Ketorol injections instruction indications. Ketorol: instructions for use, analogues and reviews, prices in Russian pharmacies

NSAIDs, a derivative of pyrrolysine-carboxylic acid.
Preparation: KETOROL®
The active substance of the drug: ketorolac
ATX encoding: M01AB15
CFG: NSAIDs with a pronounced analgesic effect
Registration number: P No. 015823/01
Date of registration: 08.07.04
The owner of the reg. credit: DR. REDDY'S LABORATORIES LTD. (India)

Ketorol release form, drug packaging and composition.

Green film-coated tablets, round, biconvex, with the letter "S" on one side; at the break - the core is white or almost white.

1 tab.
ketorolac tromethamine
10 mg

Excipients: microcrystalline cellulose, lactose, corn starch, magnesium stearate, colloidal silicon dioxide, sodium starch glycolate, hypromellose, propylene glycol, titanium dioxide, olive green.

10 pieces. - blisters (2) - packs of cardboard.
Injection
1 ml
ketorolac tromethamine
30 mg

Excipients: sodium chloride, ethanol, disodium edetate, octoxynol, propylene glycol, sodium hydroxide, water for injections.

1 ml - dark glass ampoules (10) - blisters.

DESCRIPTION OF THE ACTIVE SUBSTANCE.
All the information provided is provided only for familiarization with the drug, you should consult a doctor about the possibility of using it.

Pharmacological action Ketorol

NSAIDs, a derivative of pyrrolysine-carboxylic acid. It has a pronounced analgesic effect, also has an anti-inflammatory and moderate antipyretic effect. The mechanism of action is associated with the inhibition of the activity of COX, the main enzyme of the metabolism of arachidonic acid, which is a precursor of prostaglandins, which play a major role in the pathogenesis of inflammation, pain and fever.

Pharmacokinetics of the drug.

When taken orally, it is absorbed from the gastrointestinal tract. Cmax in blood plasma is reached in 40-50 minutes both after oral administration and after i / m administration. Eating does not affect absorption. Plasma protein binding is over 99%.

T1 / 2 - 4-6 hours both after oral administration and after i / m administration.

More than 90% of the dose is excreted in the urine, unchanged - 60%; the rest is through the intestines.

In patients with impaired renal function and elderly people, the excretion rate decreases, T1 / 2 increases.

Indications for use:

For short-term relief of moderate and severe pain of various origins.

Dosage and method of application of the drug.

Adults when taken orally - 10 mg every 4-6 hours, if necessary - 20 mg 3-4 times / day.

With intramuscular administration, a single dose is 10-30 mg, the interval between injections is 4-6 hours. The maximum duration of use is 2 days.

Maximum doses: when taken orally or intramuscularly - 90 mg / day; for patients weighing up to 50 kg, with impaired renal function, as well as for people over 65 years old - 60 mg / day.

Side effects of Ketorol:

Since the cardiovascular system: rarely - bradycardia, changes in blood pressure, palpitations, fainting.

From the digestive system: nausea, abdominal pain, diarrhea are possible; rarely - constipation, flatulence, feeling of fullness in the gastrointestinal tract, vomiting, dry mouth, thirst, stomatitis, gastritis, erosive and ulcerative lesions of the gastrointestinal tract, abnormal liver function.

From the side of the central nervous system and peripheral nervous system: anxiety, headache, drowsiness are possible; rarely - paresthesia, depression, euphoria, sleep disturbances, dizziness, changes in taste sensations, visual disturbances, movement disorders.

From the respiratory system: rarely - respiratory failure, asthma attacks.

From the urinary system: rarely - increased urination, oliguria, polyuria, proteinuria, hematuria, azotemia, acute renal failure.

From the blood coagulation system: rarely - nosebleeds, anemia, eosinophilia, thrombocytopenia, bleeding from postoperative wounds.

From the side of metabolism: increased sweating, swelling; rarely - oliguria, increased levels of creatinine and / or urea in the blood plasma, hypokalemia, hyponatremia.

Allergic reactions: possible skin itching, hemorrhagic rash; in isolated cases - exfoliative dermatitis, urticaria, Lyell's syndrome, Stevens-Johnson syndrome, anaphylactic shock, bronchospasm, Quincke's edema, myalgia.

Other: possible fever.

Local reactions: pain at the injection site.

Contraindications to the drug:

Erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, the presence or suspicion of gastrointestinal bleeding and / or craniocerebral hemorrhage, a history of blood clotting disorders, conditions with a high risk of bleeding or incomplete hemostasis, hemorrhagic diathesis, moderate and severe impaired renal function ( plasma creatinine concentration more than 50 mg / l), the risk of developing renal failure with hypovolemia and dehydration; "aspirin triad", bronchial asthma, nasal polyps, history of angioedema, prophylactic analgesia before and during surgery, children and adolescents under 16 years of age, pregnancy, childbirth, lactation, hypersensitivity to ketorolac, acetylsalicylic acid and other NSAIDs .

Use during pregnancy and lactation.

Contraindicated during pregnancy, during childbirth and during lactation (breastfeeding).

Ketorolac is contraindicated for use as a means for premedication, maintenance anesthesia and for pain relief in obstetric practice, since under its influence it is possible to increase the duration of the first stage of labor. In addition, ketorolac can inhibit uterine contractility and fetal circulation.

Special instructions for the use of Ketorol.

Use with caution in patients with impaired liver and kidney function, chronic heart failure, arterial hypertension, in patients with erosive and ulcerative lesions of the gastrointestinal tract and bleeding from the gastrointestinal tract in history.

Ketorolac should be used with caution in the postoperative period in cases where particularly careful hemostasis is required (including after resection of the prostate gland, tonsillectomy, in cosmetic surgery), as well as in senile patients, tk. the half-life of ketorolac is prolonged, and plasma clearance may decrease. In this category of patients, it is recommended to use ketorolac in doses at the lower limit of the therapeutic range. If symptoms of liver damage, skin rash, eosinophilia appear, ketorolac should be discontinued. Ketorolac is not indicated for use in chronic pain.

