What is the medicine ketorolac for? Instructions for use of ketorolac for injection

Ketorolac is a highly effective, non-narcotic medication that has a significant analgesic effect and is classified as a non-hormonal drug with anti-inflammatory activity. Additionally, it reduces fever and prevents the formation of blood clots.

The medicine is produced in four pharmacological forms. The main medicinal substance present in all pharmaceutical forms is ketorolac tromethamine (trometamol).

Medication forms:

White round convex coated tablets, placed in cell blisters of 10 units, containing 10 mg of medicinal substance per tablet.
External colorless gel Ketorol for topical use with a concentration of medicinal substance of 2%, that is, 1 gram of gel contains 20 mg of ketorolac. Packaged in aluminum tubes of 30 grams.
A light yellow transparent solution for injections into muscles and veins in 1 ml ampoules containing 30 mg of the medicinal component. The contour blister contains 5 ampoules.
Eye drops with a concentration of the active substance of 0.1 or 0.5%.

All medicinal formats of the medication are packaged in a cardboard box with attached medical instructions.

Pharmacological action, pharmacodynamics and pharmacokinetics

Therapeutic properties

The drug significantly reduces pain, suppresses inflammation and fever, due to the suppression of the activity of the enzyme cyclooxygenase (COX) of the first and second types, which is involved in the mechanism of development of pain, inflammatory processes and fever.

Unlike opiate analgesics, Ketorolac does not exhibit a psychotropic effect, does not cause euphoria and drowsiness, does not inhibit the respiratory process, does not cause addiction, and does not affect the tone of muscle fibers of organs.

In terms of the degree of analgesic effect, the drug is superior to most other analgesics and non-steroidal anti-inflammatory drugs, and when administered by injection it is comparable to codeine and morphine.

The onset of the analgesic effect after the injection is noted after half an hour, after taking the tablets - after about 45–60 minutes. The maximum analgesic effect for injection is achieved after 1-2 hours, after internal administration - after 2-3 hours. The analgesic effect lasts for 4-8 hours, which is determined by the severity of the pain syndrome.

Pharmacokinetics

The bioavailability of the drug (when using tablets and using injections), that is, the amount of ketorolac that reaches the painful site, is almost 100%.

With an intramuscular injection, absorption of the active substance occurs quickly and completely, while in the blood plasma 99% of ketorolac is in a protein-bound state. When taking tablets, absorption in the digestive tract is also active and complete.

The time at which the maximum concentration of ketorolac in the blood is observed after taking the tablet on an empty stomach is 40 minutes. Eating fatty foods reduces the amount of active substance in the plasma, while the time to reach the highest concentration increases to 90-100 minutes.

The medicinal substance penetrates the placenta and into breast milk, which limits the use of the drug in nursing and pregnant women.

When instilling ophthalmic drops, the largest amount of ketorolac in the tissues of the visual organ is detected after approximately 30–60 minutes, except for the tissues of the ciliary body and iris, in which the concentration of the active substance reaches a maximum 4 hours after administration of the drops.

When applying a gel or instilling a solution in the form of eye drops (if the doses and treatment regimen are followed), the absorption of ketorolac into the general bloodstream is very low, so there is practically no overall effect on the body.

More than half of the taken dose of the drug is processed by liver enzymes, while the function of the organ does not affect the elimination time of the drug, which is almost completely (91%) removed from the body along with the urine, and only 6% is excreted in the feces.

The elimination time of half the dose taken in patients with healthy kidneys is approximately 5 hours. In people with kidney problems and elderly patients, the drug stays in the body longer. If creatinine exceeds 50 mg/l due to severe renal failure, the half-life increases to 13–14 hours or more. Moreover, it should be taken into account that ketorolac cannot be removed from the body using hemodialysis.

What does Ketorolac help with?

The medication helps to significantly reduce the severity of pain and reduce the degree of inflammation in diseases of various organs, but it should be understood that

Ketorolac does not eliminate the cause of the pathology, does not stop the progression of the disease, but only affects the severity of symptoms.

Ketorolac tablets and injections are prescribed to relieve acute and paroxysmal pain (severe and moderate), as well as chronic pain syndrome of varying degrees due to the following pathologies:

malignant processes;
pain in the joints, spine (dorsalgia);
injuries of any nature, fractures, dislocations;
severe toothache;
vasculitis, rheumatic diseases;
muscle pain;
intercostal neuralgia, trigeminal, occipital, sciatic nerve (sciatica), neuritis, including radiculitis;
condition after childbirth and surgical interventions;
phase of maturation of the boil, carbuncle.

Since the injection solution has an effect comparable in pain relief to opiates, injections may be required in case of a life-threatening condition of pain shock, which can develop against the background of:

severe burns;
knife and bullet wounds, animal bites;
blockage of the esophagus by a foreign body;
electric shock;
renal and biliary colic, rupture of the uterus, fallopian tube, twisting of the “leg” of the cyst, perforation of the stomach with a perforated ulcer (but only with firm confidence in the diagnosis, so as not to “blur” the clinical picture).

Ketorol-gel, when applied topically, helps relieve or completely eliminate pain in the following pathological conditions:

bruises, sprains, inflammation, damage to muscles, ligaments, soft tissues;
inflammatory and dystrophic changes in joints and muscles;
rheumatic pathologies, including exacerbation of psoriatic arthritis, gout, ankylosing spondylitis,
neurological diseases;
inflammation of the nerves (neuritis) and the walls of blood vessels (vasculitis), mucous joint capsules (bursitis), synovial membrane (synovitis), tendons (tendinitis), tissues in the elbow area (epicondylitis).

What does ketorolac in the form of eye drops help with?

Ophthalmic drops are prescribed:

to reduce pain due to inflammation after surgery on the cornea, cataract removal, when a foreign object gets into the eye, damage to the organ of vision, field of medical procedures;
eliminating burning, itching in acute atopic conjunctivitis, pain in photophobia.

Instructions for use and dosage

During therapy, Ketorolac is used once or repeatedly over several days, depending on the severity of pain.

Ketorolac solution for infusions and injections

Ketorolac injections are most often prescribed in cases in which it is necessary to urgently reduce severe pain, or if the patient is unable to take a pill, for example, with nausea, vomiting, exacerbation of a peptic ulcer, or esophageal spasm.

If the pain is significant and can lead to painful shock, nervous exhaustion or psychosis, then opiate analgesics are prescribed simultaneously with ketorolac, but in lower dosages.

