Ketorol instructions for use. Painkiller "Ketorol": instructions for use. Ketorol is used for short-term treatment of moderate pain

Analgesic and non-steroidal anti-inflammatory drugs

Ketorol

pharmachologic effect

Ketorol is a non-steroidal anti-inflammatory drug 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 pain, inflammatory reactions and the mechanism of thermoregulation. According to chemical structure active substance Ketorol is a racemic mixture of +R- and -S- enantiomers, and the analgesic effect of the drug is due 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. The analgesic effect of Ketorol 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 use

For the relief of pain caused by any reason, severe or medium degree severity (including oncological pathology and pain in the period after surgical interventions).

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 of 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, jade (rare).

From the outside 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 coffee grounds", heartburn, melena, nausea) and perforation of the wall of the gastrointestinal tract, hepatitis, acute pancreatitis, cholestatic jaundice, hepatomegaly (rare).

From the central side nervous system: headache, drowsiness, dizziness (often); depression, hallucinations, psychosis, ringing in the ears, hearing impairment, 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 (rarely).

Allergic reactions: anaphylactoid reactions or anaphylaxis (skin rash, change in facial skin color, itching of the skin, urticaria, dyspnea or tachypnea, periorbital edema, swelling of the eyelids, difficulty breathing, shortness of breath, wheezing, heaviness in chest) - rarely.

From the blood coagulation system: nose bleed, 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 outside of cardio-vascular system: slight increase blood pressure(less often); pulmonary edema, loss of consciousness (rare).

Local reactions when injected into a muscle: pain or burning at the injection site (less often).

Others: 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);

hematopoietic disorder;

hemorrhagic diathesis;

pregnancy, childbirth, lactation;

high risk of bleeding (including postoperative);

age up to 16 years.

Pregnancy

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

Interaction with other drugs

The combination of paracetamol and Ketorol increases the risk of toxic effects on renal tissue, with methotrexate it causes increased nephro- and hepatotoxicity.

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

Ketorol reduces the effect of antihypertensive and diuretic drugs because 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 plasma levels 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.

The combined administration of sodium valproate and Ketorol leads to impaired platelet aggregation.

Pharmaceutically, tromethamine ketorolac is incompatible with lithium preparations and tramadol solution.

You should not mix the solution for intramuscular administration of Ketorol in the same syringe with promethazine, morphine sulfate and hydroxyzine, since they enter into chemical reaction with precipitation.

Solution for intramuscular administration of Ketorol is compatible with 5% dextrose solution, isotonic solution sodium chloride, 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 short-acting human insulin.

Overdose

Possible signs of an overdose of Ketorol: nausea, abdominal pain, vomiting, peptic ulcers or erosive lesions of the gastrointestinal tract, metabolic acidosis, impaired renal function.

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 is a solution for intramuscular administration in dark glass ampoules containing 1 ml of Ketorol (30 mg of ketorolac tromethamine). There are 10 ampoules in a blister.

Storage conditions

Store according to list B. The storage location should be dry and protected from light. Temperature – no higher than 25°C. Shelf life – 3 years. Protect from access by children. Prescription supplies from pharmacies.

Synonyms

Ketalgin, Dolak, Adolor, Ketorol, Ketanov, Ketorolac, Nato, Ketrodol, Torolak, Ketalgin, Toradol.

Compound

Ketorol tablets

Inactive ingredients: 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.

Additionally:

It is not recommended to prescribe Ketorol as a component for premedication, analgesia in obstetric practice and maintenance anesthesia due to the significant risk of bleeding. Not indicated in the treatment of chronic pain syndrome.

The effect of the active substance Ketorol on platelet aggregation is observed for 1-2 days.

For patients with disorders of the blood coagulation system, ketorolac is prescribed if constant monitoring of the platelet count is carried out - this is especially important when reliable hemostasis is necessary (postoperative period).

