Product Name: Ketorolac
Common Brand Names: Toradol
Pharmaceutical Category: Pain Relief / Muscle Relaxants / Eye Care
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There is an additional general information about this medication active ingredient ketorolac:
Ketorolac is a NSAID, derivative of pyrrolizine-carboxylic acid. This medication has a marked analgesic effect, also has anti-inflammatory and mild antipyretic action. The mechanism of action is associated with inhibition of COX activity - the main enzyme metabolism of arachidonic acid, a precursor of prostaglandins, which play a major role in the pathogenesis of inflammation, pain and fever.
After oral administration Ketorolac is absorbed from the gastrointestinal tract. Cmax plasma levels achieved after 40-50 min after ingestion as well as after IM administration. Ingestion has no effect on absorption. Plasma protein binding of this drug is more than 99%.
T1/2 is 4-6 hours after ingestion as well as after IM administration.
More than 90% of the dose is excreted in the urine; as unchanged - 60%, the remainder - through the intestines.
Patients with impaired renal function and the elderly the elimination rate is reduced, T1/2 increases.
Why is Ketorolac prescribed?
For short-term relief of moderate and severe pain of various origins.
Dosage and administration
For adults oral administration the dose is 10 mg every 4-6 hours, if necessary up to 20 mg 3-4 times / day.
For IM administration a single dose is 10-30 mg, the interval between doses - 4-6 hours.
Maximum doses: for ingestion or IM injection - 90 mg / day; for patients weighing up to 50 kg, renal impairment, as well as for those over 65 years - 60 mg / day.
Ketorolac side effects, adverse reactions
Cardiovascular system: rarely - bradycardia, changes in blood pressure, palpitations, syncope.
Digestive system: nausea, abdominal pain, diarrhea, rarely - constipation, flatulence, gastrointestinal fullness, vomiting, dry mouth, thirst, stomatitis, gastritis, erosive and ulcerative lesions of the gastrointestinal tract, liver function abnormalities.
CNS and peripheral nervous system: restlessness, headache, drowsiness, rarely - paresthesia, depression, euphoria, insomnia, dizziness, change in taste, visual disturbances, motor disturbances.
Respiratory system: rarely - respiratory failure, asthma.
Urinary system: rarely - increased frequency of urination, oliguria, polyuria, proteinuria, hematuria, azotemia, acute renal failure.
Blood coagulation system: rarely - nosebleeds, anemia, eosinophilia, thrombocytopenia, bleeding from postoperative wounds.
Metabolism: possible increased sweating, swelling, rarely - oliguria, increased creatinine and / or urea in blood plasma, hypokalemia, hyponatremia.
Allergic reactions: possible pruritus, hemorrhagic eruption; in single cases - exfoliative dermatitis, urticaria, Lyell syndrome, Stevens-Johnson syndrome, anaphylactic shock, bronchospasm, angioedema, myalgia.
Local reactions: pain at the injection site.
Erosive-ulcerative lesions of the gastrointestinal tract in acute phase, the presence or suspicion of gastrointestinal bleeding and / or cranio-cerebral hemorrhage, blood clotting in the history of the state with a high risk of haemorrhage or incomplete haemostasis, bleeding diathesis, moderate and severe renal dysfunction (serum creatinine content greater than 50 mg / L), risk of renal failure in hypovolaemia and dehydration, "aspirin triad", bronchial asthma, nasal polyps, angioedema in the history, prophylactic analgesia before surgery and during surgery, childhood and adolescence to 16 years, pregnancy, childbirth, lactation, hypersensitivity to ketorolac, aspirin and other NSAIDs.
Using during pregnancy and breastfeeding
Ketorolac is contraindicated in pregnancy, childbirth and lactation (breastfeeding). Ketorolac is contraindicated for use as a tool for sedation, maintenance of anesthesia and analgesia in obstetric practice, because under its influence may increase the duration first stage of labor. In addition, this medication may inhibit the contractility of uterine and fetal circulation.
Category of the fetus by FDA - C.
Ketorolac is used with caution in patients with impaired liver function and kidney failure, congestive heart failure, hypertension, patients with erosive and ulcerative lesions of the gastrointestinal tract and bleeding from the gastrointestinal tract in history.
This drug should be used with caution in the postoperative period in cases that require especially careful hemostasis (including after resection of the prostate, tonsillectomy, in cosmetic surgery) as well as in patients with old age, because half-life of ketorolac is lengthened, and the plasma clearance may be reduced.
If during the treatment by ketorolac drowsiness, dizziness, insomnia or depression appear you must be very careful while playing in potentially hazardous activities that require attention and psychomotor speed of reaction.
Ketorolac drug interactions
When this drug applied simultaneously with:
- other NSAIDs may develop additive effects
- pentoxifylline, anticoagulants (heparin, including in low-dose) may increase the risk of bleeding
- ACE inhibitors may increase the risk of renal dysfunction
- probenecid increases the concentration of ketorolac in plasma and its half-life period
- lithium therapy may reduce renal clearance of lithium and increase its concentration in plasma
- furosemide - a decrease in its diuretic action.
During taking Ketorolac the need for opioid analgesics to pain relief reduces.
Ketorolac in case of emergency / overdose
Symptoms: lethargy, drowsiness, nausea, vomiting, abdominal pain, the occurrence of peptic ulcers of stomach and / or erosive gastritis, renal failure, metabolic acidosis.
Treatment: symptomatic therapy, the maintenance of vital body functions. The specific antidote is not found. Ketorolac is not excreted sufficiently by dialysis.