Influence on the ability to drive vehicles and control mechanisms

If drowsiness, dizziness, insomnia or depression appear during the period of treatment with Ketorolac, special care must be taken during potentially hazardous activities that require increased attention and speed of psychomotor reactions.

Interaction of Ketorol with other drugs.

With the simultaneous use of ketorolac with other NSAIDs, additive side effects may develop; with pentoxifylline, anticoagulants (including heparin in low doses) - an increase in the risk of bleeding is possible; with ACE inhibitors - an increase in the risk of developing impaired renal function is possible; with probenecid - the concentration of ketorolac in plasma and its half-life increase; with lithium preparations - it is possible to reduce the renal clearance of lithium and increase its concentration in plasma; with furosemide - a decrease in its diuretic effect.

When using ketoralac, the need for the use of opioid analgesics for the purpose of pain relief is reduced.

Instructions for use:

Ketorol is an analgesic drug with anti-inflammatory and antipyretic effects.

pharmachologic effect

The active substance of Ketorol is ketorolac, which, by inhibiting the activity of the cyclooxygenase enzyme, helps to inhibit the biosynthesis of prostaglandins, which are modulators of inflammation, thermoregulation and pain sensitivity.

The analgesic effect of Ketorol injections can be observed within half an hour after administration, and the maximum effect is after 1-2 hours.

The therapeutic effect of Ketorol lasts for 4-6 hours.

Indications for use

The instruction recommends prescribing Ketorol for moderately or severe pain syndrome: pain in the muscles and back, pain from injuries in the joints, sprains, dislocations, postoperative pain, neuralgia, cancer, radiculitis, toothache, migraine, burns, etc.

Instructions for use Ketorol

Ketorol, the use of which is advisable only for acute pain, and not for the treatment of chronic pain, is available in the form of tablets and solution for intramuscular injection.

Depending on the severity of the pain syndrome, Ketorol tablets can be prescribed once or repeatedly.

The solution for injection should be administered by deep intramuscular route. For patients under 65 years of age, Ketorol injections are prescribed at a dose of 10-30 mg once or the same dose every 4-6 hours, while the maximum daily dose should not exceed 90 mg. For patients over 65 years of age, Ketorol injections are given according to the scheme described above, with the only difference being that the maximum single dose should be 15 mg, and the maximum daily dose should be 60 mg. Ketorol injections can be used for no longer than 5 days.

When switching from intramuscular administration to oral administration of Ketorol, the total daily doses of the drug should be taken into account: on the day of the transition - 30 mg, for patients over 65 years of age - 60 mg, for patients under 65 years of age - 90 mg.

Side effects

Ketorol tablets and injections can provoke such undesirable reactions in patients as:

diarrhea, stomach pain, vomiting, constipation, flatulence, stomatitis, nausea, heartburn;
lower back pain, acute kidney failure, frequent urination, nephritis (inflammation of the kidneys), decrease or increase in the volume of urine;
bronchospasm, laryngeal edema, rhinitis;
headache, drowsiness, dizziness, hyperactivity, depression, tinnitus, hearing loss, blurred vision.
increased blood pressure, fainting, pulmonary edema;
leukopenia (an increase in white blood cells), eosinophilia (an increase in the number of eosinophils), anemia (a decrease in the number of red blood cells or hemoglobin);
rectal, nasal, from postoperative wounds bleeding;
purpura, skin rash, urticaria, Lyell's syndrome (allergic dermatitis as a reaction to drugs), Stevens-Johnson syndrome (the appearance of vesicles on the skin and on the mucous membrane of various organs);
itching, urticaria, discoloration of the face, skin rash, swelling of the eyelids, shortness of breath, wheezing, heaviness in the chest;
weight gain, swelling of the feet, fingers, ankles, legs, face, tongue, excessive sweating, fever;
pain or burning at the injection site of Ketorol.

Contraindications to the use of Ketorol

According to the instructions, Ketorol is not used to treat chronic pain. The use of Ketorol is contraindicated in:

bronchospasm (narrowing of the bronchi as a result of muscle contraction);
"Aspirin" asthma (suffocation attacks associated with taking salicylates);
hypovolemia (decrease in blood volume);
angioedema (limited deep swelling of the mucous membranes or subcutaneous tissue and skin);
dehydration (dehydration);
peptic ulcers (an expression of the mucous membrane of the esophagus as a result of exposure to gastric juice on one of its segments);
erosive and ulcerative lesions of the digestive tract in the acute phase;
hypocoagulation (reduced blood clotting);
hemorrhagic diathesis (diseases of the blood system, which are characterized by a tendency to increased bleeding);
hemorrhagic stroke (bleeding into the brain caused by rupture of blood vessels);
liver or kidney failure;
simultaneous use with other anti-inflammatory nonsteroidal drugs;
violation of hematopoiesis;
high risk of bleeding;
hypersensitivity to ketorolac or other non-steroidal anti-inflammatory drugs.

Ketorol, the use of which must be discussed with the attending physician, is not prescribed for pregnant and lactating women, as well as children and adolescents under 16 years of age.

The instruction recommends using Ketorol with caution for cholecystitis (inflammation of the gallbladder), arterial hypertension, chronic heart failure, bronchial asthma, impaired renal function, sepsis (infection with pathogens), active hepatitis, polyps (tissue outgrowths) of the mucous membrane of the nasopharynx and nose , systemic lupus erythematosus (connective tissue disease).

Additional Information

Any pain in itself is very unpleasant, but it delivers even more inconvenience if it occurs suddenly and gradually increases. In this case, it can seriously complicate a person's life and disrupt his usual routine. To quickly eliminate pain, today pharmacies offer many different medications. Among them, Ketorol, which is available in the form of tablets, has proven itself well. Its main advantage is speed. Within 20 minutes after taking a person feels relief, and soon the pain finally disappears.