Prescribe with caution in case of cholecystitis, bronchial asthma, arterial hypertension, chronic heart failure, impaired renal function (with serum creatinine less than 50 mg/l), active hepatitis, cholestasis, systemic lupus erythematosus, sepsis, polypous growths in the nasopharynx and nasal mucosa, elderly patients over 65 years of age.

The risk of developing side effects from the urinary system increases with hypovolemia.

Ketorol, if necessary, can be used in combination with opioid analgesics.

When using Ketorol, a significant number of patients develop side effects from the central nervous system (for example, drowsiness, headache, dizziness), therefore it is better to avoid performing activities that require quick reaction and increased attention (working with machinery, driving vehicles).

Attention

Before using the drug Ketorol you should consult your doctor. This instruction is given in free translation and is intended for informational purposes only. For more complete information, please refer to the manufacturer's instructions.

Ketorol is a drug whose active substance is ketorolac, belongs to the NSAIDs, has an analgesic, anti-inflammatory and antipyretic effect.

It is used to eliminate pain of varying degrees of intensity and various etiologies (including postoperative pain and cancer pain).

On this page you will find all the information about Ketorol: full instructions on application to this drug, average prices in pharmacies, complete and incomplete analogues of the drug, as well as reviews of people who have already used Ketorol. Would you like to leave your opinion? Please write in the comments.

Clinical and pharmacological group

NSAIDs with a pronounced analgesic effect.

Conditions for dispensing from pharmacies

Dispensed with a doctor's prescription.

Prices

How much do Ketorol tablets cost? The average price in pharmacies is 45 rubles.

Release form and composition

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.

In all dosage forms of Ketorol as active substance Ketorolac is included in various concentrations. So, the tablets contain 10 mg of ketorolac, the solution contains 30 mg per 1 ml, and the gel contains 20 mg per 1 g (2%).

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 different quantities blisters, from which the price of the drug is radically different.

Pharmacological 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 pain, inflammatory reactions and the mechanism of thermoregulation. According to the 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. The analgesic effect of Ketorol 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 use

In the form of a solution and tablets, Ketorol is used to relieve pain of various origins of medium and severe intensity:

Dislocations, sprains, other injuries and their consequences;
Rheumatic diseases;
Toothache;
Radiculitis, neuralgia;
Myalgia, arthralgia;
Pain in the postoperative and postpartum period;
Oncological diseases.

In the form of a gel, the drug is used topically for pain caused by the following diseases:

Bursitis, epicondylitis, tendinitis, synovitis;
Rheumatic diseases;
Radiculitis, neuralgia;
Arthralgia, myalgia;
Injuries (ligament damage, bruises and inflammation of soft tissues, including post-traumatic origin).

Contraindications

Hyperkalemia;
Lactase deficiency;
Patients' age is up to 16 years;
Pregnancy and lactation;
Gastrointestinal bleeding or suspicion of it;
Ulcerative colitis or in the acute phase;
History of asthma attacks, bronchospasms, frequent obstructive bronchitis;
Severe damage to the liver and kidneys, accompanied by disruption of the functioning of these organs;
Hereditary blood diseases accompanied by a violation of its coagulation function;
Individual intolerance to acetylsalicylic acid or drugs from the group of non-steroidal anti-inflammatory drugs;
Chronic diseases of the gastrointestinal tract with the presence of ulcerative-erosive surfaces

Relative contraindications include:

Cardiac ischemia;
Diabetes;
Heart failure;
Cholestasis;
Patient age over 60 years;
Concomitant use of anticoagulants or antiplatelet agents.

Use during pregnancy and lactation

The solution and tablets are contraindicated during pregnancy and breastfeeding.

External use is allowed in the 1st and 2nd trimesters, however, after 27 weeks, the use of the gel may cause post-term pregnancy or complicated labor.

Instructions for use

The instructions for use indicate that Ketorol tablets are taken orally in a single dose of 10 mg.