In the age group from 16 to 64 years, if the patient’s weight is more than 50 kg, the standard regimen involves the administration of 10–30 mg of the drug (0.3–1 ampoule) every 4–6 hours, but taking into account the fact that the maximum dose per day is not should exceed 90 mg. In case of exceptionally acute pain syndrome, it is allowed to immediately administer a dose of 90 mg (3 ampoules).

Adults weighing less than 50 kg, elderly patients (over 65 years old) and patients with impaired kidney function can be administered no more than 30 mg at a time. Recommended regimen: 10–15 mg (1/3 or half an ampoule) every 6 hours, but the total amount of medicinal substance per day should not exceed 60 mg (2 ampoules).

All injection dosages are calculated taking into account whether the patient is taking additional doses of the medicine in tablets.

The duration of injection therapy is limited to 5 days.

The injection into the muscle is done slowly and deeply, intravenous infusion is given for at least 15–20 seconds.

The initial dose for continuous infusion of the drug into a vein using an infusion pump is 30 mg, after which the infusion rate is set to 5 mg per hour. The duration of intravenous infusion is limited to 24 hours.

Pills

A single oral dose is 1 tablet (10 mg). For long-term treatment (up to 5 days), the treatment regimen includes 2–4 single doses of 10 mg, depending on the intensity of pain. The upper daily limit for the amount of ketorolac a patient can receive is 40 mg.

Gel for external use

Ketorol gel is applied to the area of greatest pain on clean, dry skin with light massaging movements of the fingers 3-4 times a day in a thin layer. For 1 time, a strip of gel 10-20 mm long is used.

You can reapply the product after 3.5–4 hours. To prevent absorption of the medicine into the blood, it is not allowed to use more than the recommended volume of gel and increase the frequency of use.

If after 7-10 days the pain does not subside or even becomes stronger, you should immediately visit a specialist (surgeon, rheumatologist, phlebologist, orthopedist), taking into account the type of pathology.

Areas treated with pharmaceuticals should not be covered with compresses or sealed bandages.

Avoid getting the product on the mucous membranes of the mouth, eyes, and genitals.

Ketorolac eye drops

The solution is used only locally, instilling 1 drop behind the lower eyelid up to 4 times a day to eliminate pain, burning, and itching. Treatment can be carried out once or over 3-4 days (no longer).

During pregnancy and lactation

Due to the negative effects on the heart and vascular system and the high risk of occlusion of the ductus arteriosus in the embryo and fetus, Ketorolac injections and tablets are prohibited from being prescribed to pregnant patients (especially in the last 13 weeks before childbirth) and women in labor.

Since the medicinal substance passes into human milk and can affect the baby’s body, the nursing mother must switch the baby to artificial formula for the duration of therapy.

Important! In case of painful shock that threatens the life of a woman expecting childbirth or breastfeeding, and there is no safer pain medication, the ban on the use of Ketorolac is neglected.

Gel and drops are also not used during pregnancy (especially in the last 3 months of gestation) and breastfeeding, although full studies have not been conducted with the participation of pregnant and lactating patients.

Taking into account the fact that the absorption of the active component into the blood through the skin and conjunctiva is extremely low, in exceptional cases, one-time or short-term (1-2 days) use of ophthalmic drops and gel in this group of patients is allowed (strictly with the permission of the doctor). But even at the same time, applying the gel to the skin of the mammary glands of a nursing mother is prohibited.

The use of this medication can affect a woman’s reproductive function and reduce the likelihood of conception, so it is not advisable to prescribe the drug to patients planning a pregnancy.

Drug interactions

The simultaneous use of Ketorolac with other medications can cause various types of reactions that should be taken into account.

Pharmacological agents	Possible effect when combined with Ketorolac
COX2 blockers, glucocorticoids (Prednisolone, Dexamethasone), calcium supplements, ethanol	risk of ulceration of the mucous membrane of the esophagus, stomach, intestines
anticoagulants, including Warfarin, Heparin, thrombolytics, antiplatelet agents (Clopidogrel), aspirin, pentoxifylline, cephalosporin antibiotics	risk of bleeding
ACE enzyme blockers	risk of renal dysfunction
anticonvulsants (carbamazepine)	seizures (rare)
tranquilizers (fluoxetine, alprazolam)	hallucinations
nephrotoxic drugs, including paracetamol, gold preparations, methotrexate	increased toxicity to the kidneys

In addition, the doses of pharmaceuticals should be adjusted, taking into account that Ketorolac reduces the effect of diuretics and antihypertensive medications, but enhances:

the effect of insulin and other drugs that reduce blood sugar levels;
hepatotoxicity of methotrexate;
the effect of narcotic painkillers (therefore, the dose of opiates can be reduced);
toxicity of lithium salts;
blood levels of verapamil, nifedipine;

And you also need to consider:

that Probenecid (Probalan) and agents that block renal tubular secretion (removal of substances from the blood into the urine) increase the amount of ketorolac in the plasma and lengthen the time of its removal from the body.

Contraindications, side effects and overdose

Ketorolac in all forms is prohibited:

if the patient’s bronchial asthma is combined with worsening polyposis of the nasal cavity (or sinuses) and an allergy (rash, bronchospasm, runny nose) to non-steroidal anti-inflammatory drugs, including aspirin and medications containing pyrazolone;
with intolerance to ketorolac and other components of the medication;
pregnant patients, especially in the last 13 weeks before childbirth;
nursing mothers;
children under 3 years of age (for drops), up to 12 years of age (for gel), up to 16 years of age (for injection and tablet forms of the drug), since the safety of the drug for this age has not been established.

Selected contraindications for certain treatment forms

For injections and tablets:

hemophilia, other bleeding disorders;
erosions and ulcers in the stomach, intestines, esophagus;
bleeding in any organs and systems, including the brain, stomach, esophagus, intestines, or an increased risk of their development;
hypovolemia;
severe failure of the myocardium, kidneys (creatinine clearance below 30 ml/min), liver;
renal, hepatic pathology in the progression stage;
exacerbation of inflammatory intestinal pathologies (Crohn's disease, ulcerative colitis);
diagnosed excess potassium;
recovery after cardiac aortic bypass surgery;
pain relief before or during major operations.

Particular caution is required when prescribing the drug if the patient is diagnosed with the following conditions:

bronchial asthma;
inflammatory, infectious diseases;
brain disorders;
myocardial ischemia;
diabetes;
persistently elevated blood pressure;
vascular pathologies;
atherosclerosis;
identified infection with Helicobacter pylori;
deterioration of kidney function, cholecystitis, cholestasis;
blood poisoning;
systemic lupus erythematosus;
alcohol and tobacco abuse;
old and young age.

