Ketorolac Contraindications, Pregnancy Category

Ketorolac Indications

• For the short-term (5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting.
• Pain due to road traffic accident.
• Postoperative pain
• Acute dental pain
• Acute pain due to trauma
• Accidental pain
• Acute abdominal pain due to gastritis/appendicitis
• Ankylosing spondylitis
• Pain due to especially musculoskeletal system
• Lumbago
• Low back pain
• PLID
• Polyarthralgia
• Cystoid macular edema
• Inflammatory reaction
• A migraine, acute
• Ocular itching
• Ocular pain
• Pseudophakic cystoid macular edema
• Acute pericarditis
• Chronic aphakic cystoid macular edema
• Intraoperative miosis
• Moderate acute pain
• Severe acute pain

Ketorolac Contraindications

• Allergy to tramadol hydrochloride or any other ingredients in the medicine;
• Allergy to medicines called opioid antagonists (e.g. codeine, morphine);
• Consumed alcohol taken another drug which affects your brain. These include:
• Some painkillers, including opioid painkillers;
• Hypnotic drugs;
• Psychotropic drugs;
• Used monoamine oxidase inhibitors (MAOIs) such as phenelzine or tranylcypromine
• Epilepsy;
• Addiction or are recovering from addiction to another medication.
• History of peptic ulcer disease,
• Gastrointestinal bleeding,
• Alcohol intolerance,
• Renal impairment,
• Cerebrovascular bleeding,
• Nasal polyps,
• Angioedema, and asthma
• Acute intoxication with alcohol,
• Hypnotics,
• Heart failure,
• Coagulation disorders,
• Renal impairment,
• Hepatic impairment.

 Dosage of Ketorolac

Dose for Pain

The combined duration of use of parenteral, oral, and intranasal ketorolac should not exceed 5 days; the oral formulation is only to be used as the continuation to IV or IM therapy.

Intranasal

• Weight 50 kg or more: 31.5 mg every 6 to 8 hours (1 spray in each nostril)
• Weight less than 50 kg: 15.75 mg every 6 to 8 hours (1 spray in 1 nostril)
• Maximum dose: 4 doses per day

Parenteral, Single-Dose Treatment

• Weight 50 kg or more: 60 mg IM or 30 mg IV
• Weight less than 50 kg: 30 mg IM or 15 mg IV

Multiple-Dose Treatment

• Weight 50 kg or more: 30 mg IM/IV every 6 hours as needed
• Maximum dose: 120 mg/day
• Weight less than 50 kg: 15 mg IM/IV every 6 hours as needed
• Maximum dose: 60 mg/day

Oral, as the continuation to parenteral therapy

• Weight 50 kg or more: 20 mg orally once followed by 10 mg every 4 to 6 hours as needed
• Weight less than 50 kg: 10 mg orally once followed by 10 mg every 4 to 6 hours as needed
• Maximum dose: 40 mg/day

Geriatric Pain

The combined duration of use of parenteral, oral, and intranasal ketorolac should not exceed 5 days; the oral formulation is only to be used as the continuation to IV or IM therapy.

Intranasal

• Dose: 15.75 mg every 6 to 8 hours (one spray in 1 nostril)
• Maximum dose: 4 doses per day

Parenteral

• Single-Dose Treatment: 30 mg IM or 15 mg IV
• Multiple-Dose Treatment: 15 mg IM/IV every 6 hours as needed
• Maximum dose: 60 mg/day

Oral, as the continuation to parenteral therapy

• Dose: 10 mg orally once followed by 10 mg every 4 to 6 hours as needed
• Maximum dose: 40 mg/day

Pediatric Pain

The combined duration of use of parenteral, oral, and intranasal ketorolac should not exceed 5 days; the oral formulation is only to be used as continuation therapy to IV or IM.