How do Ketorol tablets work?

Ketorol belongs to the group of drugs with complex effects. It can not only eliminate pain syndrome, but also to suppress the inflammatory process and relieve swelling of soft tissues. Ketorol is an anti-inflammatory non-steroidal drug and has an effect in several directions:

normalizes body temperature;
relieves acute pain;
eliminates foci of inflammation.

Its main feature is a strong analgesic effect. In this regard, it is very similar to morphine, but Ketorol is a safer and more effective drug. curative effect, achieved with of these tablets, is provided with a special substance - ketorolac tromethamine, the effect of which on the body is manifested even at minimal dosages. With the help of this remedy, pains of various nature and symptoms can be effectively treated.

The therapeutic effect when using Ketorol tablets is guaranteed due to the complete absorption of active ingredients in the digestive tract. Maximum concentration the drug reaches an hour after taking a single dose. However, if a person eats fatty foods, then it will take a little longer for the drug to be absorbed. It takes about 3-4 hours for complete disintegration and transformation of the drug into active metabolites.

On average, the drug begins to act on the body, normalizing the temperature and eliminating the pain syndrome, after about 30 minutes. However, it all depends on the dosage taken. Ketorol tablets can be used not only to eliminate pain, but also as part of the full treatment of diseases that occur with swelling and fever.

Ketorol tablets and their composition

The drug is produced by the manufacturer in tablets coated with a green soluble shell. They have a biconvex shape, which makes them easier to swallow. Upon careful examination you can see on tablets S-shaped embossing. The drug is sold in metal-coated plastic blisters, each containing 10 pieces. Additionally, blisters are packed in cardboard packs, the number of which may vary. This, in turn, affects the final cost of the drug.

Ketorol tablets contain the following substances:

Different forms of the drug may have a modified composition, but in any case, it will necessarily contain the same active ingredient. At the same time, its concentration in one tablet will be 10 mg.

Ketorol Dosage Rules

The main indication for the use of the drug is severe pain that does not pose a danger to life. To eliminate a stronger pain syndrome, doctors recommend injections, because in this case the medicine is absorbed faster and reduces pain in a particular area of the body.

When calculating a safe and effective dosage, the specialist takes into account a number of factors:

features of the course of the disease;
pain intensity;
age.

In order to eliminate the pain that has arisen, it is enough to take tablets in the amount of 10 mg. If the patient worried about severe pain, it is allowed to increase the dosage to 2 tablets. When conducting a full course of Ketorol tablets, the dosage and duration of treatment should be determined by the doctor, taking into account the characteristics of each case.

In this case, it is necessary to observe the maximum daily dosage, which is 4 tablets. It is not recommended to exceed it, otherwise it can cause negative side reactions that can aggravate the course of the disease and cause unpleasant complications.

In accordance with the instructions, this medicine is recommended for medicinal purposes in the following conditions:

Treatment with Ketorol should be carried out for no more than 5 days. Ketorol helps very quickly. In most cases The desired effect can be achieved after one dose. Sometimes multiple courses may be required. In this case, it is necessary to take a break after 12 days of taking the drug, and then resume it.

Contraindications

Since Ketorol is a drug, it also has certain contraindications. From the instructions it follows that the drug is not prescribed under the following conditions:

If the patient has a tendency to cerebrovascular bleeding and edema, take drug Ketorol possible only with the approval of the attending physician. In addition, specialist supervision is required when using tablets to treat the following diseases:

kidney problems;
diabetes;
disorders of the nervous system and somatic diseases;
sepsis and pustular skin lesions;
hepatitis;
ischemic heart disease;
chronic hypertension.

It is undesirable to drink alcohol during drug treatment, since such a combination may cause body intoxication. Also, non-steroidal type drugs deserve attention, which, while taking Ketorol tablets, must be excluded or their dosage should be reduced.

Side effects

Experts distinguish the following categories of patients who have the highest risk of adverse reactions in response to taking Ketorol tablets:

having oncological diseases;
in the presence of confirmed hypersensitivity to the main components of the drug;
people over the age of 65 with chronic liver disease and ulcers.

If we talk about the side effects themselves, then they can be represented as the following subgroups:

frequent and medium frequency;
rare;
single.

The first subgroup includes the following symptoms - soft tissue edema and extremities, headache, decreased pressure, drowsiness, diarrhea, frequent urination, heartburn.

Much less often, patients experience constipation, flatulence, skin rashes, pressure drops, stomatitis, and excessive sweating.

In isolated cases, the following reactions may occur:

convulsions;
dyspnea;
mood swings;
bronchospasm;
darkening in the eyes and fainting;
tinnitus;
severe swelling;
pain in the kidneys;
stomach cramps;
vomiting with blood;
anemia.

Sometimes patients may complain of nosebleeds, laryngeal edema, rhinitis, fever.

In the presence of individual intolerance to Ketorol tablets, their administration may lead to the following adverse reactions:

edema;
anaphylaxis;
skin itching;
respiratory failure;
dryness of mucous membranes.

Elimination of allergies

In the event of an allergic reaction in response to taking Ketorol tablets, in addition to stopping their intake, it is recommended to do the following:

take an antihistamine;
drink a lot of liquid;
call for emergency help.

When confirming intolerance to a certain drug, it must be taken for the first time in a hospital setting. Moreover, in this case, the dosage of the drug is calculated as 1/8 of the allowable daily allowance. In the absence of side effects, it is allowed to gradually increase the dosage to the usual one.