In case of severe pain, the drug is taken again at 10 mg up to 4 times a day, depending on the severity of the pain. Maximum daily dose is 40 mg. The minimum effective dose should be used. When taken orally, 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 aged 16 to 65 years 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

Ketorol tablets and injections can provoke such undesirable reactions in patients as:

bronchospasm, laryngeal edema, rhinitis;
increased blood pressure, fainting, pulmonary edema;
rectal, nasal, bleeding from postoperative wounds;
diarrhea, stomach pain, vomiting, constipation, flatulence, stomatitis, nausea, heartburn;
weight gain, swelling of the feet, fingers, ankles, legs, face, tongue, increased sweating, fever;
headache, drowsiness, dizziness, hyperactivity, depression, ringing in the ears, hearing loss, blurred vision.
itching, urticaria, change in complexion, skin rash, swelling of the eyelids, difficulty breathing, wheezing, heaviness in the chest;
lower back pain, acute renal failure, frequent urination, nephritis (inflammation of the kidneys), decreased or increased volume of urine;
leukopenia (increase in white blood cells), eosinophilia (increase in the number of eosinophils), anemia (decrease in the number of red blood cells or hemoglobin);
purpura, skin rash, urticaria, Lyell's syndrome ( allergic dermatitis as a reaction to medications), Stevens-Johnson syndrome (the appearance of blisters on areas of the skin and on the mucous membrane of various organs).

Overdose

Possible signs of an overdose of Ketorol: nausea, abdominal pain, vomiting, peptic ulcers or erosive lesions of the gastrointestinal tract, metabolic acidosis, impaired renal function.

Treatment: gastric lavage followed by the administration of adsorbent drugs, symptomatic treatment. Not excreted to a significant extent by dialysis methods.

special instructions

When using tablets for more than 5 days, the risk of side effects in the patient increases, therefore, if there is no expected therapeutic effect, you should consult your doctor again.
If the pain syndrome is significantly severe or there are contraindications for oral administration Ketorol is prescribed to the patient in the form of an injection solution.
To reduce the risk of developing medicinal ulcer The patient can be prescribed antacid or enveloping drugs simultaneously with Ketorol tablets, which will reduce the irritating effect of the main substance of the tablet on the mucous membranes of the digestive tract.
Patients with blood clotting disorders during treatment with the drug should constantly monitor the level of platelets in the blood, especially for postoperative patients.

During treatment with the drug, patients should be careful when driving vehicles and operating complex devices that require increased concentration.

Drug interactions

Ketorolac enhances the hypoglycemic effect of insulin and oral hypoglycemic drugs, so recalculation of their doses is necessary; reduces the effectiveness of antihypertensive and diuretic drugs.

When prescribing Ketorol with narcotic analgesics, their doses are significantly reduced.

Antacids do not affect the absorption of ketorolac.

Probenecid and drugs that block tubular secretion reduce the clearance of ketorolac and increase its concentration in the blood plasma.

Possible undesirable (including severe) reactions:

Methotrexate – hepato- and nephrotoxicity;
Valproic acid – platelet aggregation disorder;
Lithium preparations – decreased clearance and increased toxicity;
Paracetamol and other nephrotoxic drugs, including gold preparations - nephrotoxicity;
ASA, other NSAIDs, glucocorticosteroids, calcium preparations, corticotropin, ethanol – formation of gastrointestinal ulcers, development of gastrointestinal bleeding;
Indirect anticoagulants, antiplatelet agents, thrombolytics, heparin, pentoxifylline, cefotetan, cefoperazone - development of bleeding;
Verapamil and nifedipine - increase their concentration in blood plasma.

During the treatment period, other non-steroidal anti-inflammatory drugs should not be used.

Pain associated with dental diseases. Instructions for the use of Ketorol in injection ampoules and tablets also allow the use of the drug to relieve pain in cancer patients. early stages diseases.

Forms of release of Ketorol

The drug is available in several dosage forms, which differ in the method of application and concentration of the active substance. For systemic use, Ketorol is used in the form of tablets and solution in injection ampoules, which can be administered intravenously and intramuscularly.

