home Audience 2 What does Ketorol help with and how long does it last? Carefully read the instructions for using Ketorol tablets

What does Ketorol help with and how long does it last? Carefully read the instructions for using Ketorol tablets

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Pain can occur suddenly, and its increasing strength makes it impossible to fully exist. A universal remedy, which has 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, during 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, relieving swelling of soft tissues. How such a multifaceted effect is achieved, indications and contraindications, as well as adverse reactions of the drug will be discussed 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 capable of providing sufficient multifaceted impact on the body, namely:

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

If we talk about the method of its influence at the cellular level, then a favorable result is achieved by inhibiting the synthesis of prostaglandins - enzymes that provoke pain and swelling when disturbances of natural vital activity 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 is ultimately minimized.

Analgesic effect 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 provide healing effect. With this medicine you can get rid of various types pain, differing in pathogenesis and type of manifestation.

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Irina Martynova. Graduated from Voronezh State University medical University them. N.N. Burdenko. Clinical resident and neurologist of the Moscow Polyclinic.

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

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

Ketorol binds to blood albumin by almost 99%, which increases its bioavailability and increases its effectiveness. He capable of penetrating all tissues and organs, lingering in breast milk and synovial fluid in maximum concentration (but does not accumulate like others similar drugs NSAIDs).

During metabolism, about half of the dosage introduced into the body is 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 along 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 the generally accepted ones. Since ketorolac tromethamine binds directly to blood proteins, its half-life increases several times in older people. At the same time, at a young age active organism The half-life may be much longer.

Composition and release form

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

One Ketorol tablet contains:

Active ingredient – ketorolac tromethamine – 10 mg.
Auxiliary components:

The composition of the tablets may be changed by the manufacturer, but the active ingredient (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 docking acute attacks severe pain it's better to use injections, which are absorbed faster and reduce pain in a specific area of the body. IN medical practice The following scheme is widely used: for the first three days, Ketorol is administered deeply intramuscularly, after which treatment is continued with tablets, gradually reducing the dosage to the minimum.

The dosage depends on the person’s age, the intensity of the pain and the nature of the disease.. To eliminate pain of various etiologies and dislocation, the most suitable dosage is 10 mg - this is 1 tablet of medicine. 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 permissible dose of ketorolac per day is no more than 40 mg(4 tablets). Its excess leads to the development of a number of side effects, which can affect the course of the disease, complicating it with additional painful and uncomfortable sensations in the body.

Indications for use drug NSAID groups I can be the following manifestations:

rheumatoid diseases of the musculoskeletal system
, toothache;

caused by compression of neuron endings;
muscle strains and;
oncological diseases;
relief of pain in the postoperative and rehabilitation period;
injuries and violation of integrity bone tissue(fractures, punctures, compression);
muscle neuralgia and myalgia.

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

Contraindications

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

hypersensitivity to one or more components of the drug;
intolerance to acetylsalicylic acid;
the presence of bronchial asthma and sinus polyposis;
dysfunction of hematopoiesis, especially in the presence low level coagulability;
childhood up to 16 years old;
pregnancy and lactation period;
the presence of active bleeding in 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 surgery;
peptic ulcer of the gastrointestinal tract in the acute stage;
renal failure;
stroke or pre-stroke condition;
hypovolemia.

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

Also pay Special attention on the patient’s condition when prescribing Ketorol in the case where the anamnesis contains the following diseases:

cardiac ischemia;
chronic arterial hypertension;
kidney dysfunction and excretory system generally;
diabetes mellitus (with mandatory daily use of insulin);
sepsis and skin pustular lesions of various etiologies;
hepatitis in the active stage;
serious somatic diseases and disorders 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 alcohol addiction, its treatment is carried out only in a hospital, after carrying out cleansing droppers and enemas.

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

Overdose

With significant increasing daily permissible dose ( more than 100 mg) is noted severe intoxication organism, which is characterized by the following symptoms:

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

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

Remove the remaining tablets from the gastrointestinal tract– is appropriate only when the time interval from the use of tablets to the detection of an overdose does not exceed 1 hour. You can call vomiting reflex by pressing reverse side tablespoon on the root of the tongue.
Reduce the concentration of toxins– any sorbents that can envelop and neutralize the activity of toxins will help with this. These include: Activated carbon(1 tablet per 10 kg of person’s weight), Sorbex, Polysorb, Enterosgel.
Provide water-salt balance – is achieved through drink plenty of fluids, at least 2-3 liters. You need to drink in small sips, but very often (every 2-3 minutes). The water should be at room temperature, but in no case cold, which will lead to spasms in the gastrointestinal tract. For achievement best result You can make your own saline solution. To do this, for 1 liter of water use:

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

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

Call an ambulance medical care , and also inform the local therapist about what happened.