In most patients, Ketorol does not cause allergic reactions. As a rule, this applies to those patients who are in good health and who do not have chronic diseases. It is very difficult to determine in advance the likelihood of adverse reactions. For this it is necessary take into account many factors, among which the most important are the individual characteristics of the patient, his age and lifestyle. Be that as it may, it is necessary to start treatment with Ketorol only after consulting a doctor. It is not recommended to take pills on your own, otherwise it can lead to dangerous consequences.

Manifestations of overdose and their elimination

coldness in the extremities and increased sweating;
pressure drop;
deterioration of brain activity;
speech disorders;
apathy;
muscle spasms and convulsions;
bleeding in the gastrointestinal tract;
dizziness;
nausea and vomiting;
stomach ache.

How to eliminate the consequences of an overdose?

If symptoms suggestive of an overdose appear, patients are advised to take the following measures:

Please note that overdose symptoms may occur if the patient during treatment with compliance recommended dose used other nonsteroidal drugs or did intramuscular injections. To avoid all this, it is necessary to carefully read the instructions before using the drug and follow the dosage exactly.

Combination with other drugs

Ketorol should be taken with caution with certain types of drugs, since such a combination can cause a serious deterioration in well-being. It is unacceptable to carry out therapy with Ketorol in combination with the following drugs:

corticotropins;
ethanol;
acetylsalicylic acid;
calcium-based vitamins.

If this point is not taken into account, then the patient may experience severe bleeding in the digestive tract, as well as other equally pleasant diseases.

Conclusion

In order to quickly and effectively relieve acute sudden pain, it is necessary to choose the right drug. There are a lot of those offered in pharmacies today, and among them especially worth highlighting Ketorol tablets. Many experts speak quite well about them, and therefore they recommend this drug to many of their patients who come to them with complaints of pain in different parts of the body. The drug has established itself as a tool that is well tolerated by most patients. However, it must be borne in mind that not always treatment with this drug is without consequences.

Taking Ketorol tablets can cause various allergic reactions in some patients, which may be associated with the presence they have individual intolerance to the constituent components of the drug, as well as other factors that not everyone knows about. Therefore, it is necessary to start treatment with this remedy only after consulting a specialist, strictly following the schedule of administration and dosage.

Ketorol (Ketorol)

Compound

Ketorol tablets

Inactive substances: lactose, microcrystalline cellulose, magnesium stearate, colloidal silicon dioxide, corn starch, hypromellose, sodium starch glycolate, titanium dioxide, propylene glycol, dye - olive green.

Ketorol solution for intramuscular injection
Active substance: tromethamine ketorolac.
Inactive substances: ethanol, sodium chloride, octoxynol, disodium edetate, sodium hydroxide, propylene glycol, water for injection.

pharmachologic effect

Ketorol is a non-steroidal anti-inflammatory agent with a predominantly analgesic effect. The active substance of the drug is ketorolac (ketorolac tromethamine). Ketorolac has a moderate antipyretic property, anti-inflammatory effect and a pronounced analgesic effect. Ketorolac mainly in peripheral tissues causes non-selective suppression of the activity of cyclooxygenase enzymes of types 1 and 2, resulting in inhibition of the formation of prostaglandins. Prostaglandins play an important role in the onset of pain, inflammation reactions and the mechanism of thermoregulation. According to the chemical structure, the active ingredient of Ketorol is a racemic mixture of + R- and -S- enantiomers, and the analgesic effect of the drug is due precisely to the -S-enantiomers. Ketorol does not affect opioid receptors, does not depress the respiratory center, does not have a calming and antidepressant effect, and does not cause drug dependence. The analgesic effect of Ketorol is comparable in strength to morphine and is much more superior to non-steroidal anti-inflammatory drugs of other groups. The onset of analgesic action after intramuscular injection or ingestion begins after 0.5 and 1 hour, respectively. The maximum analgesic effect is observed after 1-2 hours.

Indications for use

For the relief of pain syndromes caused by any cause, with a strong or moderate severity (including oncological pathology and pain in the period after surgical interventions).

Mode of application

Ketorol tablets
Assigned for oral administration. Depending on the severity and severity of pain, it is used once or repeatedly at a dose of 10 mg (the maximum allowable dose is 4 tablets per day - 40 mg). Duration of 1 course of treatment - no more than 5 days.

Ketorol for intramuscular injection
The minimum effective dose is selected individually, which depends on the therapeutic response of the patient and the intensity of the pain syndrome. If necessary, reduced doses of opioid analgesics can be given in parallel.
At the age of up to 65 years, 10-30 mg of the drug is used intramuscularly once or repeatedly (every 4-6 hours) at 10-30 mg. Patients over 65 years old, as well as in case of impaired renal function, Ketorol is prescribed intramuscularly once 10-15 mg or repeatedly 10-15 mg every 4-6 hours, depending on the severity of the pain syndrome.
The maximum allowable dose for patients under 65 years of age is 90 mg / day. In case of impaired renal function or age over 65 years, the maximum allowable dose is 60 mg / day. The course of therapy is no more than 5 days.

Switching from intramuscular to internal use
On the day of transition, the oral dose of Ketorol should not exceed 30 mg. The daily total dose of tablets and solution when switching from intramuscular administration to oral administration should be no more than 90 mg / day for patients 65 years of age or less, for patients with impaired renal function or over 65 years of age - 60 mg / day.

Side effects

Gradation of side effects: more than 3% - frequent, 1-3% - less frequent; less than 1% are rare.

From the urinary system: back pain without or with azotemia and / or hematuria, acute renal failure, uremic hemolytic syndrome (renal failure, thrombocytopenia, hemolytic anemia, purpura), decrease or increase in the volume of urine excreted, renal edema, frequent urination, jade (rare).