The active substance of Ketorol - ketorolac - is a derivative acetic acid and belongs to the group of anti-inflammatory medicines non-steroidal origin.

Injection ampoules contain ketorolac 30 mg/ml, so Ketorola injections are prescribed when it is necessary to quickly achieve an analgesic and anti-inflammatory effect.

For local anesthesia for bruises and injuries, Ketorol is used in the form of a gel with a 2% concentration of the active substance.

Ketorol is available from pharmacies with a prescription and can be stored for 3 years at a temperature not exceeding 25°.

pharmachologic effect

Ketorol by pharmacological properties refers to non-steroidal anti-inflammatory analgesics and cyclooxygenase inhibitors. Cyclooxygenases are a group of enzymes involved in the formation of prostaglandins. Prostaglandins belong to a group of active substances that have a lipid structure and are formed in the body from some essential fatty acids by fermentation (cleavage).

These are the main mediators of inflammatory processes in the human body, and blocking their activity makes it possible to reduce the intensity of inflammation and alleviate the patient’s condition.

Therapeutic effect of using Ketorol:

elimination of feverish syndrome;
decrease in body temperature (moderate antipyretic effect);
pain reduction;
relief of acute inflammation.

Indications for the use of Ketorol injections

Ketorol is a medicine for symptomatic therapy, and its use does not affect the cause of the inflammatory process and does not in any way affect the progression of the underlying disease.

The main objective of using Ketorol is the rapid relief of pain and inflammatory reactions in diseases accompanied by activation of inflammatory mediators.

It can be:

The drug can be used to relieve postoperative pain and pain syndrome in cancer patients, including initial stage metastasis. With the active formation of metastases, the use of Ketorol is ineffective.

Dosage according to instructions

For pain of moderate intensity, it is recommended to take Ketorol in tablet form. The use of parenteral (injection) forms is indicated for acute pain syndrome, and the course of treatment should be started with the minimum effective dose.

The dosage regimen below is indicated for patients aged 16 to 65 years. Elderly patients (over 65 years of age) require individual dose adjustment taking into account existing diseases, the functioning of the renal system and liver, since the metabolites of the active substance are not excreted by hemodialysis.

The use of drugs based on ketorolac is not recommended for adolescents under 16 years of age and children due to the lack of clinically confirmed data on the safety of treatment for this category of patients.

Ketorol in ampoules for injections

To relieve an acute inflammatory process, it is recommended intravenous administration Ketorol in a dosage of 15-30 mg. If necessary, the drug is re-introduced every 6 hours until a stable analgesic effect is achieved.

The maximum permissible single dose of the drug is 60 mg.

The drug can be administered intramuscularly in a single dose of 60 mg or according to a schedule of 30 mg every 6 hours. Starting from the third day of treatment, the patient must be transferred to oral dosage forms.

Patients with chronic renal failure, as well as for those whose body weight is less than 50 kg, the dosage is reduced by 2 times.

Ketorol tablets

Depending on the severity of the pain syndrome, Ketorol tablets can be prescribed once or repeatedly.

A single dose of 10 mg of Ketorol tablets is used for intense pain.
If long-term use is necessary, for example, during recovery from injuries or operations, the daily dose of Ketorol should not exceed 4 tablets (40 mg).

Use for more than 5 days is not allowed, as it is possible to increase side effects and develop complications from the heart, hematopoietic system and other body systems.

The use of Ketorol for the treatment of chronic pain is unacceptable.

Contraindications

Ketorol has many contraindications, so not everyone can use it. Restrictions for treatment with drugs that include ketorolac are:

diseases of the hematopoietic system accompanied by blood clotting disorders;
intolerance to acetylsalicylic acid in combination with sinus polyposis or bronchial asthma;
gastrointestinal bleeding, including cerebrovascular type bleeding;
ulceration of the mucous membranes of the stomach and intestines;
liver, kidney and heart failure of decompensated type;
spicy inflammatory processes in the intestines.

