Ketorol is an effective pain reliever. The medicine belongs to the group of anti-inflammatory non-steroidal drugs. In addition to the analgesic effect, the drug reduces inflammation and swelling. In addition, ketorol, the instructions indicate this, has antipyretic properties.
Composition, forms and effects of the drug
The strong analgesic effect of the drug is provided by the main active substance - ketorolac tromethamine. Other components may vary depending on the manufacturer, so be sure to read the instructions.
The effect after taking the medicine is comparable to the effect of morphine. But at the same time, ketorol is a safer drug to use. The product can be used to combat different types of pain, the causes of which are any pathological conditions. It is used to eliminate symptoms and to treat specific diseases that are accompanied by swelling and fever.
The drug is produced in the form of:
- Tablets in a green soluble shell (with the amount of active substance - 10 mg).
- Transparent solution for intramuscular and intravenous administration (with an amount of active substance -30 mg/ml).
- Transparent, homogeneous gel (2%).
The most popular is the tablet form. After taking the drug, the active substance is completely absorbed into the gastrointestinal tract in the shortest possible time. Wherein:
- The maximum concentration in the blood is reached after an hour.
- Antipyretic and analgesic effects are observed after 30 minutes.
- Fatty foods slow down the absorption of the active substance.
Overdose
Symptoms of overdose for parenteral use and oral administration: nausea, abdominal pain, vomiting, renal dysfunction, erosive lesions and ulceration of the gastrointestinal mucosa, metabolic acidosis .
If signs of intoxication , the victim is given gastric lavage and enterosorbents . Further treatment is symptomatic. ketorolac to be sufficiently removed from the body.
Cases of overdose with external use of the drug have not been described. If you accidentally ingest the gel, you should empty your stomach (induction of vomiting and taking an enterosorbent ) and consult a doctor.
Indications and contraindications for use
In order not to cause harm, it is important to know what ketorol helps with. Most often, ketorol, the instructions for use confirms this, is used as a symptomatic remedy to relieve headaches, dental and menstrual pain, as well as pain in the joints. In complex therapy, the drug is prescribed for the development of cancer and in the postoperative period.
The medicine is indicated to alleviate conditions in the following pathologies:
- Rheumatoid diseases.
- Spinal diseases and radiculitis.
- Ligament ruptures and muscle sprains.
Ketorol, like any non-steroidal drugs, is prohibited for use in the presence of diseases of the gastrointestinal tract. Otherwise, the risk of gastric bleeding increases. The drug is not prescribed to patients under 16 years of age or during pregnancy and lactation. You should stop using the medicine if you are hypersensitive to the components of the drug, as well as if you have the following pathologies:
- Bronchial asthma.
- Hyperkalemia.
- Heart failure.
- Liver and kidney diseases.
- Stroke.
There are other diseases for which the doctor recommends taking the drug with caution. These are chronic hypertension, diabetes mellitus, various nervous system disorders, etc.
Ketorol, for which a prescription is required, should not be taken with a number of other medications:
- Pentoxifylline.
- Acetylsalicylic acid.
- Anticoagulants.
- Lithium salts.
- Probenecid.
When taking the drug simultaneously with alcoholic beverages, the risks of intoxication of the body increase.
Interaction
Drug interactions for Ketorol solution and tablets
The use of ketorolac in combination with other NSAIDs, ASA ( acetylsalicylic acid ), ethanol, calcium preparations, corticotropin and corticosteroids can lead to ulceration of the gastrointestinal mucosa and the development of bleeding from ulcerative defects.
Co-administration with Methotrexate increases hepato- and nephrotoxicity, and with Paracetamol - nephrotoxicity. With Methotrexate, ketorolac can be prescribed only if Methotrexate is used in the lowest possible dose (in this case, plasma concentrations of methotrexate ).
Probenecid reduces the volume of distribution and plasma clearance of ketorolac , increases its plasma concentration and increases the half-life. With the use of ketorolac, Methotrexate may decrease , and the toxicity of these substances may increase.
Use in combination with indirect anticoagulants and drugs for thrombolytic therapy , Heparin , cephalosporin antibiotics , antiplatelet agents increases the risk of bleeding.
Ketorolac , acting as an inhibitor of Pg synthesis in the kidneys, reduces the effect of diuretics and antihypertensive drugs .
