Ketorol belongs to the group of nonsteroidal anti-inflammatory drug with pronounced analgesic effects with the main active substance under the name Ketorolac. As with all drugs of the group of non-steroidal anti-inflammatory substances, ketorol exhibits a moderate antipyretic and anti-inflammatory with good analgesic effect. In oral administration of ketorol tablets, the active ingredient of the drug being absorbed through the gastrointestinal tract, causing non-selective inhibition of enzymes in the cascade, cyclooxygenase, which leads to further suppression of the synthesis of prostaglandins.
Ketorol it binds with opioid receptors of the cellular membrane, does not affect the functioning of the respiratory center of the medulla oblongata and has no sedative effect.
Pain syndrome in various diseases of the spine it is possible to quickly and effectively terminate with a highly effective drug ketorol.
Analgesic effect ketorol has a comparable morphine, but he is much stronger than other drugs from this group. Analgesic effect of the drug after oral administration of tablets develops in 60 minutes, and the most intense analgesic effect – in 1-2 hours. In addition, ketorol contributes to the development of addiction and dependence on the drug.
The ingestion of the tablet of ketorol is well and rapidly absorbed in the gastrointestinal tract. The bioavailability of ketorol is in the area of 80-100%. Affinity to proteins of blood plasma – 99%.
Ketorol it penetrates in breast milk: for single intake maximum concentration is reached in breast milk in 2 hours.
The metabolism of the bulk of the drug occurs in the liver with formation of inactive compounds – glucuronides. The excretion of the latter is unchanged in the kidneys in a small amount of excretion occurs through the intestine (about 9%).
Indications for use
The use of ketorol tablets are indicated for the relief of pains of different origin and of varying severity, including tumor pathology and after performing invasive procedures. Tablet form of the drug used, when it is possible to dispense with the use of the injectable form in the treatment of radiculitis, rheumatism and rheumatic diseases, cupping toothache, relief of pain of vertebral origin, sprains and strains, myalgia and arthralgia.
Application method and features of the destination
In the form of tablets ketorol credited for oral administration. Individual easily tolerated dose of the drug and application instruction is determined by the type of pain and its severity. For a single dose the optimal dose is 10 mg. If you are particularly strong in the severity of pain a single starting dose for persons older than 16 and younger than 64 with body weight more than 50 kg can be 20 mg (2 tablets). For use for individuals weighing less than 50 kg, the recommended dose is 10 mg.
The highest dose that can be taken in 24 hours should not exceed 40 mg (tablets). In case of pronounced pain syndrome possible re-use of the drug. The course of treatment tablet form of the drug should not be more than 5 days.
Side effects are divided into:
- frequent (frequency of occurrence more than 3%);
- the average frequency (occurrence 1 to 3%);
- rare (frequency of less than 1%);
Organs of the urinary tract possible the appearance of pain in the lumbar region, hematuria, signs of acute renal failure, oliguria or polyuria, swelling.
For the gastrointestinal tract likely to occur, such side reactions as disorders of stool and the appearance of pain in the epigastric region (which is quite often seen in individuals older than 65 years with a history of erosive or ulcerative disease); flatulence in the bowels; constipation; defeat mucous membrane of the oral cavity with the occurrence of stomatitis; vomiting; gastrointestinal bleeding; perforation of the stomach wall or intestine; signs of stagnation in the hepatobiliary system; enlargement of the liver. Possible rectal bleeding.
CNS: dizziness, drowsiness, lethargy, headaches; manifestation of depression and psychosis, noise and tinnitus, the appearance of moderate severity of disorders of hearing and vision (disorder processes of accommodation), the appearance of symptoms of aseptic meningitis.
From the broncho-pulmonary system: swelling of the larynx with the occurrence of dyspnea or asthmatic component.
Allergic reactions are possible anaphylactoid-type reactions, urticaria, swelling of the eyelids, the presence of various skin rashes, hives, expression of Lyell’s syndrome and Stevens-Johnson.