The use of Ketorol during pregnancy and lactation is prohibited.

Ketorolac penetrates into breast milk. The drug can accumulate in the tissues of the placenta and fetus even after a single dose of Ketorol tablets at a dosage of 10 mg.

Ketorol is not used for patients the day before surgical operations because of increased risk bleeding.

Side effects from Ketorol tablets and injections

The incidence of side effects when using Ketorol is about 30%. Most of of which is related to the functioning of the nervous system. This may be a headache, increased nervous excitability, drowsiness, irritability.

In some patients (mainly patients over 60 years of age), digestive disorders and functional dyspepsia are common side effects: nausea, vomiting, abdominal pain, diarrhea.

Less frequent negative reactions organism for oral or parenteral administration of Ketorol may be:

stomatitis;
frequent urination or impaired daily diuresis;
cholestatic jaundice;
tinnitus;
blurred visual perception;
laryngeal edema and bronchospasm;
convulsions;
increased blood pressure.

In predisposed patients, intolerance and an allergic reaction to the active substance, manifested by skin rash, itching and burning, are possible.

Price

tablets 10 mg – 36-50 rubles;
ampoules with solution for intravenous and intramuscular administration - 110-140 rubles;
ampoules with solution for intramuscular administration - 110-145 rubles.

You can buy Ketorol in tablets in Ukraine at a price of 63 hryvnia, solution for injections – from 145 hryvnia.

Analogs

Structural analogues (pharmaceutical equivalents) of the drug are drugs under the trade names Ketorolac, Ketanov, Ketolac, Dolomin, Dolak, etc.

If ketorolac or acetic acid derivatives are poorly tolerated, the doctor may prescribe other NSAIDs from the list of drugs below:

Ibuprofen.
One of the most effective drugs to get rid of dental, headache, muscle and joint pain. Can be used in childhood, starting from 3 months.
Paracetamol.
It is considered the safest analgesic and antipyretic drug and belongs to the anilides group. Approved for use in children and infants over 1 month. If necessary, can be used during pregnancy.
(Nimulid).
One of the most effective analgesics for relieving pain in diseases of the musculoskeletal system. It is also used for dislocations, bruises and injuries.

The listed drugs have various contraindications and can cause side effects, therefore, before using them, you should consult your doctor and read the instructions for use.

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 in the form of a solution for intravenous and intramuscular administration, film-coated tablets, and gel for external use.

Indications for use

Severe and moderate pain syndrome in the following diseases and conditions:

injuries;
toothache;
postpartum and postoperative pain;
oncological diseases;
myalgia;
arthralgia;
neuralgia;
radiculitis;
dislocations and sprains;
rheumatic diseases.

Contraindications

hypersensitivity to tromethamine ketorolac;
aspirin triad, that is, a combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses;
intolerance to ASA and pyrazolone 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;
severe 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.

Use with caution in the following conditions:

intolerance to other NSAIDs;
the presence of factors that increase gastrointestinal toxicity;
bronchial asthma;
cholecystitis;
arterial hypertension;
cholestasis;
active hepatitis;
bad habits (alcoholism, smoking);
postoperative 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, repeated use of 10 mg up to 4 times a day is possible, depending on the severity of the pain. The maximum daily dose is 4 mg. The minimum effective dose should be taken for a course of no more than 5 days.

When switching from a parenteral drug to oral administration, the total daily dose of both dosage forms 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.

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

Maximum dose when taken orally or intramuscular injection- 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. The 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 Ketorol often causes the following side effects:

gastralgia, diarrhea, flatulence, constipation, vomiting;
headache, dizziness, drowsiness;
burning or pain at the injection site;
skin rash, swelling;
increased sweating.

Less commonly causes the following symptoms:

decreased appetite;
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, pulmonary and laryngeal edema;
cramps, anxiety;
depression, psychosis, fainting;
anemia, eosinophilia, leukopenia;
nose bleed;
various allergic reactions;
fever.