Intranasal Age: Greater than 17 years

• Weight 50 kg or more: 31.5 mg every 6 to 8 hours (1 spray in each nostril)
• Weight less than 50 kg: 15.75 mg every 6 to 8 hours (1 spray in 1 nostril)
• Maximum: 4 doses per day

Oral, as the continuation of parenteral therapy, Age: 17 years or older

• Weight 50 kg or more: 20 mg orally once followed by 10 mg every 4 to 6 hours as needed
• Weight less than 50 kg: 10 mg orally once followed by 10 mg every 4 to 6 hours as needed
• Maximum dose: 40 mg/day

Parenteral Age: 17 years or older

• Single-Dose Treatment:
• Weight 50 kg or more: 60 mg IM or 30 mg IV
• Weight less than 50 kg: 30 mg IM or 15 mg IV

Multiple-Dose Treatment

• Weight 50 kg or more: 30 mg IM/IV every 6 hours as needed
• Maximum dose: 120 mg/day
• Weight less than 50 kg: 15 mg IM/IV every 6 hours as needed
• Maximum dose: 60 mg/day

Age: 2 to 16 years, Single-Dose Treatment

• IM: 1 mg/kg up to a maximum of 30 mg
• IV: 0.5 mg/kg up to a maximum of 15 mg
• Maximum dose: 1 dose

Side Effects of Ketorolac

The most common

• GI disorders (e.g. dyspepsia, abdominal pain, nausea, vomiting, diarrhea, flatulence, constipation,, ulcerative stomatitis, ), indigestion,
• Disturbances of the gut such as diarrhea, constipation, nausea, vomiting or abdominal pain.
• Drowsiness and lightheadedness
• Nausea and vomiting
• joint pain
• Nausea and vomiting
• Severe stomach ache
• Severe diarrhea
• Vaginal thrush
• Skin rash
• A headache
• Chest pain
• Diarrhea or loose stools
• Difficulty with breathing
• Dizziness
• Heartburn
• Muscle pain

More common

• Abdominal or stomach pain,
• Chills or fever
• A headache,
• Joint or back pain
• Muscle aching or cramping
• Muscle pains or stiffness
• Chest pressure or squeezing pain in the chest
• Excessive sweating
• feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
• sudden tingling or coldness in an arm or leg
• Constipation
• Diarrhea
• Loss of muscle coordination
• Sleepiness or unusual drowsiness
• Clumsiness or unsteadiness
• Drowsiness

Rare

• Anxiety
• change in vision
• seizures
• abnormal or fast heart rate
• tremors
• weight loss
• chest pain or tightness
• confusion
• a cough
• Agitation
• arm, back, or jaw pain
• blurred vision
• chest pain or discomfort
• convulsions
• extra heartbeats
• fainting
• hallucinations
• a headache
• irritability
• lightheadedness
• mood or mental changes
• muscle pain or cramps
• muscle spasm or jerking of all extremities
• muscle pains or stiffness
• chest pressure or squeezing pain in the chest
• discomfort in arms, shoulders, neck or upper back

Drug Interactions of Ketorolac

Ketorolac may interact with following drugs, supplements & may change the efficacy of drugs

• aminoglycoside antibiotics (e.g., amikacin, gentamicin, tobramycin)
• angiotensin-converting enzyme inhibitors (ACEIs; e.g., captopril, enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• beta-adrenergic blockers (e.g., metoprolol, atenolol)
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• celecoxib
• cilostazol
• clopidogrel
• corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
• cyclosporine
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• 5-ASA medications (e.g, sulfasalazine)
• glucosamine
• haloperidol
• heparin
• methotrexate
• multivitamins
• other non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, ketorolac, naproxen)
• Omega-3 fatty acids
• pentoxifylline
• quinolone antibiotics (e.g., ciprofloxacin, ofloxacin)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine,fluoxetine, paroxetine, sertraline)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g, duloxetine, )
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• warfarin

Pregnancy & Lactation of Ketorolac

FDA Pregnancy Category C

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. It must not be used during the last 3 months of pregnancy as it may cause heart and kidney problems for the developing baby and cause prolonged labor with excessive bleeding during delivery.

Breastfeeding

This medication passes into breast milk. If you are a breastfeeding mother and are taking ketorolac, it may affect your baby. Breastfeeding is not recommended while you are taking ketorolac.