On the part of the digestive system: diarrhea and gastralgia, especially in patients over the age of 65 who had a history of erosive and ulcerative diseases of the gastrointestinal tract (often); flatulence, feeling of fullness in the stomach, constipation, stomatitis, vomiting (less often); erosive and ulcerative lesions of the gastrointestinal tract, including bleeding (burning or spasm in the epigastric region, abdominal pain, coffee grounds vomiting, heartburn, melena, nausea) and perforation of the gastrointestinal tract wall, hepatitis, acute pancreatitis, cholestatic jaundice, hepatomegaly (rare).

From the side of the central nervous system: headache, drowsiness, dizziness (often); depression, hallucinations, psychosis, tinnitus, hearing impairment, visual impairment (including blurred visual perception), hyperactivity (anxiety, mood changes), aseptic meningitis (severe headache, fever, stiffness of the muscles of the back and / or neck, convulsions) - rarely.

From the respiratory system: laryngeal edema (difficulty breathing, shortness of breath), dyspnea or bronchospasm, rhinitis (rarely).

Allergic reactions: anaphylactoid reactions or anaphylaxis (skin rash, discoloration of the skin of the face, itching of the skin, urticaria, dyspnea or tachypnea, periorbital edema, swelling of the eyelids, shortness of breath, shortness of breath, wheezing, heaviness in the chest) - rarely.
From the blood coagulation system: epistaxis, bleeding from a postoperative wound, bleeding from the intestines (rarely).

On the part of the hematopoietic organs: eosinophilia, anemia, leukopenia (rarely).

Skin reactions: purpura and skin rash, including maculo-papular rash (less often); urticaria, exfoliative dermatitis (fever with or without chills, peeling or thickening of the skin, redness, soreness and / or swelling of the tonsils), Lyell's syndrome, Stevens-Johnson syndrome (rarely).

From the side of the cardiovascular system: a slight increase in blood pressure (less often); pulmonary edema, loss of consciousness (rare).

Local reactions when injected into the muscle: pain or burning at the injection site (less often).

Others: swelling of the legs, face, ankles, feet, fingers, weight gain (often); excessive sweating (less often); fever, swelling of the tongue, (rare).

Contraindications

Aspirin triad;
angioedema;
bronchospasm;
hypersensitivity to tromethamine ketorolac and / or other drugs of the NSAID group;
hypovolemia, regardless of the cause of its development;
erosive and ulcerative diseases of the digestive system in the acute phase;
hypocoagulation (including cases of hemophilia);
dehydration;
peptic ulcers;
hemorrhagic stroke (suspected or confirmed);
combination with other NSAIDs;
renal and / or liver failure (if plasma creatinine is more than 50 mg / l);
violation of hematopoiesis;
hemorrhagic diathesis;
pregnancy, childbirth, lactation;
high risk of bleeding (including postoperative);
age up to 16 years.

Pregnancy

Ketorol is contraindicated in pregnant women. If it is necessary to prescribe the drug during lactation, breastfeeding is temporarily stopped.

drug interaction

The combination of paracetamol and Ketorol increases the risk of toxic effects on the renal tissue, with methotrexate it causes increased nephro- and hepatotoxicity.
Simultaneous administration of ketorolac with calcium preparations, glucocorticosteroids, acetylsalicylic acid, non-steroidal anti-inflammatory drugs from other groups, corticotropin and ethanol can provoke ulceration in the mucosa of the gastrointestinal tract, which threatens the development of gastrointestinal bleeding.
Against the background of the use of the drug, a decrease in the clearance of lithium and methotrexate and an increase in the toxicity of both of these substances may occur.

Simultaneous use with indirect anticoagulants, thrombolytics, heparin, cefoperazone, antiplatelet agents, pentoxifylline and cefotetan increases the possible risk of bleeding.
Ketorol reduces the effect of antihypertensive and diuretic drugs, as it causes a decrease in the formation of prostaglandins in the kidneys.
Probenecid reduces the volume of distribution and plasma clearance of Ketorol, increases its content in the blood serum and increases the half-life of Ketorolac tromethamine.
The combined use of methotrexate and ketorolac is possible only with the appointment of small doses of methotrexate (in this case, it is necessary to carefully monitor the plasma concentration of methotrexate).

The absorption of Ketorolac tromethamine is not affected by the use of antacids.
Ketorol increases plasma levels of nifedipine and verapamil.
With the simultaneous use of Ketorol, the hypoglycemic effect of oral hypoglycemic drugs and insulin increases, which requires a change in the dose of the latter. When prescribing the drug with other drugs that have a nephrotoxic effect (including gold-containing drugs), the risk of nephrotoxicity increases.
Drugs that inhibit tubular secretion reduce the clearance of ketorolac tromethamine and increase its serum concentration.
When the drug is combined with opioid analgesics, a significant reduction in the dosage of the latter is possible.
The joint appointment of sodium valproate and Ketorol leads to a violation of platelet aggregation.
Pharmaceutically, tromethamine ketorolac is incompatible with lithium preparations and tramadol solution.

Do not mix Ketorol solution for intramuscular injection in the same syringe with promethazine, morphine sulfate and hydroxyzine, as they interact chemically with precipitation.
Solution for intramuscular administration Ketorol is compatible with 5% dextrose solution, isotonic sodium chloride solution, plasmalite, Ringer-lactate solution and Ringer's solution, as well as with infusion solutions that include lidocaine hydrochloride, dopamine hydrochloride, aminophylline, heparin sodium salt and human insulin short action.

Overdose

Possible signs of an overdose of Ketorol: nausea, abdominal pain, vomiting, peptic ulcers or erosive lesions of the gastrointestinal tract, metabolic acidosis, impaired renal function.
Treatment: gastric lavage followed by the appointment of adsorbing drugs, symptomatic treatment. It is not excreted to a large extent by dialysis methods.

Release form

Ketorol tablets: round, coated green, with the symbol "S" on 1 side, biconvex, contain 10 mg of ketorolac tromethamine. The fracture is white or almost white. Pack of 20 pieces (10 pieces in each blister).