Overdose

If the dose of Ketorol is exceeded, the following symptoms appear:

abdominal pain, nausea, vomiting;
peptic ulcers;
metabolic acidosis;
renal dysfunction.

In this case, gastric lavage, administration of adsorbents and symptomatic treatment to maintain vital important functions body. Dialysis is ineffective.

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.
It 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. The analgesic effect of this drug is comparable in effectiveness 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 quickly and completely absorbed. When taking tablets orally, the active substance is also quickly and well absorbed into the gastrointestinal tract. The drug passes 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 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 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.
Use caution while driving while taking this drug. Vehicle and other occupations potentially dangerous species activities.

During pregnancy and breastfeeding

Contraindicated during pregnancy and breastfeeding.

In childhood

Contraindicated in 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

When taken with acetylsalicylic acid or other NSAIDs, calcium preparations, corticosteroids, ethanol, corticotropin, it can cause ulcerative lesions of the gastrointestinal tract and the development of gastrointestinal bleeding.
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 simultaneous use with methotrexate is required, the dose of the latter should be reduced.
Probenecid increases the concentration of drugs 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 drugs, 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.
Ketorolac clearance may be reduced medicines, blocking tubular secretion.

Ketorol is a non-steroidal analgesic drug that has a pronounced analgesic effect, as well as a slight anti-inflammatory and antipyretic effect.

Composition and release form

Ketorol tablets are available in blisters. There are 10 tablets in one blister, 2 blisters in a package. One tablet contains 10 mg of the active substance ketorolac.
Ketorol solution is available in ampoules. The ampoule contains 1 ml of Ketorol, that is, 30 mg of the active substance. There are 10 ampoules in a package.

List B. According to the instructions, store in a dry place, protected from light, at a temperature not exceeding 25 degrees. Keep out of the reach of children. The shelf life of the drug is 3 years.

Composition of Ketorol tablets

Each film-coated tablet contains:

active substance- ketorolac tromethamine 10 mg;
Excipients- microcrystalline cellulose 132 mg, peptized maize starch 30 mg, maize starch 12.5 mg, colloidal silicon dioxide 1 mg, magnesium stearate 1.5 mg.

pharmachologic effect

The active ingredient of the drug is ketorolac. It provides an antipyretic effect and relieves inflammation. The principle of action of the drug is to suppress the activity in peripheral tissues of cyclooxygenase enzymes type 1 and 2. Under the influence of the substance, inhibition of the formation of prostaglandins, enzymes that are responsible for the occurrence of pain in the body, inflammatory reactions and thermoregulation is observed.

Ketorol does not provide negative influence on respiratory system, does not cause lethargy and depression, ketorolac does not cause drug dependence. The medicine is the most powerful pain reliever among all non-steroidal drugs, its effectiveness is equal to the effectiveness of morphine, but taking the drug does not cause such side effects.

The drug begins to act after oral administration in an hour, and after an injection - in half an hour. The maximum analgesic effect can be observed after 1-2 hours. When taken orally, Ketorol is well absorbed into the walls of the gastrointestinal tract. Its bioavailability is 80-100%. Ketorol should not be combined with fatty foods, since fats delay the achievement of the effect.

Plasma protein binding is 99%; Ketorol passes through breast milk from mother to child. Metabolized predominantly in the liver, pharmacologically inactive metabolites are formed. Excreted through the kidneys - 90%, through the intestines - 10%. After oral administration, in patients with normal operation kidneys, the half-life is 5.3 hours, with a single dose of 10 mg.

Elderly patients have a longer half-life than younger patients. Impaired liver function does not affect the duration of elimination of the drug. In patients with renal failure, the duration of drug withdrawal after use increases, and the half-life can be 10-11 hours.

Indications for use of Ketorol

The drug is prescribed to relieve pain syndromes, regardless of what caused them. The medicine is prescribed after operations, to get rid of cancer pain, or orthopedic pain. The drug is intended for symptomatic therapy, reducing or eliminating pain syndromes. The product is intended for symptomatic treatment and does not affect the progression of the disease.