In the case of simultaneous use with narcotic painkillers, the doses of the latter may be significantly lower.
Antacids do not alter the absorption of ketorolac .
Increases the hypoglycemic effect of oral antidiabetic agents and insulin , which requires dose recalculation.
Combined use with valproic acid provokes a violation of platelet aggregation.
Increases plasma concentrations of Nifedipine and Verapamil .
When combined with other nephrotoxic drugs (for example, with Au preparations), the likelihood of nephrotoxic effects increases.
Drugs that block tubular secretion reduce clearance and increase plasma concentrations of ketorolac .
Drug interactions with topical use of ketorolac
The possibility of pharmacokinetic interaction with drugs competing for binding to plasma proteins cannot be ruled out.
The gel should be used with caution in combination with Phenytoin , other NSAIDs, diuretics , Digoxin , Cyclosporine , Li drugs, Methotrexate , antidiabetic and antihypertensive drugs .
Patients using any of the listed drugs should begin treatment with Ketorol only with the approval of a physician.
Dosage and recommendations for treatment
In the postoperative period, tablets are usually prescribed, the price of which is affordable. This especially applies to cases where the instructions for use exclude ketorol injections against the background of certain consequences of operations. To relieve pain of any etiology, take one tablet. In case of intense severe pain, repeated use is allowed up to 4 times a day with a break of 4-6 hours. The duration of treatment is 5 days.
Ketorol tablets, the instructions for use emphasize this, should not be taken for any stomach problems. In this case, you need to purchase ketorol injection ampoules. In particular, intramuscular administration is indicated for persistent vomiting or difficulty swallowing. When they ask ketorol injections what they help with, experts often indicate radiculitis. In this case, the pain caused by this pathology can be dealt with quickly. Injections can be repeated with a break of 4 hours.
Ketorol gel is applied in a thin layer to clean and dried skin in areas of pain. Then rub in with soft massage movements. Procedures can be repeated 3-4 times a day until pain is relieved. The break between them is at least 4 hours. The duration of use of the gel is no more than 10 days.
Side effects
More than 3% of patients with parenteral administration and oral administration of Ketorol experience:
- diarrhea and gastralgia (especially in older people with a history of peptic ulcer disease);
- dizziness , increased drowsiness , headache ;
- swelling (fingers, feet, ankles, legs, face);
- weight gain.
Somewhat less frequently (in 1-3% of patients) the following were recorded:
- flatulence , stomatitis , feeling of fullness in the stomach, vomiting, constipation ;
- increased blood pressure ;
- purpura, rash (including maculopapular) on the skin;
- pain and/or burning sensation at the injection site;
- increased sweating .
Rare side effects that occur in less than 1% of patients:
- nausea;
- formation of erosions on the gastrointestinal mucosa or its ulceration (including with perforation and/or bleeding, the symptoms of which are burning, pain and spasm in the epigastric region, bloody vomiting (coffee grounds), melena, heartburn , nausea, etc.);
- hepatomegaly;
- hepatitis;
- acute inflammation of the pancreas;
- surge arrester;
- cholestatic jaundice;
- lower back pain (sometimes accompanied by azotemia and/or hematuria );
- renal failure dominating the clinical picture , as well as hemolytic anemia and thrombocytopenia ;
- change in urine volume (decrease or increase);
- frequent urination;
- edema of renal origin;
- nephritis;
- hearing loss, tinnitus ;
- visual impairment (blurred perception of visual images);
- rhinitis , bronchospasm , laryngeal edema;
- aseptic meningitis;
- hyperactivity (restlessness, mood swings);
- depression;
- mental disorders;
- hallucinations;
- sudden loss of consciousness;
- edema ;
- swelling of the tongue;
- leukopenia , eosinophilia , anemia ;
- bleeding (from the lower gastrointestinal tract, nose, postoperative wound);
- exfoliative dermatitis;
- Lyell's syndrome , malignant exudative erythema , urticaria ;
- anaphylactoid reactions or anaphylaxis ;
- fever.
When ketorolac , peeling of the skin at the site of application of the gel, urticaria , and itching .