Ketorol - solution for intramuscular injection in dark glass ampoules containing 1 ml of Ketorol (30 mg of ketorolac tromethamine). There are 10 ampoules in a blister.

Storage conditions

Store according to list B. The storage place should be dry and protected from light. Temperature - not higher than 25 ° С. Shelf life - 3 years. Keep out of reach of children. Prescription dispensing from pharmacies.

Additionally

It is not recommended to prescribe Ketorol as a component for premedication, anesthesia in obstetric practice and maintenance anesthesia due to the significant risk of bleeding. Not indicated in the treatment of chronic pain syndrome.
The effect of the active substance Ketorol on platelet aggregation is observed for 1-2 days.
For patients with disorders in the blood coagulation system, ketorolac is prescribed if constant monitoring of the platelet count is carried out - this is especially important if reliable hemostasis is required (postoperative period).
Use with caution in cholecystitis, bronchial asthma, arterial hypertension, chronic heart failure, impaired renal function (with serum creatinine less than 50 mg/l), active hepatitis, cholestasis, systemic lupus erythematosus, sepsis, polypous growths in the nasopharynx and nasal mucosa , elderly patients over 65 years of age.

The risk of developing side effects from the urinary system increases with hypovolemia.
Ketorol, if necessary, can be used in combination with opioid analgesics.
Ketorol is not recommended to be taken simultaneously with paracetamol for more than 5 days.
When using Ketorol, a significant number of patients develop side effects from the central nervous system (for example, drowsiness, headache, dizziness), so it is better to avoid performing activities that require a quick reaction and increased attention (working with mechanisms, driving vehicles).
Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide on the appointment of the drug, as well as determine the dose and methods of its use.

average rating

Based on reviews

Pain can occur suddenly, and its growing strength makes it impossible to fully exist. A universal remedy with a pronounced analgesic effect is the drug Ketorol. In just 15-20 minutes, the first signs of its beneficial effects on the body will become noticeable, in which the pain will gradually begin to subside until it disappears completely.

In addition to pain relief, Ketorol is capable of eliminate the inflammatory process, removing swelling of soft tissues. How such a multifaceted effect is achieved, indications and contraindications, as well as adverse reactions of the drug, we will analyze further.

Pharmacological effects

The drug Ketorol belongs to the group of NSAIDs (non-steroidal anti-inflammatory drugs). Like many other drugs in this group, the drug is able to provide enough multifaceted impact on the body, namely:

eliminates the focus of inflammation by suppressing the synthesis of enzyme compounds of prostaglandins;
relieves acute symptomatic pain;
has an antipyretic effect.

If we talk about the method of its action at the cellular level, then a favorable result is achieved by inhibiting the synthesis of prostaglandins - enzymes that provoke soreness and swelling when violations of natural life appear in a certain area. Absorbed in the gastrointestinal tract, the active components of the drug combine with protein cells, causing non-selective inhibition of the cyclooxygenase cascade, after which the synthesis of prostaglandins slows down and eventually is reduced to a minimum.

Pain relief comparable in strength with morphine, however, the use of Ketorol is much more efficient and safer. The main active ingredient is ketorolac tromethamine, which can have a therapeutic effect even in minimal dosages. With the help of this drug, you can get rid of various types of pain that differ in pathogenesis and type of manifestation.

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Irina Martynova. Graduated from the Voronezh State Medical University. N.N. Burdenko. Clinical intern and neurologist of BUZ VO \"Moscow Polyclinic\".

Oral administration of the drug provides maximum effectiveness due to the complete absorption of active components in the organs of the gastrointestinal tract. The maximum concentration in the blood occurs one hour after taking the medicine. She directly depends on the type of food patient. Fatty foods (mostly of animal origin) in the diet help to slow down the absorption process for several hours. The half-life and the formation of active metabolites occurs within 3-5 hours.

Analgesic and antipyretic effect occurs immediately after the first dose of the drug, after 25-50 minutes, depending on dosage. Ketorol is used both to eliminate symptomatic pain, and for the full treatment of serious diseases, which are characterized by the addition of fever and swelling.

Ketorol is almost 99% bound to blood albumin, which increases its bioavailability and increases the effectiveness of exposure. He able to penetrate into all tissues and organs, lingering in breast milk and synovial fluid at a maximum concentration ( but does not accumulate like other similar NSAIDs).

In the process of metabolism, about half of the dosage introduced into the body falls on inactive metabolites. The second half (glucuronides and hydroxyketorolac) has a direct effect on the synthesis of prostaglandins, acting locally and selectively.

After active metabolism in the liver, the drug is largely excreted by the kidneys with urine. A small proportion of Ketorol is excreted from the body through the intestines. In patients with liver problems, the half-life and maximum concentration of the drug may have individual indicators that differ from those generally accepted. Since ketorolac tromethamine binds directly to blood proteins, its half-life in the elderly increases several times. At the same time, in a young active organism, half-life can occur much longer.

Composition and form of release

Ketorol is produced in the form of tablets coated with a special soluble green coating. The biconvex shape of the tablet facilitates the process of swallowing the medicine. Each tablet has a special embossing in the form of the Latin letter S. Tablets are packaged in 10 pieces in a plastic blister with a metal coating. The package may have a different number of blisters, from which the price of the drug is radically different.

One Ketorol tablet contains:

The active ingredient is ketorolac tromethamine - 10 mg.
Auxiliary components:

lactose;
corn starch;
cellulose microcrystalline;
colloidal silicon dioxide;
sodium carboxymethyl starch;
titanium dioxide;
hypromellose;
natural diamond dye;
propylene glycol.

The composition of the tablets can be changed by the manufacturer, however, the active substance (ketorolac tromethamine) remains unchanged, maintaining the generally accepted dosage of 10 mg.