The gel cannot be used on areas where there is:

weeping dermatosis, eczema;
purulent or open wounds and abrasions.

The drug is used after consultation with an endocrinologist and dermatologist for exacerbation of porphyria cutanea tarda.

Eye drops are contraindicated in patients:

with postoperative complications in the eyes due to corneal damage;
with concomitant diabetes mellitus, rheumatoid arthritis,
with pathology of the mucous membrane of the visual organ (including dry eye syndrome),
with short intervals between eye surgeries.

The ban is being introduced due to the high risk of corneal damage and the threat of visual disorders.

Side effects are more often observed when using high doses and long-term use of tablets and injections.

3 out of 100 patients may experience:

gastralgia, loose stools;
headache, dizziness, drowsiness;

in 1–2 patients out of a hundred:

stomatitis, gas formation, constipation, nausea;
increased blood pressure;
skin rash, purpura;
burning at the injection site.

in 1 in 100 patients:

ulceration of the mucous membrane of the stomach, intestines, esophagus, perforation of the ulcer, bleeding, pain in the epigastric region, vomiting;
cholestasis, hepatitis, pancreatitis;
pulmonary edema, loss of consciousness;
acute kidney dysfunction, blood in the urine, lower back pain, nephritis, edema;
visual and auditory impairments;
aseptic meningitis;
overexcitement, depression;
changes in blood counts;
bleeding, including bleeding from the nose, rectum;
exfoliative dermatitis, urticaria, Stevens-Johnson and Lyell syndrome.
acute anaphylactic reaction with shortness of breath, bronchospasm, swelling of the eyelids, tongue, larynx, chest pain, heavy breathing.

Side effects for the gel: itchy rashes, red blisters and spots, swelling and flaking.

It is important to consider that when treating a large area of skin with gel, the occurrence of general body-wide adverse reactions, characteristic of injections and tablets, cannot be ruled out.

Side effects for ophthalmic drops: allergies in the form of lacrimation, eye irritation, itching, burning, swelling of the eyelids.

Overdose is possible with uncontrolled use of ketorolac, ignoring contraindications, or excessive doses. In this case, the indicated side effects of the drug occur or become stronger. You should immediately cancel treatment, take Polysorb (adsorbent) and call an ambulance to hospitalize the patient in order to carry out full therapy for drug poisoning.

Drug analogues

Synonyms of the drug - that is, drugs with the same therapeutic component: Ketanov, Dolak, Ketocam, Acular (eye drops).

Analogues of Ketorolac or medications with a similar therapeutic effect, but other active substances: Xefocam, Lornosikam, Ketonal, Ketoprofen, Etoricoxib, Arcoxia.

Photo of the drug

Latin name: Ketorolac

ATX code: M01AB15

Active substance: Ketorolac

Analogs: Dolak, Ketorol, Ketanov, Ketofril, Adorol

Manufacturer: Vertex (Russia), Tatkhimfarmpreparaty (Russia), Borisov Medical Preparations Plant (Belarus), Moskhimfarmpreparaty im. N.A. Semashko OJSC (Russia)

Description is valid on: 02.10.17

Ketorolac is a non-steroidal anti-inflammatory drug with a pronounced analgesic effect.

Active substance

Ketorolac.

Release form and composition

Available in two forms: injection solution and tablets.

The solution for intravenous and intramuscular administration is yellowish in color, transparent. Packaged in dark glass ampoules of 1 ml. There are 5 or 10 ampoules in a cardboard package.

Tablets, film-coated, white, round, biconvex in shape. The cross section shows 2 layers. Packed in blister packs of 10 pieces.

pharmachologic effect

NSAIDs with a pronounced analgesic effect.

Indications for use

Injuries, dislocations, sprains, severe bruises, postoperative and postpartum pain, rheumatic diseases, myalgia, arthralgia, radiculitis, neuralgia, cancer, toothache.

Application does not affect the progression of the disease, but only relieves symptoms: inflammation and pain.

Contraindications

Hypersensitivity to ketorolac or other NSAIDs, aspirin-induced asthma, bronchospasm, angioedema. Hypovolemia (regardless of the cause), dehydration. Erosive and ulcerative lesions of the gastrointestinal tract in the acute stage, peptic ulcers. Hypocoagulation (including hemophilia), liver and/or renal failure. Hemorrhagic stroke (confirmed or suspected), hemorrhagic diathesis. Concomitant use with other NSAIDs.

High risk of development or recurrence of bleeding (including after operations), impaired hematopoiesis. Pregnancy, childbirth and lactation. Children under 16 years of age (efficacy and safety have not been established). Anesthesia before and during surgery (as there is a high risk of bleeding). Chronic pain.

Cotorolac should be taken with caution in case of bronchial asthma, cholecystitis, chronic heart failure, arterial hypertension, renal dysfunction, cholestasis, active hepatitis, sepsis, systemic lupus erythematosus; old age (over 65 years); polyps of the nasal and nasopharyngeal mucosa.

Instructions for use Ketorolac (method and dosage)

Pills

Orally once or repeatedly depending on the severity of the pain syndrome. A single dose is 10 mg; when taken again, it is recommended to take 10 mg up to 4 times a day, depending on the severity of pain. The maximum daily dose should not exceed 40 mg. The duration of the course should not exceed 5 days.

Solution

The drug should be administered deeply intramuscularly or intravenously (stream) slowly for at least 15 seconds in the minimum effective doses, selected in accordance with the intensity of pain and the patient’s response. If necessary, additional opioid analgesics can be prescribed at the same time in reduced doses.

Single doses for a single intramuscular or intravenous injection: adults under 65 years of age 10 – 30 mg, depending on the severity of the pain syndrome; Elderly patients over 65 years of age or with impaired renal function 10 - 15 mg.
When administered intramuscularly, adults under 65 years of age and children over 16 years of age are given 10–60 mg IM for the first injection, then 10–30 mg every 6 hours (usually 30 mg every 6 hours). For elderly patients over 65 years of age or with impaired renal function, 10–15 mg every 4–6 hours.
When administered intravenously, adults under 65 years of age and children over 16 years of age are injected in a dose of 10–30 mg, then 10–30 mg every 6 hours. With continuous infusion using an infusion pump, the initial dose is 30 mg, then the infusion rate is 5 mg/h.
When administered intravenously to elderly patients over 65 years of age or with impaired renal function, a dose of 10–15 mg is injected every 6 hours. The maximum daily dose for intramuscular and intravenous administration for adults under the age of 65 years and children over 16 years of age is 90 mg; for elderly patients over 65 years of age or with impaired renal function - 60 mg. Continuous intravenous infusion should not last more than 24 hours.
When administered parenterally, the duration of treatment should not exceed 5 days. When switching from parenteral administration of the drug to oral administration, the total daily dose of the drug in both dosage forms on the day of transfer should not exceed: 90 mg for adults under 65 years of age and children over 16 years of age and 60 mg for elderly patients over 65 years of age or with impaired renal function. In this case, the dose of the drug in tablets on the day of transition should not exceed 30 mg.

