KETOROLAC

Indications & Dose:

Short-term management of moderate to severe acute postoperative pain only

• BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION

Adult (body-weight up to 50 kg): Initially 10 mg, then 10–30 mg every 4–6 hours as required for maximum duration of treatment 2 days, frequency may be increased to up to every 2 hours during initial postoperative period; maximum 60 mg per day Adult (body-weight 50 kg and above): Initially 10 mg, then 10–30 mg every 4–6 hours as required for maximum duration of treatment 2 days, frequency may be increased to up to every 2 hours during initial postoperative period; maximum 90 mg per day

Elderly: Initially 10 mg, then 10–30 mg every 4–6 hours as required for maximum duration of treatment 2 days, frequency may be increased to up to every 2 hours during initial postoperative period; maximum 60 mg per day 

Contraindications:

Active or history of gastrointestinal bleeding . active or history of gastro-intestinal ulceration . coagulation disorders . complete or partial syndrome of nasal polyps . confirmed or suspected cerebrovascular bleeding . dehydration . following operations with high risk of haemorrhage or incomplete haemostasis . haemorrhagic diatheses . history of gastrointestinal perforation . hypovolaemia . severe heart failure 

Side Effects:

Rare Alveolitis . aseptic meningitis (patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible) . hepatic damage . interstitial fibrosis associated with NSAIDs can lead to renal failure . pancreatitis . papillary necrosis

associated with NSAIDs can lead to renal failure . pulmonary eosinophilia . Stevens-Johnson syndrome . toxic epidermal necrolysis

Frequency not known Abnormal dreams . angioedema . asthma . blood disorders . bradycardia . bronchospasm . chest pain . colitis (induction of or exacerbation of) . confusion . convulsions . Crohn’s disease (induction of or exacerbation of) . depression . diarrhoea . dizziness . drowsiness . dry mouth . dyspnoea . euphoria . fluid retention (rarely precipitating congestive heart failure) . flushing . gastrointestinal bleeding . gastro-intestinal discomfort . gastro-intestinal disturbances . gastrointestinal ulceration . haematuria . hallucinations.

headache . hearing disturbances . hyperkalaemia. hyperkinesia . hypersensitivity reactions . hypertension . hyponatraemia . insomnia . malaise . myalgia . nausea . nervousness . optic neuritis . pain at injection site . pallor . palpitation .paraesthesia . photosensitivity . psychosis . purpura . raised blood pressure . rashes . renal failure (especially in patients with pre-existing renal impairment) . sweating . taste disturbances . thirst . tinnitus . urinary frequency . vertigo . visual disturbances 

Cautions:

 Allergic disorders . cardiac impairment (NSAIDs may impair renal function) . cerebrovascular disease.

coagulation defects . connective-tissue disorders . Crohn’s disease (may be exacerbated) . elderly (risk of serious sideeffects and fatalities) . heart failure . ischaemic heart disease . peripheral arterial disease . risk factors for cardiovascular events . ulcerative colitis (may be exacerbated) . uncontrolled hypertension 

Precautions:

Interaction:

Drugs

Aminoglycosides: Reduced clearance with elevated aminoglycoside levels and potential for toxicity (especially indomethacin in premature infants; other NSAIDs probably)

Anticoagulants: Excessive hypoprothrombinemia, decreased platelet aggregation with increased risk of GI bleeding

Antihypertensives  (a blockers,  ngiotensinconverting enzyme inhibitors, angiotensin 11 receptor blockers, bbockers, diuretics): Inhibition of antihypertensive and other favorable hemodynamic effects

Corticosteroids: Increased risk of GI ulceration

Cyclosporine: Increased nephrotoxicity risk .

Lithium: Decreased clearance of lithium (mediated via prostaglandins)- resulting in elevated serum lithium levels and risk of toxicity

Methotrexate: Decreased renal secretion of methotrexate resulting in elevated methotrexate levels and risk of toxicity

Phenylpropanolamine: Possible acute hypertensive reaction

Potassium sparing diuretics: Additive hyperkalemia potential

Triamterene:

Acute renal failure reported with addition of indomethacin; caution with other NSAIDs 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: