Ketorolac tromethamine
Ketorolac tromethamine (Acular, Toradol)
Ketorolac tromethamine
(kee-toh- ROH-lack)
Pregnancy Category: C Acular Acular PF Toradol Toradol IM (Rx)

Classification: Nonsteroidal anti-inflammatory drug

See Also: See also Nonsteroidal Anti-Inflammatory Drugs .

Action/Kinetics: Possesses anti-inflammatory, analgesic, and antipyretic effects. Completely absorbed following IM use. Onset: Within 30 min. Maximum effect: 1-2 hr after IV or IM dosing. Duration: 4-6 hr. Peak plasma levels: 2.2-3.0 mcg/mL 50 min after a dose of 30 mg. t 1/2, terminal: 3.8-6.3 hr in young adults and 4.7-8.6 hr in geriatric clients. Over 99% is bound to plasma proteins. Metabolized in the liver with over 90% excreted in the urine and the remainder excreted in the feces.

Uses: PO: Short-term (up to 5 days) management of severe, acute pain that requires analgesia at the opiate level. Always initiate therapy with IV or IM followed by PO only as continuation treatment, if necessary. IM/IV: Ketorolac has been used with morphine and meperidine and shows an opioid-sharing effect. The combination can be used for break through pain. Ophthalmic: Relieve itching caused by seasonal allergic conjunctivitis. Reduce ocular pain and photophobia following incisional refractive surgery (Acular PF).

Contraindications: Hypersensitivity to the drug, incomplete or partial syndrome of nasal polyps, angioedema, and bronchospasm due to aspirin or other NSAIDs. Use in clients with advanced renal impairment or in those at risk for renal failure due to volume depletion. Use in suspected or confirmed cardiovascular bleeding, hemorrhagic diathesis, or incomplete hemostasis and in those with a high risk of bleeding. Use as an obstetric preoperative medication or for obstetric analgesia. Routine use with other NSAIDs. Intrathecal or epidural administration. Use in labor and delivery. Use of the ophthalmic solution in clients wearing soft contact lenses.

Special Concerns: Use with caution in impaired hepatic or renal function, during lactation, in geriatric clients, and in clients on high-dose salicylate regimens. The age, dosage, and duration of therapy should receive special consideration when using this drug. Safety and effectiveness have not been determined in children.

Additional Side Effects: CV: Vasodilation, pallor. GI: GI pain, peptic ulcers, nausea, dyspepsia, flatulence, GI fullness, stomatitis, excessive thirst, GI bleeding (higher risk in geriatric clients), perforation. CNS: Headache, nervousness, abnormal thinking, depression, euphoria. Hypersensitivity: Bronchospasm, anaphylaxis. Miscellaneous: Purpura, asthma, abnormal vision, abnormal liver function.
Ophthalmic solution: Transient stinging and burning following instillation, ocular irritation, allergic reactions, superficial ocular infections, superficial keratitis.

Drug Interactions: Ketorolac may plasma levels of salicylates due to plasma protein binding.

How Supplied: Injection: 15 mg/mL, 30 mg/mL; Ophthalmic solution: 0.5%; Tablet: 10 mg

Dosage
?IM Analgesic, single dose.
Adults: less than 65 years of age: One 60-mg dose. Adults, over 65 years of age, in renal impairment, or weight less than 50 kg: One 30-mg dose.
Analgesic, multiple dose.
Adults, less than 65 years of age: 30 mg q 6 hr, not to exceed 120 mg daily. Adults, over 65 years of age, in renal impairment, or weight less than 50 kg: 15 mg q 6 hr, not to exceed 60 mg daily.
?IV Analgesic, single dose.
Adults, less than 65 years of age: One 30-mg dose. Adults, over 65 years of age, in renal impairment, or weight less than 50 kg: One 15-mg dose.
?Tablets Transition from IV/IM to PO.
Adults less than 65 years of age: 20 mg as a first PO dose for clients who received 60 mg IM single dose, 30 mg IV single dose, or 30 mg multiple dose IV/IM; then 10 mg q 4-6 hr, not to exceed 40 mg in a 24-hr period. Adults, over 65 years of age, in renal impairment, or weight less than 50 kg: 10 mg as a first PO dose for those who received a 30-mg IM single dose, a 15-mg IV single dose, or a 15-mg multiple dose IV/IM; then 10 mg q 4-6 hr, not to exceed 40 mg in a 24-hr period.
?Ophthalmic Solution Seasonal allergic conjunctivitis.
1 gtt (0.25 mg) q.i.d. Efficacy has not been determined beyond 1 week of use.
Following cataract extraction.
1 gtt to the affected eye(s) q.i.d. beginning 24 hr after surgery and continuing for 2 weeks postoperatively.
Ocular pain and photophobia after incisional refractive surgery.
1 gtt (0.25 mg) q.i.d. for up to 3 days after surgery.