Side effects

The use of the drug may cause the following side effects: diarrhea, gastralgia, drowsiness, dizziness, headache, swelling of the feet, fingers, legs, ankles, faces, weight gain.

Less common side effects (less than 3%): flatulence, constipation, vomiting, stomatitis, increased blood pressure, purpura, skin rash, pain and burning at the injection site, increased sweating.

In rare cases (less than 1%), taking Ketorolac can provoke nausea, loss of appetite, the formation of erosive and ulcerative lesions of the gastrointestinal tract, hepatitis, cholestatic jaundice, acute pancreatitis, hepatomegaly, hematuria, acute renal failure, lower back pain, azotemia, nephritis, edema, hemolyticouremic syndrome, increased frequency of urination, hearing loss, visual impairment, dyspnea or bronchospasm, pulmonary or laryngeal edema, rhinitis, aseptic meningitis, hyperactivity, depression, psychosis, hallucinations, fainting, nasal and rectal bleeding, bleeding from postoperative wounds, exfoliative dermatitis, urticaria , toxic epidermal necrolysis, malignant exudative erythema, anaphylaxis and anaphylactoid reactions, anemia, leukopenia, eosinophilia.

Overdose

In case of an overdose of the drug, the following symptoms may occur: abdominal pain, nausea, vomiting, the occurrence of peptic ulcers of the stomach or erosive gastritis, impaired renal function, metabolic acidosis.

Treatment in this case will be gastric lavage, administration of adsorbents (activated carbon) and symptomatic therapy (maintaining vital functions of the body).

Not eliminated sufficiently by dialysis.

Analogs

Ketanov, Ketocam, Dolak, Ketadrop, Ketalgin, Dolomin.

special instructions

Do not use simultaneously with paracetamol for more than 5 days. Patients with blood coagulation disorders are prescribed the drug only with constant monitoring of the platelet count, which is especially important in the postoperative period, which requires careful monitoring of hemostasis.

When using Ketorolac, it is recommended to avoid performing work that requires increased attention and quick reaction (driving a vehicle, working with machinery, etc.), as side effects from the central nervous system (drowsiness, dizziness, headache) may develop.

During pregnancy and breastfeeding

Contraindicated during pregnancy and breastfeeding.

In childhood

Contraindicated under the age of 16 years.

In old age

Should be used with caution and in accordance with recommended dosages.

For impaired renal function

Contraindicated in renal failure. Use with caution in case of impaired renal function.

For liver dysfunction

Contraindicated in liver failure.

Drug interactions

Concomitant use with acetylsalicylic acid or other NSAIDs, calcium preparations, glucocorticosteroids, ethanol, corticotropin can lead to the formation of gastrointestinal ulcers and the development of gastrointestinal bleeding.
Co-administration with paracetamol increases nephrotoxicity, and with methotrexate - hepato- and nephrotoxicity. The combined administration of Ketorolac and Methotrexate is possible only when using low doses of the latter (monitor the concentration of methotrexate in the blood plasma).
Co-administration with indirect anticoagulants, heparin, thrombolytics, antiplatelet agents, cefoperazone, cefotetan and pentoxifylline increases the risk of bleeding. Reduces the effect of antihypertensive and diuretic drugs (the synthesis of prostaglandins in the kidneys decreases). When combined with opioid analgesics, the doses of the latter can be significantly reduced.
Antacids do not affect the complete absorption of the drug.
The hypoglycemic effect of insulin and oral hypoglycemic drugs increases (dose recalculation is necessary). Co-administration with sodium valproate causes disruption of platelet aggregation. Increases the plasma concentration of verapamil and nifedipine.
When prescribed with other nephrotoxic drugs (including gold preparations), the risk of developing nephrotoxicity increases. Drugs that block tubular secretion reduce the clearance of Ketorolac and increase its concentration in the blood plasma.

The drug "Ketorolac" is available in the form of a solution intended for intramuscular administration. 1 ml of the medicine contains 30 mg of the active substance - trometamol ketorolac (tromethamine ketorolac), as well as ethanol, sodium chloride and a number of other auxiliary components.

The medicine is a transparent solution of a light yellow hue, which is contained in dark glass ampoules of 1 ml or 2 ml. The package may contain 5 or 10 ampoules, which are placed in contour cells and a cardboard pack.

pharmachologic effect

The drug "Ketorolac" is included in the group of non-teroid pro-inflammatory drugs (NSAIDs), providing a strong analgesic effect, as well as a moderate antipyretic effect.

The active substance "Ketorolac" is a derivative of pyrrolysine-carboxylic acid. The mechanism of its action is due to the ability to have an inhibitory effect on the activity of COX (the main enzyme in the metabolism of arachidonic acid), which is involved in the pathogenesis of inflammation and pain, as well as fever.

Pharmacokinetics

The concentration of Ketorolac in the blood plasma reaches its maximum levels approximately 40-50 minutes after administration, regardless of the route of administration - orally or as intramuscular injections. Over 99% of the active ingredients of the drug bind to plasma proteins.

The half-life is approximately 4-6 hours, regardless of how the drug is administered. Over 90% leaves the patient’s body through the kidneys, including about 60% unchanged. The remaining amount is excreted through the intestines.

Indications

The drug "Ketorolac" is used for short-term relief of moderate and severe pain that can be observed against the background of various diseases, pathological conditions and traumatic injuries.

Dosage and duration of use

When administered intramuscularly, Ketorolac is prescribed to adult patients in a single dose of 10-30 mg. An interval of at least four hours must be maintained between injections. The drug should not be used for more than two days.

The maximum daily dose of the drug is 90 mg. When prescribing Ketorolac to patients with body weight less than 50 kg, severe renal impairment and advanced age, the dosage should not exceed 60 mg per day.

Possible side effects

When prescribing the drug Ketorolac, patients may experience various undesirable effects. From the cardiovascular system are likely:

bradycardia;
changes in blood pressure;
feeling of a strong heartbeat.

The most common disorders from the central and peripheral nervous system are:

anxiety;
headache;
drowsiness;
much less often - paresthesia, euphoria, depression, sleep disorders, altered taste sensations, motor disorders.

From the gastrointestinal tract organs are possible:

dry mouth;
nausea and vomiting;
pain in the abdominal area;
less often - stomatitis, flatulence, constipation, feeling of intestinal fullness, etc.

From the respiratory system, attacks of suffocation are possible (rare).

In rare cases, the urinary system may experience:

frequent urination;
oliguria;
polyuria;
hematuria, etc.

From the blood coagulation system the following are likely:

anemia;
less often - nosebleeds;
thrombocytopenia;
in the postoperative period - bleeding from wounds.

On the metabolic side, under the influence of Ketorolac, increased sweating and increased swelling may be observed. In more rare cases:

oliguria;
an increase in the level of creatinine and/or urea in the blood plasma;
hypokalemia;
hyponatremia.

Among the most common reactions that occur while taking Ketorolac:

skin itching and rashes;
hemorrhagic rash;
in isolated cases, urticaria, exfoliative dermatitis, Lyell's syndrome, Stevens-Johnson syndrome, anaphylactic shock, bronchospasm, and Quincke's edema were recorded.

In addition, taking into account the method of administration of the drug, local reactions in the form of pain at the injection site cannot be excluded.

Contraindications

The drug "Ketorolac" is not used in the following cases:

erosive and ulcerative lesions of the digestive system (during exacerbation); gastrointestinal bleeding (including suspicions of it);
cranial hemorrhage (including suspicion of it);
history of blood clotting disorders;
conditions in which the patient has a high risk of bleeding or incomplete hemostasis;
hemorrhagic diathesis;
impaired renal function in moderate or severe form (with serum creatinine levels above 50 mg/l);
the risk of developing renal failure due to dehydration and a significant decrease in circulating blood volume;
"aspirin triad";
bronchial asthma;
nasal polyps;
history of angioedema.

Contraindications to the use of Ketorolac are also:

children and adolescents up to 16 years of age;
period of pregnancy and breastfeeding;
labor activity;
hypersensitivity to the active substance of the drug, acetylsalicylic acid and other NSAIDs.

In addition, Ketorolac is not used as a drug for prophylactic pain relief before and during surgery.

The drug is contraindicated for use for premedication, maintenance of anesthesia and for pain relief in obstetric practice. Under the influence of the drug, the duration of the first stage of labor may increase, as well as uterine contractility and fetal blood circulation may be impaired.

special instructions

The drug "Ketorolac" is prescribed with caution to elderly patients, given the high likelihood of an extended half-life and decreased plasma clearance. For patients in this category, it is recommended to use the medicine in dosages that are close to the lower limit of the therapeutic range.

When using the drug in the postoperative period, including resection of the prostate gland, tonsillectomy and cosmetic surgery, patients require especially careful hemostasis.

Patients who experience side effects such as drowsiness, dizziness or depression (as well as other severe manifestations of the central nervous system) while taking Ketorolac are advised to avoid driving and other potentially dangerous activities that require increased concentration during the treatment period. attention and quick psychomotor reactions.

Interaction with other drugs

When taking Ketorolac and other NSAIDs together, patients may experience additive side effects.

When prescribing the drug simultaneously with pentoxifylline, anticoagulants, including low doses of heparin, an increased risk of bleeding is likely.

The combination of Ketorolac with ACE inhibitors can provoke a risk of renal dysfunction.

Simultaneous administration of the drug with probenecid causes an increase in the concentration of Ketorolac in plasma and lengthens its half-life.

When Ketorolac is prescribed together with lithium preparations, the renal clearance of lithium may decrease and the level of its concentration in plasma may increase.

Taking Ketorolac together with furosemide reduces the severity of the diuretic effect of this drug.

When using Ketorolac, the need for prescribing opioid analgesics used for pain relief is reduced.

Analogs

Among medicines with a similar active ingredient, you can buy in Russian pharmacies

"Acular";
"Vatorlak";
"Dolak";
"Dolamin";
"Ketorolac-eskom";
“Ketofril” and other drugs of domestic and foreign production, which are produced in various dosage forms - tablets, solution for injections and in the form of eye drops.

If Ketorolac is not available in the pharmacy, a possible replacement of the drug, its dosage and duration of use are determined solely by the doctor.

Often inflammatory diseases occur with pain. In this case, the best option is to use a broad-spectrum drug that eliminates several symptoms at once.

These include Ketorol. Its properties, action and rules of application will be discussed in the article.

What kind of drug?

Ketorol belongs to a non-steroidal group of drugs that have anti-inflammatory and anesthetic effects.

The product also effectively relieves fever.

The main component of the drug: ketorolac tromethamine (30 mg/1 ml).

To facilitate the absorption of the product by the body, the composition additionally includes:

injection water;
sodium chloride, sodium hydroxide;
disodium edetate;
ethanol;
octoxynol;
propylene glycol.

Release form: solution, bottled into ampoules, packed in boxes of 10 units. The liquid has no characteristic color or has a slight pale yellow tint. No foreign particles are observed.

Principle of operation: non-selective suppression of the activity of two cyclooxygenase isoenzymes existing in the human body, which stimulates the production of prostaglandins. This leads to a decrease in inflammation and pain relief.

Active substance has the ability to quickly accumulate in tissues, dispersing into them with a uniform coating. The drug is excreted through the kidneys after conversion by hepatocytes into inactive breakdown products.

Manufacturer information: Dr. Reddy's Laboratories Ltd., (India).

Indications for use

Ketorol is often prescribed after surgery, when the effect of general or local anesthesia ends

It is often prescribed after surgery, when the effect of general or local anesthesia wears off.

Among the main areas of use of anesthetic are the following indications:

bruises and injuries;
toothache;
ligament ruptures and stretch marks;
fractures, joint damage;
neuralgia;
rheumatism, arthritis;
inflammation of the mucous bursae in the joint area, as well as the synovium.

Instructions for use of ampoules

Corrections regarding the duration of the course and the addition of therapy with other means are carried out exclusively by a specialist

Ketorol should be used for injection into a muscle or vein. The product is not suitable for spinal and epidural injections.

The number of injections per day, as a rule, does not exceed 2 times. This is due to the effectiveness of the product and its long-lasting effect.

It is allowed to use Ketorol for 5 days.

Corrections regarding the duration of the course and the addition of therapy with other means are carried out exclusively by a specialist.