Overdose and its symptoms can appear even if a single dose of Ketorol was taken, combined with taking other drugs from the NSAID group, or when used simultaneously 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 according to 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 an individual intolerance to the components of the drug, or any drugs from the NSAID group;
people with cancer, as well as destructive processes in the liver.

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

Frequent(more than 3% of all cases):

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

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

Rare(up to 1%):

vomiting with blood;
ulceration of the mucous membrane of the gastrointestinal tract;
stomach spasm;
pain and discomfort, indicating the presence of kidney problems;
decreased volume of urine excreted;
severe swelling;

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

In isolated cases:

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

hives and itchy skin;
swelling of the whole body or its individual parts;
labored breathing;
anaphylaxis;
dry mucous membranes.

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

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

If there are allergic reactions to medications that are indicated in the anamnesis, the patient is recommended to take the first medication in the hospital, using 1/8 of 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 have no health complaints and chronic diseases. The occurrence of adverse reactions is directly related to individual characteristics patient, his age and general condition health and lifestyle.

Since the drug can cause a whole range of adverse reactions on the body, its use is possible only after consultation with a doctor. Self-medication can cause the development of new diseases and also cause death.

Interaction with other drugs

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

The combination of these drugs with Ketorol provokes heavy bleeding organs of the gastrointestinal tract, as well as the development of serious complications.

Also Not recommended simultaneous use of Ketorol with other non-steroidal anti-inflammatory drugs, since overdoses with resulting negative consequences for the body.

The development of nephrotoxicity, as well as serious dysfunction 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 the effectiveness of antihypertensive drugs decreases, when their use is combined with Ketorol.

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

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

Additionally

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

Treatment with Ketorol for patients who have problems at work circulatory system , implies constant control the state and quantity of platelets produced, as well as their sedimentation rate. Tests are taken both before taking the pill and after it is absorbed. A coagulogram performed at least 2 times a day will help avoid serious consequences, as well as predict further treatment.

When using Ketorol in patients with cancer, it is possible to combine him with in small doses opium-containing preparations, since the concentration of the latter will double. However, the combination of Ketolor and antitumor drugs , since this can cause serious impairment of kidney function, including kidney failure.

Advantages over other drugs

Among the most pronounced advantages of using Ketorol, the following qualities can be highlighted:

It is not able to bind to opioid receptors of cell membranes, which allows it to be used as a safe pain reliever.
It does not affect brain performance or concentration in any way - it can be used when performing work that requires increased concentration and speed of psychomotor reactions.
Does not have a pronounced sedative effect.
It is not addictive, so it can be used for long-term treatment chronic diseases accompanied by the presence acute pain, heat and swelling of soft tissues.
Allowed for liver dysfunction, since this does not affect the level of absorption and half-life from the body.
It does not have an anxiolytic effect, allowing the drug to be used for disorders of psycho-emotional reactions.
Affordable price and well tolerated by patients.

Price

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

Conditions for 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 reach of children. Shelf life is 2 years from the date of manufacture, the exact date of which is indicated on the packaging.

Analogs

The most accessible and no less effective means of similar effects on the body are the following:

Ketorolac, 10 mg, price for 20 pcs. from 26 rub.
, 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 rub.
Tempalgin, price for 20 pcs. from 115 rub.

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

Thus, Ketorol in tablet form can have the same effects on the body as other drugs in the NSAID group. However, he is well tolerated and quick to respond, which is achieved through easy absorption and metabolism by the liver. He's quite can be combined with drugs from other drug groups V complex therapy, but at the same time requires hospitalization and constant medical monitoring of the patient’s condition. An affordable price and the ability to quickly eliminate any type of pain make it so popular and in demand on the pharmacological market.

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Photo of the drug

Latin name: Ketorol

ATX code: M02AA

Active substance: Ketorolac

Manufacturer: Dr. Reddy's Laboratories Ltd., India

Description is valid on: 25.10.17

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

Active substance

Ketorolac.

Release form and composition

Available as a solution for intravenous and intramuscular injection, film-coated tablets, gel for external use.

Indications for use

It is used to relieve severe and moderate pain in:

Contraindications

Contraindicated in case of hypersensitivity to tromethamine ketorolac, aspirin triad, that is, with a combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses and intolerance to ASA and pyrazolone-type drugs.

Among other contraindications:

hypovolemia of any etiology,
exacerbation of erosive and ulcerative lesions of the gastrointestinal tract,
hypocoagulation, including hemophilia,
bleeding or high risks of their development,
heavy renal failure,
liver failure,
dehydration,
peptic ulcers,
hemorrhagic stroke.

Not prescribed during childbirth, during pregnancy and breastfeeding, and for children under 16 years of age.

The use of Ketorol is possible with caution in conditions such as intolerance to other NSAIDs, the presence of factors that increase gastrointestinal toxicity, diseases such as bronchial asthma, cholecystitis, arterial hypertension, cholestasis, active hepatitis, bad habits(alcoholism, smoking), post-operative recovery, chronic heart failure, edema syndrome, sepsis, age over 65 years.

Instructions for use of Ketorol (method and dosage)

Film-coated tablets

Take orally in a single dose of 10 mg.

In case of severe pain, it is possible reuse 10 mg up to 4 times a day depending on the severity of pain. The maximum daily dose is 4 mg. Minimum should be taken effective dose course no more than 5 days.

When switching from a parenteral drug to oral administration, the total daily dose of both dosage forms e on the day of transfer should not exceed 90 mg for people from 16 to 65 years of age and 60 mg for people over 65 years of age or with impaired renal function. The dose on the day of transition should not exceed 30 mg.

Solution for intramuscular and intravenous administration

When taken orally, adults are prescribed from 10 mg every 4-6 hours to 20 mg every 6-8 hours.

Catorol solution is administered intravenously at 10-30 mg at intervals of 4-6 hours for 2 days.

The maximum dose for oral or intramuscular administration is 90 mg per day, for patients with body weight, impaired renal function or over 65 years of age - 60 mg per day.

Gel for external use

A repeat dose is prescribed after 4 hours. Ketorol gel is used no more than 4 times a day.

If there is no improvement after 10 days of use, you should stop treatment and consult a doctor. It is not recommended to use the gel for more than 10 days without consulting a doctor.

Side effects

The use of the drug often causes side effects such as gastralgia, diarrhea, flatulence, constipation, vomiting, headache, dizziness, drowsiness, burning or pain at the injection site, skin rash, swelling, increased sweating. Less commonly causes loss of appetite, the appearance of erosive and ulcerative lesions of the gastrointestinal tract, cholestatic jaundice, hepatitis, acute pancreatitis, acute renal failure, lower back pain, hematuria, nephritis, increased frequency of urination, hearing loss, ringing in the ears, bronchospasm, rhinitis, swelling of the lungs and larynx, convulsions, anxiety, depression, psychosis, fainting. Anemia, eosinophilia, leukopenia, nose bleed, various allergic reactions, fever.

Overdose

If the dose of the drug is exceeded, symptoms such as abdominal pain, nausea, vomiting, peptic ulcers, metabolic acidosis, renal dysfunction. In this case, gastric lavage, administration of adsorbents and symptomatic treatment to maintain vital body functions. Dialysis is ineffective.

Ketorol's analogs

Analogs by ATC code: Ketorolac, Dolak, Adolor, Ketanv, Torolac.

Do not decide to change the drug on your own; consult your doctor.

pharmachologic effect

Ketorol has a predominantly analgesic effect. Ketorolac tromethamine, the active ingredient of the drug, has a moderate antipyretic property, an anti-inflammatory effect and a pronounced analgesic effect. In peripheral tissues it leads to indiscriminate suppression of the activity of cyclooxygenase enzymes types 1 and 2, thereby inhibiting the formation of prostaglandins. It is prostaglandins that are the main factor in the appearance of pain, inflammation reactions and the mechanism of thermoregulation.