What does Ketorol help with:

Toothache.
Tissue injuries.
Fractures, dislocations.
Postpartum pain.
Postoperative pain.
Cancer pain
Neuralgic diseases.
Arthritis, arthrosis.
Radiculitis.
Rheumatic diseases.

Contraindications

Bronchial asthma.
Polyposis of the nose or paranasal sinuses.
Ulcers and erosions of the stomach.
Active gastric bleeding.
Intestinal inflammation in the acute phase.
Liver failure or any other liver disease.
Kidney failure.
Poor blood clotting, hemophilia.
Hyperkalemia.
Lactose deficiency, lactose intolerance.
Pregnancy and lactation period.
Heart failure.
Ketorol is not prescribed as a pain reliever during childbirth.
Age up to 16 years.
Intolerance to ketorolac.

The drug Ketorol is prescribed with caution when hypersensitivity to substances of the NSAID category, bronchial asthma, predisposition to edema, renal dysfunction, diabetes mellitus, hepatitis, cholestasis, sepsis, as well as alcohol abuse,

Side effects

The drug Ketorol has a number of side effects. On the part of the kidneys and urinary system, after taking the drug, lower back pain, acute renal failure, uremic hemolytic syndrome, hemolytic anemia, purpura, increased urge to urinate, rare urge to urinate, renal edema, nephritis in rare cases may be observed.

Patients over 65 years of age often suffer from diarrhea, gastralgia, flatulence, constipation, sometimes stomatitis, vomiting and nausea. In especially severe cases, when using Ketorol, ulcerative lesions of the stomach and intestines, internal bleeding, hepatitis, acute pancreatitis, hepotomegaly and jaundice occur.

On the part of the nervous system and brain, there are such side effects of Ketorol as headache, drowsiness, dizziness. These effects occur quite often. Less commonly observed effects after taking the drug are depression, hallucinations, psychosis, tinnitus, hearing loss, visual impairment, hyperactivity, aseptic meningitis, restlessness, anxiety, fever, convulsions and mood swings.

The drug Ketorol can cause allergic reactions, such as anaphylaxis, including shortness of breath, skin rash, urticaria, itching, dysponea and swelling, including swelling of the eyelids, dermatitis, fever with and without chills, Stevens-Jones syndrome. Swelling of the larynx, rhinitis, and difficulty breathing may also occur. From the outside circulatory system– eosinophilia, anemia, thrombocytopenia. The drug Ketorol can also affect the heart; patients experience increased blood pressure, pulmonary edema and loss of consciousness. Very often, patients experience an increase in body weight after using the drug.

Instructions for use

Method and dosage of tablets

According to the instructions, Ketorol is taken orally. Depending on the severity of the disease, the medicine is prescribed once or in a repeated dose. Prescribed 10 mg per dose, with a maximum dose of 40 mg per day. The maximum dose is prescribed for severe pain. It is not recommended to combine the drug with fatty foods, as it reduces the effectiveness of the drug.

Method and dosage of solution for injection

Ketorol in the form of a solution is injected intramuscularly; it must be injected deeply. You should start with the minimum effective doses and can increase them if necessary. Ketorol in the form of injections can be administered simultaneously with other opioid analgesics in small doses. The single dose of the drug for a single administration varies depending on the intensity of pain and the age of the patient. For patients under 65 years of age minimum dose is 10-30 mg; for patients over 65 or patients with severe renal failure, 10-15 mg is prescribed.

With repeated administration of the drug, patients under 65 years of age are given 10-30 mg, and then, after 4-6 hours, the same doses of the substance are administered. For patients over 65 years of age, 10-15 mg is administered every 4-6 hours. The maximum dose for the first age group for patients is 90 mg, for elderly patients – 60 mg. The same dose is indicated for patients with renal impairment.