Instructions on how to prick:

An intramuscular injection is made with deep penetration into the muscle tissue. The product should be released slowly. The pharmacological effect declared by the manufacturer occurs after half an hour and lasts up to 6 hours. 1-2 hours after the injection, the peak analgesic effect is observed. A single dose per adult is 1-3 ampoules. For long-term treatment, the first dose can be 30 mg, subsequent doses are reduced to 10-15 mg.
Intravenous administration of the drug is also carried out slowly with a solution release rate of 15 s/1 ml. Before the procedure, a clearly visible vein is selected (usually in the arms or in the chest area). The puncture site is treated with an antiseptic before and after administering the solution. It is not allowed to administer simultaneously with other drugs (put in the same syringe).

Do not use Ketorol in therapy where other NSAIDs are already used.

Dosage regimen

If necessary, the effect is enhanced with opioid analgesics

The amount of the drug is selected individually, but mainly in the minimum dosage.

The solution is injected deep into the muscle tissue.

If necessary, the effect is enhanced with opioid analgesics (reduced doses).

The main criteria for determining the amount of solution are:

age factor;
health status;
etiology of the disease.

The course of treatment with Ketorol is on average 5 days.

patients in the age group over 65 years old, or those who have impaired renal function - 10-15 mg (with a maximum daily dose of 60 mg);
patients under 65 years of age – 10-30 mg (with a maximum daily dose of 90 mg).

A time interval of 4-6 hours is maintained between injections; after surgery, it is allowed to reduce the interval to 2 hours.

Contraindications

The drug Ketorol has a number of restrictions on its use.

The list is impressive, so you should carefully read the contraindications before using the medicine:

By-effect

During studies of the drug, a number of side effects were identified.

Respiratory system:

dyspnea;
rhinitis;
bronchospasm;
swelling in the throat area.

lack of coordination;
physical weakness;
headache;
increased tone of the back/neck muscles (strong resistance to bending and motor function of the body);
altered psycho-emotional background (mood swings, hyperactivity, abruptly giving way to apathy);
problems of various types with hearing, vision;
hallucinations.

Genitourinary system:

pain in the lumbar girdle (may be accompanied by azotemia, hematuria);
kidney dysfunction;
change in the volume of urine produced, frequent urge to urinate;
swelling associated with kidney dysfunction;
nephritis (extremely rare).

Blood-forming organs:

decrease in the number of leukocytes (extremely rare);
increased number of eosinophils in the blood;
anemia.

The cardiovascular system:

blood pressure surges;
loss of consciousness;
pulmonary edema.

Allergy to drug components: anaphylaxis or anaphylactoid symptoms.

An overdose of Ketorol is possible.

It can be recognized by the following signs:

nausea;
vomiting;
pain in the abdominal cavity;
peptic ulcers;
damage to the walls of the esophagus, stomach, intestines;
accumulation of acids in the body as a result of their excessive production or consumption;
kidney dysfunction.

Drug interactions

Conditions and shelf life

The medicine retains its properties for 3 years.

Before purchasing the drug, you need to check the date of manufacture.

It appears on every package and ampoule label.

The following requirements apply to the storage rules for the drug Ketorol:

lack of sunlight (shading is provided by the packaging, so it is better to keep the ampoules in it);
temperature range – from 5° to 25° (it is important not to let the solution freeze);
limited access to a home medicine cabinet containing medications.

Terms of sale

The drug Ketorol is dispensed upon presentation of a prescription sheet. The special rules for selling the product are indicated by the corresponding inscription on the packaging.

Price

You can purchase the drug Ketorol in pharmacies. The price of a package containing 10 ampoules is 121-130 rubles.

As substitutes for Ketorol, it is allowed to use drugs that have similar pharmacological effects:

Ketocam Ketorolac Dolak Ketanov

Name:

Ketorolac

Pharmacological
action:

Ketorolac - NSAID, has a pronounced analgesic (pain-relieving) effect, also has anti-inflammatory and moderate antipyretic effects.
The mechanism of action is associated with non-selective inhibition of the activity of the enzymes COX-1 and COX-2, mainly in peripheral tissues, resulting in inhibition of the biosynthesis of prostaglandins - modulators of pain sensitivity, inflammation and thermoregulation. Ketorolac is a racemic mixture of R(+) and S(-)-enantiomers, with the analgesic (pain-relieving) effect due to the S(-)-enantiomer.
Ketorolac does not affect opioid receptors, does not depress respiration, does not cause drug dependence, and does not have a sedative or anxiolytic effect.
The strength of the analgesic (pain-relieving) effect is comparable to morphine and significantly superior to other NSAIDs.
After oral administration, the onset of analgesic (pain-relieving) effect is observed after 1 hour, the maximum effect is achieved after 2-3 hours.
After intramuscular administration, the onset of analgesic (pain-relieving) effect is noted after 0.5 hours, the maximum effect is achieved after 1-2 hours.

Pharmacokinetics
Suction
When taken orally, ketorolac is well absorbed from the gastrointestinal tract. Bioavailability is 80-100%. Cmax in blood plasma is 0.7-1.1 mcg/ml and is achieved 40 minutes after taking the drug on an empty stomach at a dose of 10 mg. Food rich in fat reduces the Cmax of the drug in the blood and delays its achievement by 1 hour.
With intramuscular administration, absorption is complete and rapid. After intramuscular administration of the drug at a dose of 30 mg, Cmax in blood plasma is 1.74-3.1 mcg/ml, at a dose of 60 mg - 3.23-5.77 mcg/ml. Tmax is respectively 15-73 min and 30-60 min.
After an intravenous infusion of the drug at a dose of 15 mg, Cmax is 1.96-2.98 mcg/ml, at a dose of 30 mg - 3.69-5.61 mcg/ml.

Distribution
Plasma protein binding - 99%. With hypoalbuminemia, the amount of free substance in the blood increases.
Vd is 0.15-0.33 l/kg.
The time to reach Css when taken orally is 24 hours when used 4 times a day (above subtherapeutic). Css after oral administration at a dose of 10 mg is 0.39-0.79 mcg/ml.
Css with parenteral administration is achieved after 24 hours when used 4 times a day (above subtherapeutic) and with IM administration at a dose of 15 mg is 0.65-1.13 mcg/ml, with IM administration at a dose of 30 mg - 1.29-2.47 mcg /ml; with intravenous infusion at a dose of 15 mg - 0.79-1.39 mcg/ml, with intravenous infusion at a dose of 30 mg - 1.68-2.76 mcg/ml.
Poorly passes through the BBB, penetrates the placenta (10%).
Excreted in breast milk: when the mother takes 10 mg of ketorolac orally, Cmax in breast milk is achieved 2 hours after taking the first dose and is 7.3 ng/ml, 2 hours after taking the second dose of ketorolac (when using the drug 4 times a day) Cmax is 7.9 ng/ml.
When administered parenterally, it is excreted in breast milk in small quantities.