The use of Ketorol does not cause drug dependence, since its active substance does not affect opioid receptors, does not cause depression of the respiratory center and does not have a sedative or antidepressant effect. Analgesic effect this drug Its effectiveness is comparable to morphine and significantly superior to other non-steroidal anti-inflammatory drugs.

After intramuscular injections or oral tablets, the analgesic effect occurs after 30 and 60 minutes, respectively. The peak analgesic effect of the drug is achieved after 1-2 hours.

At intramuscular injections Ketorol is quickly and completely absorbed. When taking tablets orally, the active substance is also quickly and well absorbed from the gastrointestinal tract. The drug penetrates into breast milk. More than half of the administered drug is metabolized in the liver with the formation of pharmacologically inactive metabolites. Excretion from the body is carried out mainly by the kidneys, partly through the intestines. Not excreted by hemodialysis.

special instructions

The first dose of the drug should be administered under medical supervision due to the high risk of allergic reactions. The drug is not recommended for use for premedication or maintenance of anesthesia.

Concomitant use with other non-steroidal anti-inflammatory drugs can cause fluid retention, cardiac decompensation, and increased blood pressure.

In case of bleeding disorders, the use of Ketorol must be accompanied by constant monitoring of the platelet count, this is especially true for patients after surgery who need control of hemostasis.

Prolonging the course of treatment increases the risk of drug complications.

During treatment with this drug, use caution when driving vehicles or engaging in other potentially dangerous activities. dangerous species activities.

During pregnancy and breastfeeding

Contraindicated during pregnancy, childbirth, and breastfeeding.

In childhood

Contraindicated for children under 16 years of age.

In old age

Patients over 65 years of age are prescribed with caution.

For impaired renal function

Contraindicated in cases of severe renal failure.

For liver dysfunction

Contraindicated in cases of severe liver failure.

Drug interactions

Ketorol when taken with acetylsalicylic acid or other NSAIDs, calcium preparations, corticosteroids, ethanol, corticotropin may cause ulcerative lesions Gastrointestinal tract and the development of gastrointestinal bleeding.

Ketorol increases the effect of other nephrotoxic drugs. Simultaneous administration with paracetamol increases the toxic effect on the kidneys, and with methotrexate - on the kidneys and liver. If you want to simultaneous administration with methotrexate, the dose of the latter should be reduced.

Probenecid increases the concentration of Ketorol in the blood plasma. The use of ketorolac may reduce the clearance of methotrexate and lithium, as well as increase the toxicity of these substances.

Combination with indirect anticoagulants, heparin, thrombolytics, antiplatelet agents, cefoperazone, cefotetan and pentoxifylline increases the risk of bleeding.

Reduces the effect of antihypertensive and diuretic drugs.

While taking Ketorol, the dose of opioid analgesics can be significantly reduced.

Strengthens the hypoglycemic effect of insulin and oral hypoglycemic drugs, which requires dose adjustment.

Combination with valproic acid causes disruption of platelet aggregation. Increases the plasma concentration of verapamil and nifedipine.

The clearance of ketorolac can be reduced by drugs that block tubular secretion.

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Any pain or elevated body temperature brings little benefit to anyone positive emotions. Moreover, the appearance of these syndromes always indicates a malfunction of the body, some kind of inflammatory process, or injury. Help you overcome this medicinal product Ketorol. To get to know the drug in more detail, let's look at what Ketorol is - medicine in ampoules, indications for use, instructions for its use.

Instructions for use of Ketorol

Ketorol contains tromethamine, which is the active ingredient of the drug, and has a pronounced analgesic and anti-inflammatory property, it also moderately reduces elevated temperature bodies.

The mechanism of action of the drug is based on the inhibition of the enzymes CEC 1 and CEC 2, most of all at the site of inflammation. This stops the formation of prostaglandins, which are the main “culprits” of pain, inflammation, and increased body temperature.

The medicine Ketorol has important feature, it does not suppress the function of the respiratory center, is not addictive, and does not affect opioid receptors. It does not have a sleeping pill or antidepressant effect, and is not addictive. In terms of analgesic properties, it is close to morphine, and is much superior in analgesia to other drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs). All these actions are explained by the composition of the substances included in Ketorol. After intramuscular administration of ampoule Ketorol, it begins to act after 30 minutes. After oral administration 1 hour, maximum effect achieved in 1-2 hours.