When administering Ketorol parenterally, the duration of treatment should not exceed 5 days. After completing the course, if necessary, the patient is transferred to oral administration. In any case, the total dose of both forms of drugs should not exceed 90 mg for adults and 60 mg for the elderly and patients with renal failure. When combining tablets and injections, the dose of the substance in tablets should be no more than 30 mg.

Method and dosage of the gel

Ketorol gel is used externally. It is recommended to apply the drug to clean, dry skin. A small amount of gel is applied to damaged or inflamed areas in a thin layer, maximum amount applications – 3-4 times a day. Apply the gel carefully, with gentle movements. The application of the gel can be repeated at intervals of at least 4 hours. Even with serious pain syndromes It is not recommended to exceed the specified norm.

If the symptoms of the disease worsen and improvements do not occur after using Ketorol gel, you should stop using it and consult a doctor. The maximum duration is 10 days, then Ketorol can be taken only after consultation with a doctor.

Ketorol for children

In any dosage forms, this drug is contraindicated under the age of 16 years.

During pregnancy and lactation

According to the instructions, Ketorol is contraindicated for use during pregnancy. If it is necessary to take the drug during lactation, breastfeeding should be temporarily stopped.

Overdose

In case of an overdose of Ketorol, symptoms such as abdominal pain accompanied by nausea, vomiting are observed, stomach ulcers, renal dysfunction, and metabolic acidosis are possible. When such symptoms appear, gastric lavage, the use of any absorbent drugs, as well as symptomatic therapy are prescribed. Dialysis is ineffective in overdoses.

special instructions

It is not recommended to take Ketorol for a long time; the maximum period of use of the drug is 5 days. After this, a break must be taken; after some time, the course can be repeated. Ketorol should be taken under the supervision of a doctor. The use of the gel is possible for 10 days without monitoring, then only on the recommendation of a doctor.

Interaction with other drugs

It is not recommended to use Ketorol simultaneously with acetylsalicylic acid and any other NSAID drugs, as well as with calcium drugs, corticosteroids and ethanol, as this combination can cause peptic ulcers and gastric bleeding. The risk of bleeding increases when taking the drug simultaneously with heparin, thrombolytics, cefoperazones and cefotetan.
Ketorol reduces the effect of diuretics, so it is not prescribed together with them.
Taking ketolorolac with nephrotoxic drugs leads to the development of nephrotoxicity. Also, simultaneous use with paracetamol can lead to nephrotoxicity.
Parallel administration of Ketorol with valproic acid causes disruption of platelet aggregation. Increases the plasma concentration of verapamil and nifedipine.
Medicines that block tubular secretion reduce the clearance of ketorolac and increase its concentration in the blood plasma.

Domestic and foreign analogues

Ketanov - an analogue of medicine

The drug has an analgesic effect and is classified as an NSAID. Has anti-inflammatory and antipyretic effect. This analogue inhibits the activity of COX and relieves pain well, regardless of the cause of its occurrence. A potent drug whose active ingredient is ketorolac.

Ketorol analogue - Dolak

An anesthetic that has a slight anti-inflammatory and antipyretic effect. The drug inhibits the activity of COX, which determines its analgesic effect. This analogue is contraindicated for use in pregnant women and children. Available in the form of tablets and solution, it has a lower cost than Ketorol.

Adolor - analogue of Ketorol

The active substance is ketorolac. The drug is available in the form of an injection solution and tablets. Adolor is contraindicated in pregnant women and during lactation, and Adolor is not prescribed for children. The drug has a strong analgesic effect and is prescribed to relieve any pain - postpartum, postoperative, pain due to arthrosis and arthritis, cancer pain.

Price in pharmacies

The price of Ketorol in different pharmacies may vary significantly. This is due to the use of cheaper components and pricing policy pharmacy network.

Read the official information about the drug Ketorol, the instructions for use of which include general information and treatment plan. The text is provided for informational purposes only and cannot serve as a substitute for medical advice.