On the part of the organs of hematopoiesis and hemostasis, the possible emergence of nasal bleeding, bleeding from wounds, the appearance of anaemia, eosinophilia and leukopenia.
- aspirin triad (a combination of intolerance of drugs pirazolonovogo series with the presence of asthma and polyps of the nose);
- hypersensitivity to nonsteroidal anti-inflammatory drugs;
- hypovolemia of different etiology;
- diseases of the gastrointestinal tract peptic ulcer etiology in the acute stage;
- of the disease by the blood coagulation system and system of hematopoiesis;
- organic lesions of the Central nervous system;
- renal failure;
- early and late terms of pregnancy, childbirth, lactation;
- the post-operative condition, complicated by postoperative bleeding;
- the age of 16;
- the drug is not recommended as a means of anesthesia or to prepare for it.
Function during pregnancy
Ketorol contraindicated in all women during pregnancy. In case there is an urgent need to use ketorol during lactation, breastfeeding during the therapy is not carried out, but the lactation are trying save it by pumping breastmilk. About 10% of the drug crosses the blood-placental barrier.
Interaction with other medications
Increased risk of toxic injury of the liver tissue with concomitant nephrotoxicity possible with the simultaneous use of ketorol tablets and medicines containing paracetamol. In this regard, it is not necessary to assign ketorol tablets with paracetamol more than 5 days.
Not recommended to use a tablet of ketorol with calcium supplementation, hormonal therapy and other non-steroidal anti-inflammatory drugs and etanolsodergaszczye products. Concomitant use may cause the patient education nonhealing ulcers and erosions in the gastrointestinal tract and trigger the development of complications such as bleeding.
Tablet of ketorol is not recommended to use with anticancer drugs and drugs with cytostatic type of action, as this may cause a decrease in renal excretory function. Manual combining of these drugs is possible only if the expected benefit from the simultaneous use outweighs the potential risk of all possible complications.
Increased risk of bleeding occurs when you combine ketorol drugs, the statement which indicates the effect of the drug on the hemostatic system. In the case of exceptional need may prescription of ketorol with drugs of this group are under the constant control of the deployed coagulation of the patient.
Ketorol helps to reduce the effects of drugs aimed at lowering blood pressure, and diuretics, as it helps to reduce the concentration of prostaglandins in the kidneys.
In combination with oral hypoglycemic drugs and insulin with tablets of ketorol is the potentiation of the effect of the latter that determines the adjustment of the dosage of the latter and careful attention to the use of ketorol in combination with these drugs, but not as much as the instruction of General application. In appointing the drug with nephrotoxic effects of drugs, further increases the risk of nephrotoxicity.
Medicines reducing or completely inhibiting the secretion in the tubules of the nephron, reduce clearance of active ingredient of ketorol and increase its concentration in the blood serum.
Platelet aggregation violates the combination of sodium valproate and ketorol.
Ketorolac is contraindicated in concomitant therapy with lithium-containing drugs tramadol.
Symptoms of overdose that causes ketorol: dyspepsia, nausea, abdominal pain, the appearance of peptic ulcers of erosive lesions of the bowel, acidosis, disorders of renal function. Therapy the ingestion of high doses of the drug consists in gastric lavage, appointment of adsorbents (activated carbon, etc.). Symptomatic therapy should be aimed at maintaining vital body functions. The use of dialysis techniques for the treatment of overdose ineffective.
Release form of the drug
Tablet form of the drug is a rounded shell pill light green color, with the symbol S on 1 side, 10 mg of Ketorolac tromethamine. On the fracture of the tablets are of white color. Pack of 20 pieces (10 pieces in one blister). The drug in the vials (injections) and as an ointment.
Conditions of supply of pharmacies and storage
The drug retain, under list B in dry, ventilated place with low light, no access to children at temperature not exceeding 25°C. method of preparation for parenteral administration do not freeze. Shelf life – 3 years. The drug is released from pharmacies by prescription.