Indications for use of Ketorol are indicated in the instructions:

Ketorol is used for toothache, muscle pain, radiculopathy, psoriatic and rheumatoid arthritis and generally relieves any pain syndrome;
tumors;
V postoperative period;
injuries: fractures, bruises, sprains, dislocations;

Application of Ketorol in ampoules and tablets

The drug is available in ampoules for intramuscular (IM) administration, one ampoule contains 1 ml (30 mg).

The instructions for use of Ketorol say that its dose is selected individually, it all depends on how severe the pain is. Along with taking the drug, you can slightly reduce the dose of narcotic analgesics if the patient’s condition allows.

Up to 65 years of age, patients are prescribed the drug intramuscularly at a rate of 10-30 mg from one to 6 times a day, the most high dose may be 90 mg. Older than this age and with impaired renal function 10-15 mg 1-6 times, maximum dose up to 60 mg. The duration of the course should not exceed 5 days.

The drug is available in tablets of 10 mg, used once a day, maximum 40 mg. The course of treatment is no more than 5 days!

The instructions indicate contraindications for Ketorol. Let's list them:

Allergy to aspirin and other NSAIDs;
Quincke's edema;
tendency to bronchospasms;
reduced volume of circulating blood;
erosions and ulcers in the gastrointestinal tract;
disorders of blood clotting processes;
hemorrhagic stroke and in case of only suspicion of it;
combination with other NSAIDs;
hemorrhagic vasculitis, diathesis;
Ketorol is prohibited during lactation and pregnancy;
increased risk bleeding, including postoperative bleeding;
children under 16 years of age;
nasal polyposis;
impaired renal and liver function;

Unfortunately, like most medications, Ketorol has side effects. Here they are:

Urinary system: lumbar pain, acute renal failure, increase or decrease in the amount of urine per day, edema, nephritis.
Gastrointestinal tract: diarrhea, abdominal pain, ulcers and erosions, bleeding of the stomach or intestines (vomiting “coffee grounds”, melena), heartburn, pancreatitis, nausea, vomiting, bloating.
Nervous system: headaches, hallucinations, dizziness, ringing in the ears, decreased hearing, vision, labile mood, increased body temperature, convulsions (rarely), loss of consciousness.
Respiratory system: laryngeal edema, shortness of breath, bronchospasm, runny nose;
Allergies: anaphylactic shock, urticaria, Quincke's edema, skin itching, heaviness behind the sternum, ;
Blood: bleeding disorders, bleeding tendency, anemia, decreased number of white blood cells and eosinophils.
Skin, mucous membranes: rash, peeling and thickening of the skin, redness, Stevens-Jones and Lyell syndrome, swelling and tenderness of the tonsils.
Heart, blood vessels: increased blood pressure.
Locally: burning, pain at the injection site.
Others: swelling of the face, lower leg, finger, tongue, causeless increase in body temperature, weight gain, increased sweating.

special instructions

On the day of switching from an ampoule to a tablet, the IM dose of Ketorol should not be more than 30 mg, and the total daily dose should not be more than 90/60 mg.

Overdose of Ketorol

An overdose of Ketorol leads to nausea, vomiting, and abdominal pain. There is no antidote in this case, it must be carried out normal procedure"laundering". Ketorol and alcohol are also incompatible; it is better not to mix them.

The estimated cost of Ketorol is 130 rubles. Analogue of Ketorol - Dolak, Adolor, Ketanov, Ketalgin, Ketorolac-Verte, Ketorolac, Ketofril, Ketorolac tromethamine, Torolac, Toradol, Ketolac, Dolomin.

To check the compatibility of the drug with other medicines read the official instructions. And although the package contains instructions for Ketorol in ampoules, the instructions are not a panacea, and therefore the medicine can only be used as prescribed by a doctor!

NSAIDs with a pronounced analgesic effect

Active substance

Release form, composition and packaging

Solution for intramuscular administration colorless or pale yellow, transparent, free from visible foreign particles.

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

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

pharmachologic effect

NSAIDs have a pronounced analgesic effect, as well as anti-inflammatory and moderate antipyretic effects. The mechanism of action is associated with non-selective inhibition of the activity of COX-1 and COX-2, which catalyze the formation of prostaglandins from arachidonic acid, which play an important role in the pathogenesis of pain, inflammation and fever. Ketorolac is a racemic mixture of (-)S- and (+)R-enantiomers, with the analgesic effect due to the (-)S-form.

