Ketorolac

Ketorolac Brand Names

Acular | Acular LS | Acular PF | Acuvail | SPRIX

What is Ketorolac

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) of the acetic acid chemical class.

Ketorolac possesses antipyretic and analgesic properties. As a pyrrolo-pyrrole, ketorolac is chemically related to indomethacin and tolmetin.

The onset and efficacy of analgesia after systemic administration are claimed to be comparable to that of morphine, but ketorolac causes less drowsiness, nausea, and vomiting.

Post-marketing studies have not found IM ketorolac to be superior to oral ibuprofen for the treatment of acute musculoskeletal pain.

Unlike other NSAIDs, ketorolac should only be used for up to 5 consecutive days. Also, oral use is only for therapy continuation after parenteral administration.

Ketorolac was approved by the FDA for parenteral use in November 1989, oral use in December 1991, ophthalmic use in November 1992, and intranasal use in May 2010.

A preservative-free and a lower strength ophthalmic solution were FDA-approved in November 1997 and May 2003, respectively.

Indications

1. allergic conjunctivitis
2. headache
3. migraine
4. moderate pain
5. ocular pain
6. ocular pruritus
7. ocular surgery
8. postoperative ocular inflammation
9. severe pain

For the short-term treatment of acute moderate pain or moderately severe pain that requires analgesia at the opioid level

for the short-term treatment of moderate pain

Side Effects

1. abdominal pain
2. agranulocytosis
3. alopecia
4. anaphylactic shock
5. anaphylactoid reactions
6. anemia
7. angioedema
8. anorexia
9. anxiety
10. aplastic anemia
11. arrhythmia exacerbation
12. aseptic meningitis
13. asthenia
14. azotemia
15. bleeding
16. blurred vision
17. bradycardia
18. bronchospasm
19. bullous rash
20. chest pain (unspecified)
21. coma
22. confusion
23. conjunctival hyperemia
24. conjunctivitis
25. constipation
26. corneal degeneration
27. corneal edema
28. corneal erosion
29. cough
30. cystitis
31. depression
32. diaphoresis
33. diarrhea
34. dizziness
35. drowsiness
36. dysgeusia
37. dyspepsia
38. dysphagia
39. dyspnea
40. dysuria
41. ecchymosis
42. edema
43. elevated hepatic enzymes
44. eosinophilia
45. epistaxis
46. eructation
47. erythema multiforme
48. esophageal stricture
49. esophageal ulceration
50. esophagitis
51. euphoria
52. exfoliative dermatitis
53. fever
54. flank pain
55. flatulence
56. flushing
57. gastritis
58. GI bleeding
59. GI perforation
60. glossitis
61. hallucinations
62. headache
63. hearing loss
64. heart failure
65. hematemesis
66. hematuria
67. hemolytic anemia
68. hemolytic-uremic syndrome
69. hepatic failure
70. hepatic necrosis
71. hepatitis
72. hyperglycemia
73. hyperkalemia
74. hyperkinesis
75. hypertension
76. hyphema
77. hyponatremia
78. hypotension
79. impaired wound healing
80. increased urinary frequency
81. infection
82. injection site reaction
83. insomnia
84. interstitial nephritis
85. iritis
86. jaundice
87. keratitis
88. lacrimation
89. laryngeal edema
90. leukopenia
91. lymphadenopathy
92. malaise
93. melena
94. myalgia
95. myocardial infarction
96. nasal irritation
97. nausea
98. nephrotic syndrome
99. ocular infection
100. ocular inflammation
101. ocular irritation
102. ocular pain
103. odynophagia
104. oliguria
105. pallor
106. palpitations
107. pancreatitis
108. pancytopenia
109. paresthesias
110. peptic ulcer
111. photosensitivity
112. platelet dysfunction
113. polyuria
114. prolonged bleeding time
115. proteinuria
116. pruritus
117. psychosis
118. pulmonary edema
119. purpura
120. pyrosis (heartburn)
121. rash
122. renal failure (unspecified)
123. renal papillary necrosis
124. respiratory depression
125. rhinalgia
126. rhinitis
127. seizures
128. serious hypersensitivity reactions or anaphylaxis
129. sinus tachycardia
130. Stevens-Johnson syndrome
131. stomatitis
132. stroke
133. syncope
134. throat irritation
135. thrombocytopenia
136. thromboembolism
137. tinnitus
138. toxic epidermal necrolysis
139. tremor
140. urinary retention
141. urticaria
142. vasculitis
143. vertigo
144. visual impairment
145. vomiting
146. xerophthalmia
147. xerostomia

Monitoring Parameters

• CBC
• LFTs
• serum creatinine/BUN
• stool guaiac

Contraindications

• acute bronchospasm
• acute myocardial infarction
• alcoholism
• anemia
• angina
• asthma
• bleeding
• bone marrow suppression
• breast-feeding
• caesarean section
• cardiac arrhythmias
• cardiac disease
• cardiomyopathy
• cerebrovascular disease
• chemotherapy
• children
• coagulopathy
• contact lenses
• coronary artery bypass graft surgery (CABG)
• coronary artery disease
• Crohn’s disease
• dehydration
• diabetes mellitus
• edema
• epidural administration
• geriatric
• GI bleeding
• GI disease
• GI perforation
• heart failure
• hematological disease
• hemophilia
• hepatic disease
• hypertension
• hypoalbuminemia
• hypovolemia
• immunosuppression
• infants
• inflammatory bowel disease
• intracranial bleeding
• intrathecal administration
• jaundice
• keratitis
• labor
• limit duration of use
• myocardial infarction
• nasal polyps
• neonates
• neutropenia
• NSAID hypersensitivity
• obstetric delivery
• ocular disease
• ocular exposure
• ocular surgery
• peptic ulcer disease
• peripheral vascular disease
• pregnancy
• renal disease
• renal failure
• renal impairment
• rheumatoid arthritis
• salicylate hypersensitivity
• serious hypersensitivity reactions or anaphylaxis
• stroke
• surgery
• systemic lupus erythematosus (SLE)
• tachycardia
• thrombocytopenia
• thromboembolism
• tobacco smoking
• ulcerative colitis
• urticaria

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