When applying the drug to a large area of the body, the possibility of developing systemic effects cannot be excluded, including:
- ulceration of the mucous membrane of the digestive canal;
- heartburn , diarrhea , vomiting, nausea, gastralgia ;
- increased activity of liver aspartate and alanine aminotransferase;
- dizziness , headache ;
- hematuria;
- fluid retention;
- hypersensitivity reactions;
- prolongation of bleeding time;
- anemia , leuko- and thrombocytopenia , agranulocytosis .
special instructions
The choice in favor of one or another dosage form is made taking into account the indications for use and the intensity of pain.
Pills:
Use of Ketorol for more than five days in a row and/or at a dose exceeding the maximum allowable increases the risk of adverse reactions.
The drug should not be prescribed simultaneously with other NSAIDs, since simultaneous use with them leads to cardiac decompensation, fluid retention, and increased blood pressure .
The effects due to the effect of ketorolac on platelet disappear after 24–48 hours.
Ketorolac can change the properties of platelets, but the drug does not replace the preventive effect of ASA in pathologies of the heart and blood vessels.
To reduce the likelihood of developing NSAID gastropathy , the drug should be taken with Omeprazole , Misoprostol , and antacids .
Before prescribing the solution, you should find out whether the patient has previously had an allergic reaction to the drug or other NSAIDs. Due to the risk of hypersensitivity reactions, the first dose is administered under close medical supervision.
Hypovolemia increases the risk of nephrotoxic effects.
It is not recommended to use the solution as a means to prepare a patient for general anesthesia, as well as to maintain anesthesia during extensive surgical interventions.
During treatment with Ketorol, it is recommended to be careful when driving a car or using machinery.
gel (ointment) is recommended to be applied only to intact skin, avoiding contact with wounds and mucous membranes (including the eyes).
The drug should not be used under dressings made of airtight materials. After applying Ketorol to the skin, you should wash your hands well with soap.
Reviews of Ketorol
Reviews of Ketorol tablets, as well as reviews of injections and gel, are positive in 95-98% of cases. Ketorol helps with toothache, back and muscle pain, and headaches within half an hour, and its effect lasts up to six hours.
Most patients note that when using the medicine in accordance with the instructions, side effects occur extremely rarely. Sometimes the disadvantages of Ketorol are a large number of contraindications and the impossibility of long-term use.
Is it possible to give Ketorol to children?
The annotation states that all dosage forms of the drug are intended for the treatment of patients over 16 years of age (according to Wikipedia, age under 16 years of age is a relative contraindication).
The reason for this restriction is that the use of ketorolac in children can cause visual and hearing impairment, depression , nephritis , pulmonary edema , allergic reactions and other severe complications.
Therefore, it is better to give the child safer means to relieve pain - for example, paracetamol or ibuprofen .
Ketorol's analogs
Level 4 ATC code matches:
Voltaren Emulgel
Ultrafastin
Indomethacin
Dicloran
Dicloran Plus
Dolgit
Nise
Ketonal
Febrofeed
Fastum gel
Diclofenac
Finalgel
Bystrumgel
Deep Relief
Butadion
Diklovit
Artrosilene
Olfen
Fanigan Fast
Structural analogues of tablets and solution: Adolor , Vatorlak , Ketanov , Dolak , Dolomin , Ketofril , Ketalgin , Ketorolac , Ketocam .
Drugs with a similar mechanism of action: Arthrotek , Bioran , Voltaren , Diclak , Diclogen , Diclofenac , Indomethacin , Naklofen , Ortofen , Neurodiclovit , Flotac , SwissJet .
Suppositories with a similar effect: Voltaren , Diclak , Diclonate P , Naklofen , Diclofenac , Indomethacin .
What is better - Ketorol or Ketonal?
Ketonal is a drug based on the NSAID ketoprofen (a derivative of propionic acid). The medicine has the same indications for use as Ketorol.
When administered parenterally, the analgesic effect appears within 15-30 minutes. With intravenous infusion of ketorolac , plasma concentrations reach maximum values after 4 minutes.
The difference between ketoprofen and ketorolac is also a shorter half-life - less than 2 hours.
Studies of the effectiveness of drugs for pain relief in postoperative patients have shown that ketorolac provides a faster, more effective and longer-lasting effect than its analogue, and also has a lesser effect on the hemostatic system.