Metabolism
More than 50% of the administered dose is metabolized in the liver with the formation of pharmacologically inactive metabolites. The main metabolites are glucuronides and p-hydroxyketorolac.
Removal
Excreted in urine - 91% (40% in the form of metabolites), in feces - 6%. Not excreted by hemodialysis.
After oral administration, T1/2 in patients with normal renal function is 2.4-9 hours (average 5.3 hours).
After intramuscular administration of 30 mg T1/2 - 3.5-9.2 hours, after intravenous administration of 30 mg T1/2 - 4-7.9 hours.
The total clearance with intramuscular injection of 30 mg is 0.023 l/kg/h, with intravenous infusion of 30 mg - 0.03 l/kg/h.

Pharmacokinetics in special clinical situations
In patients with renal failure, the Vd of the drug may increase by 2 times, and the Vd of its R-enantiomer by 20%. With a plasma creatinine concentration of 19-50 mg/l with intramuscular administration of 30 mg of the drug, the total clearance is 0.015 l/kg/h.
In patients with impaired renal function with a plasma creatinine concentration of 19-50 mg/l (168-442 µmol/l), T1/2 is 10.3-10.8 hours, with more severe renal failure - more than 13.6 hours.
Liver function has no effect on T1/2.
In elderly patients, the total clearance when administered intramuscularly at a dose of 30 mg is 0.019 l/kg/h. T1/2 lengthens in elderly patients and shortens in young ones.

Indications for
application:

Pain syndrome of strong and moderate severity:
- injuries;
- toothache;
- pain in the postpartum and postoperative period;
- oncological diseases;
- myalgia, arthralgia, neuralgia, radiculitis;
- dislocations, sprains;
- rheumatic diseases.
Intended for symptomatic therapy, reducing pain and inflammation at the time of use, does not affect the progression of the disease.

Mode of application:

For oral administration
Ketorolac should be used orally once or repeatedly depending on the severity of the pain syndrome.
A single dose is 10 mg; when taken again, it is recommended to take 10 mg up to 4 times a day, depending on the severity of pain. The maximum daily dose should not exceed 40 mg.
When taken orally, the duration of the course should not exceed 5 days.

Parenterally
The drug should be administered deep IM or IV (stream) slowly for at least 15 seconds in the minimum effective doses, selected in accordance with the intensity of pain and the patient’s response. If necessary, additional opioid analgesics can be prescribed at the same time in reduced doses.
Doses for single parenteral administration
Single doses for a single intramuscular or intravenous injection: adults under the age of 65 years - 10-30 mg, depending on the severity of the pain syndrome; for elderly patients over 65 years of age or with impaired renal function - 10-15 mg.

Doses for repeated parenteral administration
For intramuscular administration, adults under 65 years of age and children over 16 years of age are administered intramuscularly with 10-60 mg for the first injection, then 10-30 mg every 6 hours (usually 30 mg every 6 hours); Elderly patients over 65 years of age or with impaired renal function - 10-15 mg every 4-6 hours.
When administered intravenously to adults under 65 years of age and children over 16 years of age, a dose of 10-30 mg is injected in a stream, then 10-30 mg every 6 hours. With continuous infusion using an infusion pump, the initial dose is 30 mg, then the infusion rate is 5 mg/h.
When administered intravenously to elderly patients over 65 years of age or with impaired renal function, a dose of 10-15 mg is injected in a bolus every 6 hours.

Maximum daily dose for intramuscular and intravenous administration for adults under 65 years of age and children over 16 years of age is 90 mg; for elderly patients over 65 years of age or with impaired renal function - 60 mg.
Continuous IV infusion should not last more than 24 hours.
When administered parenterally, the duration of treatment should not exceed 5 days.
When switching from parenteral administration of the drug to oral administration, the total daily dose of the drug in both dosage forms on the day of transfer should not exceed: 90 mg for adults under 65 years of age and children over 16 years of age and 60 mg for elderly patients over 65 years of age or with impaired renal function.
In this case, the dose of the drug in tablets on the day of transition should not exceed 30 mg.

Side effects:

Often - >3%; less often - 1-3%; rarely -< 1%.
From the digestive system: often (especially in elderly patients over 65 years of age with a history of erosive and ulcerative lesions of the gastrointestinal tract) - gastralgia, diarrhea; less often - stomatitis, flatulence, constipation, vomiting, feeling of fullness in the stomach; rarely - loss of appetite, nausea, erosive and ulcerative lesions of the gastrointestinal tract (including with perforation and/or bleeding - abdominal pain, spasm or burning in the epigastric region, melena, vomiting with blood or coffee grounds, nausea, heartburn), cholestatic jaundice, hepatitis, hepatomegaly, acute pancreatitis.
From the urinary system: rarely - acute renal failure, lower back pain, hematuria, azotemia, hemolytic-uremic syndrome (hemolytic anemia, renal failure, thrombocytopenia, purpura), frequent urination, increased or decreased urine volume, nephritis, edema of renal origin.
From the central nervous system and peripheral nervous system: often - headache, dizziness, drowsiness; rarely - aseptic meningitis (including fever, severe headache, convulsions, stiffness of the neck and/or back muscles), hyperactivity (including mood changes, anxiety), hallucinations, depression, psychosis.
From the cardiovascular system: less often - increased blood pressure; rarely - fainting.

From the respiratory system: rarely - bronchospasm, dyspnea, rhinitis, pulmonary edema, laryngeal edema (including shortness of breath, difficulty breathing).
From the senses: rarely - hearing loss, ringing in the ears, visual impairment (including blurred vision).
From the hematopoietic system: rarely - anemia, eosinophilia, leukopenia.
From the blood coagulation system: rarely - bleeding from a postoperative wound, nosebleeds, rectal bleeding.
From the skin: less often - skin rash (including maculopapular), purpura; rarely - exfoliative dermatitis (including fever with or without chills, redness, thickening or flaking of the skin, swelling and/or tenderness of the tonsils), urticaria, Stevens-Johnson syndrome, Lyell's syndrome.
Allergic reactions: rarely - anaphylaxis or anaphylactoid reactions (including change in facial skin color, skin rash, urticaria, itching of the skin, tachypnea or dyspnea, swelling of the eyelids, periorbital edema, shortness of breath, difficulty breathing, heaviness in the chest, wheezing).
Local reactions Less common: burning or pain at the injection site.
Others: often - swelling (including face, legs, ankles, fingers, feet), weight gain; less often - increased sweating; rarely - swelling of the tongue, fever.