Application

Ketorol tablets are used in cases where the intensity of pain does not have a life-threatening effect. When stopping acute attacks of severe pain, it is better to use injections, which are absorbed faster and reduce the soreness of a certain area of the body. In medical practice, the following scheme is widely used: for the first three days, Ketorol is administered deep intramuscularly, after which the treatment is continued with tablets, gradually reducing the dosage to the minimum.

The dosage depends on the age of the person, the intensity of the pain and the nature of the course of the disease.. To eliminate pain of various etiologies and dislocations, the most appropriate dosage is 10 mg - this is 1 tablet of the drug. If the pain is severe, the dose can be increased to 20 mg (2 tablets). When prescribing Ketorol as a course, its duration, as well as the dosage, is determined individually.

The maximum allowable dose of ketorolac per day is not more than 40 mg(4 tablets). Its excess leads to the development of a number of side effects that can affect the course of the disease, complicating it with additional painful and uncomfortable sensations in the body.

Indications for use drugs of the NSAID group can become the following manifestations:

rheumatoid diseases of the musculoskeletal system
, toothache;

caused by compression of neuronal endings;
muscle sprains and;
oncological diseases;
relief of pain in the postoperative and rehabilitation period;
traumatism and violation of the integrity of the bone tissue (fractures, pins, squeezing);
muscular neuralgia and myalgia.

Usually the course of treatment with Ketorol is up to 5 days., but in most cases one dose of the medicine is enough to get rid of severe pain. His do not use in childhood ( up to 16 years), limited to taking other NSAIDs to relieve fever, fever and inflammation. If necessary, long-term use of the drug, take a break every 12 days, after which the reception is continued.

Contraindications

not used in therapy, when the patient has the presence of the following indicators:

hypersensitivity to one or more components of the drug;
intolerance to acetylsalicylic acid;
the presence of bronchial asthma and nasal sinus polyposis;
violation of hematopoietic functions, especially in the presence of a low level of coagulability;
children's age up to 16 years;
pregnancy and lactation;
the presence of active bleeding in the organs of the gastrointestinal tract;
chronic inflammatory processes of the stomach and intestines, which are in the acute stage;

hemorrhagic diathesis;
lactose intolerance;
decompensated heart failure;
rehabilitation period after coronary artery bypass grafting;
peptic ulcer of the gastrointestinal tract in the acute stage;
renal insufficiency;
stroke or pre-stroke condition;
hypovolemia.

Carefully the drug is used if the patient has predisposition to edema and cerebrovascular bleeding.

Also draw Special attention on the patient's condition when prescribing Ketorol in the case when the history contains the following diseases:

cardiac ischemia;
chronic arterial hypertension;
impaired functioning of the kidneys and the excretory system as a whole;
diabetes mellitus (with mandatory daily use of insulin);
sepsis and skin pustular lesions of various etiologies;
hepatitis in the activation stage;
serious somatic diseases and disorders of the nervous system.

It is not recommended to combine the drug with alcohol, since the latter can provoke severe intoxication of the body. If a person has an alcohol dependence, his treatment is carried out only in a hospital, after cleansing droppers and enemas.

When using Ketorol, it is important to limit or completely stop taking other NSAIDs, since an increased concentration of the active ingredient can provoke intoxication, which will lead to the development of side effects.

Overdose

With a significant increase daily allowable dose ( over 100 mg) is noted severe intoxication organism, which is characterized by the following symptoms:

nausea and vomiting;
soreness in the abdomen;
bleeding in the organs of the gastrointestinal tract (impurities of blood in the feces and vomit);
dizziness;
apathy;
cramps and muscle spasms;
coldness and sweating of the extremities;
disorders of brain activity;
slurred speech.

If an overdose has been detected, it is necessary to carry out a set of measures aimed at restoring vital functions:

Remove the remains of tablets from the digestive tract- it is appropriate only if the time interval from the use of tablets to the detection of an overdose does not exceed 1 hour. You can induce a gag reflex by pressing the back of a tablespoon on the root of the tongue.
Reduce the concentration of toxins- any sorbents that are able to envelop and neutralize the activity of toxins will help with this. These include: Activated carbon (1 tablet per 10 kg of human weight), Sorbex, Polysorb, Enterosgel.
Ensure water-salt balance- achieved by drinking plenty of water, at least 2-3 liters. You need to drink in small sips, but very often (every 2-3 minutes). Water should be at room temperature, but in no case not cold, which will lead to spasm in the digestive tract. For best results, you can make your own saline solution. To do this, for 1 liter of water use:

1 tablespoon of table salt;
1 tablespoon of sugar;
1 teaspoon baking soda.

The resulting mixture of vital salts is drunk for several days, until the residual manifestations of adverse reactions disappear.

Call an ambulance, as well as inform the local therapist about what happened.

An overdose and its symptoms can occur even when a single dose of Ketorol has been drunk, combined with taking other drugs of the NSAID group, or while using intramuscular injections and tablets. Therefore, before starting treatment, the instructions should be carefully studied, and the total doses of NSAIDs entering the body per day should be compared.

Side effects

At risk by the likelihood of adverse reactions fall:

people over 65 years of age with a history of chronic liver disease, as well as peptic ulcer of the gastrointestinal tract;
people who have individual intolerance to the components of the drug, or any drugs of the NSAID group;
people with the presence of cancer, as well as destructive processes in the liver.

Side effects provoked by Ketorol can be considered taking into account the frequency of manifestation:

Frequent(more than 3% of all cases):

diarrhea;
heartburn;
increased painful urination;
swelling of the soft tissues of the face and limbs;
headache with persistence of acute symptoms for quite a long time;
lowering blood pressure;
drowsiness;
pain in the epigastric part of the abdomen.

Medium frequency(from 1 to 3% of the total mass):

constipation;
flatulence;
stomatitis;
abrupt increase in blood pressure;
skin rash;
increased sweating.