The drug does not affect opioid receptors, does not depress respiration, does not cause drug dependence, and does not have a sedative or anxiolytic effect.

After intramuscular administration, the development of an analgesic effect is noted after 0.5 hours, the maximum effect is achieved after 1-2 hours.

Pharmacokinetics

Bioavailability - 80-100%. Absorption with intramuscular administration is complete and rapid. After intramuscular administration of 30 mg of the drug, Cmax is 1.74-3.1 µg/ml, 60 mg - 3.23-5.77 µg/ml, the time to reach Cmax is 15-73 minutes and 30-60 minutes, respectively. The time to reach C ss with parenteral administration is 24 hours when administered 4 times a day (above subtherapeutic) and is 0.65-1.13 μg/ml with intramuscular administration, 30 mg - 1.29-2.47 μg/ml. Vd is 0.15-0.33 l/kg. In patients with renal failure, the Vd of the drug may increase by 2 times, and the Vd of its R-enantiomer by 20%.

Penetrates into breast milk: when the mother takes 10 mg of ketorolac, Cmax in 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) is 7.9 ng /l.

More than 50% of the administered dose is metabolized in the liver with the formation of pharmacologically inactive metabolites. The main metabolites are glucuronides, which are excreted by the kidneys, and p-hydroxyketorolac. It is excreted 91% by the kidneys, 6% through the intestines.

T 1/2 in patients with normal function kidneys averages 5.3 hours (3.5-9.2 hours after intramuscular administration of 30 mg). T 1/2 is lengthened in elderly patients and shortened in young ones. Liver function has no effect on T1/2. In patients with impaired renal function with a blood 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.

The total clearance is 0.023 l/kg/h with intramuscular administration of 30 mg (0.019 l/kg/h in elderly patients); in patients with renal failure with a plasma creatinine concentration of 19-50 mg/l with intramuscular administration of 30 mg - 0.015 l/kg/h.

Not excreted during hemodialysis.

Indications

- moderate to severe pain syndrome of various origins(including in the postoperative period, for cancer, etc.)

Contraindications

- “aspirin” 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 (plasma creatinine above 50 mg/l);

- hemorrhagic stroke (confirmed or suspected);

- hemorrhagic diathesis;

- simultaneous use with other NSAIDs;

- high risk of development or recurrence of bleeding (including after operations);

- hematopoiesis disorder;

- pregnancy, childbirth;

- lactation period;

- children under 16 years of age;

— increased sensitivity to ketorolac or other NSAIDs.

The drug is not used for pain relief before and during surgical operations due to the high risk of bleeding, and also for the treatment of chronic pain.

WITH caution- bronchial asthma; cholecystitis; chronic heart failure; arterial hypertension; impaired renal function (plasma creatinine below 50 mg/l); cholestasis; active hepatitis; sepsis; systemic lupus erythematosus; elderly age(over 65 years old); polyps of the nasal and nasopharyngeal mucosa.

Dosage

In the form of an injection solution, Ketorol is administered deeply intramuscularly, in minimally 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 injection: patients under 65 years of age- 10-30 mg depending on the severity of the pain syndrome, - 10-15 mg.

Doses for repeated intravenous administration: patients under 65 years of age 10-30 mg is administered, then 10-30 mg every 4-6 hours, patients over 65 years of age or with impaired renal function- 10-15 mg every 4-6 hours.

Maximum daily dose for patients under 65 years of age should not exceed 90 mg, and for patients over 65 years of age or with impaired renal function- 60 mg.

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 both dosage forms on the day of transfer should not exceed 90 mg for patients under 65 years of age and 60 mg - for 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 - more than 3%; less often - 1–3%; rarely - less than 1%.

From the outside 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 - 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 " coffee grounds", nausea, heartburn), cholestatic jaundice, hepatitis, hepatomegaly, acute pancreatitis.

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

From the senses: rarely - hearing loss, ringing in the ears, visual impairment (including blurred vision).

From the outside respiratory system: rarely - bronchospasm, shortness of breath, rhinitis, laryngeal edema.

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

From the outside of cardio-vascular system: less often - increased blood pressure; rarely - pulmonary edema, fainting.