Contraindications:

Complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses and intolerance to acetylsalicylic acid or other NSAIDs (including a history);
- urticaria, rhinitis caused by taking NSAIDs (history);
- intolerance to pyrazolone drugs; - dehydration, hypovolemia (regardless of the cause);
- bleeding or a high risk of their development;
- condition after coronary artery bypass surgery;
- confirmed hyperkalemia;
- inflammatory bowel diseases;
- erosive and ulcerative lesions of the gastrointestinal tract in the acute stage, peptic ulcers;
- hypocoagulation (including hemophilia);
- severe renal failure (creatinine clearance less than 30 ml/min);
- severe liver failure or active liver disease;
- hemorrhagic stroke (confirmed or suspected);
- hemorrhagic diathesis;
- hematopoiesis disorder;
- pregnancy;
- childbirth;
- lactation period (breastfeeding);
- children under 16 years of age (efficacy and safety have not been established);
- hypersensitivity to ketorolac and other NSAIDs.

The drug is not used as means for premedication, maintenance of anesthesia, pain relief before and during surgical operations (including in obstetric practice) due to the high risk of bleeding.
The drug is not indicated for the treatment of chronic pain.

Carefully: bronchial asthma; cholecystitis; chronic heart failure; arterial hypertension; impaired renal function (plasma creatinine below 50 mg/l); cholestasis; active hepatitis; sepsis; systemic lupus erythematosus; old age (over 65 years); polyps of the nasal and nasopharyngeal mucosa, simultaneous use with other NSAIDs; the presence of factors that increase gastrointestinal toxicity: alcoholism, smoking; postoperative period, edema syndrome, ischemic heart disease, cerebrovascular diseases, dyslipidemia/hyperlipidemia, diabetes mellitus, peripheral arterial diseases, creatinine clearance less than 60 ml/min, history of ulcerative lesions of the gastrointestinal tract, presence of Helicobacter pylori infection, long-term use of NSAIDs, severe somatic diseases, simultaneous taking oral corticosteroids (including prednisolone), anticoagulants (including warfarin), antiplatelet agents (including clopidogrel), selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline ).

When used together with other NSAIDs, fluid retention, cardiac decompensation, and arterial hypertension may occur.
To reduce the risk of developing NSAID gastropathy, antacids, misoprostol, and omeprazole are prescribed.
The effect on platelet aggregation lasts for 24-48 hours.
Hypovolemia increases the risk of developing adverse reactions from the kidneys.
If necessary, can be prescribed in combination with opioid analgesics.
Do not use simultaneously with paracetamol for more than 5 days.
Patients with blood coagulation disorders are prescribed the drug only with constant monitoring of the platelet count, especially in the postoperative period, which requires careful monitoring of hemostasis.
Impact on the ability to drive vehicles and operate machinery
Since a significant proportion of patients who are prescribed Ketorolac develop side effects from the central nervous system (drowsiness, dizziness, headache), it is recommended to avoid performing work that requires increased attention and quick reaction (driving vehicles, working with machinery).

Interaction
other medicinal
by other means:

Simultaneous use ketorolac with acetylsalicylic acid or other NSAIDs, calcium preparations, corticosteroids, ethanol, corticotropin can lead to the formation of gastrointestinal ulcers and the development of gastrointestinal bleeding.
Co-administration with paracetamol increases nephrotoxicity, and with methotrexate - hepato- and nephrotoxicity.
Co-administration of ketorolac and methotrexate is possible only when using low doses of the latter (monitor the concentration of methotrexate in the blood plasma).
With the use of ketorolac, the clearance of methotrexate and lithium may decrease and the toxicity of these substances may increase.
Simultaneous prescription with indirect anticoagulants, heparin, thrombolytics, antiplatelet agents, cefoperazone, cefotetan and pentoxifylline increases the risk of bleeding.
Reduces the effect of antihypertensive and diuretic drugs (the synthesis of prostaglandins in the kidneys decreases).
When used simultaneously with opioid analgesics, the doses of the latter can be significantly reduced, because their effect is enhanced.

When used simultaneously, it enhances the hypoglycemic effect of insulin and oral hypoglycemic drugs (dose recalculation is necessary).
Co-administration with valproic acid causes disruption of platelet aggregation.
Increases plasma concentrations of verapamil and nifedipine.
When prescribed with other nephrotoxic drugs (including gold preparations), the risk of developing nephrotoxicity increases.
Probenecid and drugs that block tubular secretion reduce the clearance of ketorolac and increase its concentration in the blood plasma.
Myelotoxic drugs increase the manifestations of hematotoxicity of the drug.
The injection solution should not be mixed in the same syringe with morphine sulfate, promethazine and hydroxyzine due to precipitation.
Pharmaceutically incompatible with tramadol solution, lithium preparations.
The injection solution is compatible with 0.9% sodium chloride solution, 5% dextrose (glucose) solution, Ringer's solution and Ringer-lactate, Plasmalit solution, as well as infusion solutions containing aminophylline, lidocaine hydrochloride, dopamine hydrochloride, short-acting human insulin and heparin sodium salt.

Pregnancy:

Contraindicated use of the drug during pregnancy, during childbirth and during breastfeeding.

Overdose:

Symptoms: abdominal pain, nausea, vomiting, erosive and ulcerative lesions of the gastrointestinal tract, impaired renal function, metabolic acidosis.
Treatment: in case of taking the drug orally - gastric lavage, administration of adsorbents (activated carbon); when taken orally and parenterally - carrying out symptomatic therapy (maintaining vital functions of the body). Not eliminated sufficiently by dialysis.

1 tablet Ketorolac contains:
- active ingredient: ketorolac trometamol (ketorolac tromethamine) - 10 mg;
- excipients: microcrystalline cellulose - 42.5 mg, magnesium stearate - 1 mg, talc - 2 mg, crospovidone (kollidon CL) - 1 mg, lactose monohydrate (milk sugar) - until a core weighing 100 mg is obtained.

1 ml of Ketorolac solution for IV and IM administration contains:
- active ingredient: ketorolac trometamol (ketorolac tromethamine) - 30 mg;
- excipients: sodium chloride - 4.35 mg, disodium edetate (disodium salt ethylenediamine-N,N,N",N"-tetraacetic acid 2-aqueous (Trilon B)) - 500 mcg, water d/i - up to 1 ml.