Rare(up to 1%):

vomiting with blood impurities;
ulceration of the mucous membrane of the digestive tract;
spasm of the stomach;
pain and discomfort, indicating the presence of problems with the kidneys;
decrease in the amount of urine excreted;
severe swelling;

tinnitus;
darkening in the eyes;
loss of consciousness;
convulsions;
sudden mood swings;
bronchospasm;
severe shortness of breath and lack of air;
anemia.

In isolated cases:

nosebleeds;
swelling of the larynx;
rhinitis;
thrombocytopenia;
acute pancreatitis;
hepatitis;
fever.

In case of individual intolerance to the drug an allergic reaction may develop, which is manifested by the following reactions:

urticaria and pruritus;
swelling of the whole body or its individual parts;
labored breathing;
anaphylaxis;
dry mucous membranes.

When diagnosing allergic reactions, treatment with Ketorol is stopped by carrying out the following set of measures:

Give a person any antihistamine drug: Suprastin, Diazolin, Finistil.
Provide plenty of fluids.
Call an ambulance.

In the presence of allergic reactions to medications that are indicated in the anamnesis, the patient is recommended to take the first medication in a hospital, using 1/8 of the daily dosage. In the absence of adverse reactions, the dose is gradually adjusted to the generally accepted dose.

Usually in medical practice Ketorol is well tolerated patients who do not have health complaints and chronic diseases. The occurrence of adverse reactions is directly related to the individual characteristics of the patient, his age and general health and lifestyle.

Since the drug is capable of exerting a whole range of adverse reactions on the body, it is possible to take it only after consulting a doctor. Self-medication can cause the development of new diseases, as well as provoke a fatal outcome.

Interaction with other drugs

Acetylsalicylic acid;
Corticotropins;
Calcium-containing vitamin complexes;
Ethanol.

Combining these drugs with Ketorol provokes profuse bleeding of the gastrointestinal tract and the development of serious complications.

Also Not recommended concomitant use of Ketorol with other non-steroidal anti-inflammatory drugs, since overdoses are likely to occur with the ensuing negative consequences for the body.

The development of nephrotoxicity, as well as serious violations of the excretory system, is achieved through the simultaneous use of Ketorol with the following drugs:

Paracetamol;

preparations containing a small concentration of gold.

Decreased prostaglandin synthesis has a direct effect on drugs of the diuretic group, reducing their activity. Also decreased effectiveness of antihypertensive drugs when their intake is combined with Ketorol.

If a patient has diabetes, an adjustment in the dose of insulin is necessary, since the drug used can affect the level of glucose in the blood and the process of its splitting.

Simultaneous use Ketorol with Verapamil and Nefidipine, leads to an increase in the concentration of the latter by several times. This property is widely used in the treatment of neuralgia and myalgia, when it is required to achieve sedative and muscle relaxant effect.

Additionally

Not recommended use the drug as an anesthetic with minor surgical interventions, since there is a high probability of bleeding. Not effective during treatment pain syndrome who wears chronic.

Treatment with Ketorol in patients who have problems in the circulatory system, implies constant control the state and number of platelets produced, as well as the rate of their sedimentation. The sampling of analyzes is carried out both before taking the tablet and after its absorption. A coagulogram performed at least 2 times a day will avoid serious consequences, as well as predict further treatment.

When Ketorol is used by patients with oncological diseases, it is possible to combine it in small doses opium-containing preparations, since the concentration of the latter will double. However, the combination of Ketolor and anticancer drugs is unacceptable, since this can provoke serious violations of kidney function, up to their failure.

Advantages over other drugs

Among the most pronounced benefits of using Ketorol, the following qualities can be distinguished:

It is not able to bind to opioid receptors on cell membranes, which allows it to be used as a safe analgesic drug.
It does not affect the performance of the brain and concentration of attention in any way - it can be used when performing work that requires increased concentration of attention and speed of psychomotor reactions.
Does not have a pronounced sedative effect.
It is not addictive, therefore it can be used in the long-term treatment of chronic diseases accompanied by the presence of acute pain, fever and swelling of soft tissues.
Allowed for violations of liver function, since this does not affect the level of absorption and half-life from the body.
It does not have an anxiolytic effect, allowing the use of the drug in violation of psycho-emotional reactions.
Affordable price and good patient tolerance.

Price

Indian Ketorol, containing 2 blisters with 20 tablets in a package, costs 43 rubles. The domestic drug will cost the buyer a little cheaper - 35 rubles. Prices may differ slightly from pharmacy prices, since they completely depend not only on the manufacturer, but also on the percentage of pharmacies.

Terms of dispensing from pharmacies

The drug is available by prescription, because it has a pronounced analgesic effect.

Storage conditions and expiration dates

The drug is stored in a cool dry place out of the reach of children. Shelf life - 2 years from the date of manufacture, the exact date of which is indicated on the package.

Analogues

The most accessible and no less effective means similar in effect on the body are the following:

Ketorolac, 10 mg, price for 20 pcs. from 26 rubles
, 10 mg, price for 10 pcs. from 58 rub.
Ketotifen, 1 mg, price for 30 pcs. from 70 rub.
Ketofril, 10 mg, price for 20 pcs. from 88 rub.
Pentalgin, price for 24 pcs. from 141 rubles
Tempalgin, price for 20 pcs. from 115 rubles

Similar drugs have their own contraindications and adverse reactions, so it is important to consult a specialist when choosing them. Self-replacement of Ketorol with an analogue can provoke the development of concomitant negative reactions.

Thus, Ketorol in the form of tablets is able to have the same effects on the body as other drugs of the NSAID group. However, he good tolerance and fast response, which is achieved due to easy absorption and metabolism by the liver. He is quite can be combined with drugs of other drug groups in complex therapy, but it requires hospitalization and constant medical monitoring of the patient's condition. Affordable price and the ability to quickly eliminate any kind of pain makes it so popular and in demand in the pharmacology market.

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