From the hematopoietic organs: rarely - anemia, eosinophilia, leukopenia.

From the hemostasis system: rarely - bleeding from postoperative wound, nosebleeds, rectal bleeding.

From the outside skin: less often - skin rash (including maculopapular rash), purpura; rarely - exfoliative dermatitis (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 (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 chest, wheezing).

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

Overdose

Symptoms: abdominal pain, nausea, vomiting, erosive and ulcerative lesions of the gastrointestinal tract, renal dysfunction, metabolic acidosis.

Treatment: symptomatic therapy (maintaining vital functions of the body). Not eliminated sufficiently by dialysis.

Drug interactions

The simultaneous use of ketorolac with 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. The simultaneous administration of ketorolac and methotrexate is possible only when using low doses of the latter (it is necessary to monitor the concentration of methotrexate in the blood plasma).

Probenecid reduces the plasma clearance and Vd of ketorolac, increases its concentration in the blood plasma and increases T1/2.

With the use of ketorolac, the clearance of methotrexate and lithium may decrease and the toxicity of these substances may increase.

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.

Increases the hypoglycemic effect of insulin and oral hypoglycemic drugs (dose recalculation is necessary).

Co-administration with causes a violation 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 injection solution should not be mixed in the same syringe with promethazine and hydroxyzine due to precipitation. Pharmaceutically incompatible with tramadol solution and lithium preparations.

The injection solution is compatible with saline, 5% dextrose solution, and Ringer's lactate, Plasmalit solution, as well as with infusion solutions containing aminophylline, lidocaine hydrochloride, dopamine hydrochloride, human insulin short acting and heparin sodium salt.

special instructions

The effect on platelet aggregation ceases after 24-48 hours.

Hypovolemia increases the risk of developing adverse reactions from the kidneys. If necessary, can be prescribed in combination with narcotic analgesics.

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

In a dry place, protected from light, at a temperature not exceeding 25°C. Keep out of the reach of children. Shelf life - 3 years.

Name:

Ketorol

Pharmacological
action:

Ketorol– non-steroidal anti-inflammatory agent with a predominantly analgesic effect. The active ingredient of the drug is ketorolac (ketorolac tromethamine). Ketorolac has moderate antipyretic properties, an anti-inflammatory effect and a pronounced analgesic effect. Ketorolac, predominantly in peripheral tissues, causes indiscriminate inhibition of the activity of cyclooxygenase enzymes types 1 and 2, resulting in inhibition of prostaglandin formation.
Prostaglandins play an important role in the occurrence of pain, inflammatory reactions and the mechanism of thermoregulation. By chemical structure The active substance 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 sedative or antidepressant effect, and does not cause drug dependence.
Analgesic effect Ketorola 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 administration or oral administration begins after 0.5 and 1 hour, respectively. The maximum analgesic effect is observed after 1-2 hours.

Indications for
application:

Local use for pain relief in the following conditions and diseases:

- injuries(soft tissue bruises, soft tissue inflammation, including post-traumatic origin, ligament damage, bursitis, tendonitis, epicondylitis, synovitis and osteoarthritis);
- pain in muscles and joints(myalgia, arthralgia);
- neuralgia;
- radiculitis;
- rheumatic diseases (articular syndrome during exacerbation of gout, psoriatic arthritis, ankylosing spondylitis).

Intended for symptomatic therapy, reducing the intensity of pain and inflammation at the time of use, does not affect the progression of the disease.

Mode of application:

Ketorol tablets
Prescribed for oral administration. Depending on the severity and severity of pain, apply once or repeatedly in a dose of 10 mg (the maximum permissible dose is 4 tablets per day - 40 mg). The duration of 1 course of treatment is no more than 5 days.

Ketorol for intramuscular administration
The minimum effective dose is selected individually, which depends on the patient’s therapeutic response and the intensity of the pain syndrome. If necessary, reduced doses of opioid analgesics can be prescribed in parallel.
For people under 65 years of age, 10-30 mg of the drug is used intramuscularly once or repeatedly (every 4-6 hours) at 10-30 mg. For patients over 65 years old, as well as for those with 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 permissible 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 dose of Ketorol for oral administration should not exceed 30 mg. The total daily 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 age over 65 years - 60 mg/day.

