible for anti-inflammatory, antipyretic and analgesic effects is the inhibition of prostaglandin synthesis by competitive blocking of the enzyme cyclooxygenase (COX)

It is a non-selective COX inhibitor.

It is able to prevent inflammation, pupil contraction, conjunctival hyperemia and changes in intraocular pressure by inhibiting the COX pathway and subsequent production of prostaglandins.

A relatively higher risk NSAID when compared to celecoxib, and ibuprofen.

For short-term management of moderate to moderately severe pain requiring analgesia at the opioid level.

Acts by inhibiting the synthesis of prostaglandins.

Its anti-inflammatory, antipyretic and analgesic effects occurs by the inhibition of prostaglandin synthesis by competitive blocking of the enzyme cyclooxygenase (COX).

Used to treat eye pain and to relieve the itchiness and burning of seasonal allergies.

Maximum duration of treatment should not exceed five days for tablets, or two days for continuous daily dosing with intravenous or intramuscular formulations.

A dose-response relationship with average daily dose for both gastrointestinal bleeding and operative site bleeding.

Association exists between gastrointestinal bleeding and therapy for more than five days.

Severe allergic reactions including: anaphylactoid reactions, asthma, bronchospasm, Stevens–Johnson syndrome, toxic epidermal necrolysis may occur.

May cause fluid retention and edema, and it should be used with ciaution in patients with cardiac decompensation, hypertension or similar conditions.

Ophthalmic formulation can lead burning pain in the eye for 4–5 seconds.

Fluid and sodium retention and edema may occur.

Elevates liver protein levels.

When administered intravenously through the same IV catheter as morphine, sometimes causes a precipitate.

Ketorolac is not recommended for anesthesia because it inhibits platelet aggregation.

Not recommended for obstetric analgesia.

Not recommended for long-term chronic pain patients.

Greater than 90% renal excretion and should be avoided in patients with renal disease.

Patients at highest risk for toxicity, especially in the elderly, are those with fluid imbalances or with compromised renal function.

The protein-binding effect is inhibited by aspirin.

Not recommended to be used with other NSAIDs because of potential for additional side effects.

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