Side effects:

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

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

From the digestive system: diarrhea and gastralgia, especially in patients over 65 years of age who have 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, vomiting like “coffee grounds”, heartburn, melena, nausea) and perforation of the wall of the gastrointestinal tract, hepatitis, acute pancreatitis, cholestatic jaundice, hepatomegaly (rare).

From the central nervous system: headache, drowsiness, dizziness (often); depression, hallucinations, psychosis, ringing in the ears, hearing loss, blurred vision (including blurred vision), hyperactivity (restlessness, mood changes), aseptic meningitis (severe headache, fever, stiff back and/or neck muscles, convulsions) - rarely.

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

Allergic reactions: anaphylactoid reactions or anaphylaxis (skin rash, change in facial skin color, itchy skin, urticaria, dyspnea or tachypnea, periorbital edema, swelling of the eyelids, difficulty breathing, shortness of breath, wheezing, heaviness in the chest) - rare.
From the blood coagulation system: nosebleeds, bleeding from a postoperative wound, bleeding from the intestines (rare).

From the hematopoietic organs: eosinophilia, anemia, leukopenia (rare).

Skin reactions: purpura and skin rash, including maculopapular rash (less common); urticaria, exfoliative dermatitis (fever with or without chills, peeling or hardening of the skin, redness, tenderness and/or swelling of the tonsils), Lyell's syndrome, Stevens-Johnson syndrome (rare).

From the cardiovascular system: slight increase 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 common).

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

Contraindications:

Aspirin triad;
- angioedema;
- bronchospasm;
- hypersensitivity to tromethamine ketorolac and/or other NSAIDs;
- 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);
- hematopoiesis disorder;
- hemorrhagic diathesis;
- pregnancy, childbirth, lactation;
- high risk of bleeding (including postoperative);
- age up to 16 years.

Interaction
other medicinal
by other means:

Combination of paracetamol and Ketorol increases the risk of toxic effects on kidney tissue, with methotrexate – causes increased nephro- and hepatotoxicity.
The simultaneous administration of ketorolac with calcium supplements, glucocorticosteroids, acetylsalicylic acid, non-steroidal anti-inflammatory drugs from other groups, corticotropin and ethanol can provoke ulceration in the gastrointestinal mucosa, which threatens the development of gastrointestinal bleeding.
During 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.

Concomitant use with anticoagulants indirect action, thrombolytics, heparin, cefoperazone, antiplatelet agents, pentoxifylline and cefotetan increases the possible risk of bleeding.
Ketorol reduces the effect of antihypertensive and diuretic drugs, since 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 when prescribing 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 the content in the blood plasma of nifedipine and verapamil.
When used simultaneously with 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 nephrotoxic effects (including gold-containing drugs), the risk of nephrotoxicity increases.
Drugs that inhibit tubular secretion reduce the clearance of ketorolac tromethamine and increase its concentration in the blood serum.
When combining the drug with opioid analgesics, a significant reduction in the dosage of the latter is possible.
Co-administration of sodium valproate and Ketorola leads to impaired platelet aggregation.
Pharmaceutically, tromethamine ketorolac is incompatible with lithium preparations and tramadol solution.

Do not mix the solution for intramuscular administration of Ketorol in one syringe with promethazine, morphine sulfate and hydroxyzine, since they react chemically with precipitation.
Solution for intramuscular administration of Ketorol is compatible with 5% dextrose solution, isotonic sodium chloride solution, plasmalit, lactated Ringer's 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.

Pregnancy:

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

Overdose:

Possible signs Ketorol overdose: nausea, abdominal pain, vomiting, peptic ulcers or erosive lesions gastrointestinal tract, metabolic acidosis, renal dysfunction.
Treatment: gastric lavage followed by the administration of adsorbent drugs, symptomatic treatment. Not excreted to a significant extent by dialysis methods.

Release form:

Ketorol tablets: round, green-coated, with the symbol “S” on 1 side, biconvex, containing 10 mg of ketorolac tromethamine. The fracture is white or almost white. There are 20 pieces in a package (10 pieces in each blister).

Ketorol – solution for intramuscular administration in dark glass ampoules containing 1 ml of Ketorol (30 mg of tromethamine ketorolac). 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– no higher than 25°C.
Best before date- 3 years.
Protect from children's access.
Prescription leave from pharmacies.

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