Ketolab
Generic Name
Ketorolac Tromethamine 60 mg Injection
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ketolab 60 mg injection | ৳ 115.00 | N/A |
Description
Overview of the medicine
Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used for the short-term management of moderately severe acute pain that requires opioid-level analgesia, usually in a postoperative setting. It provides pain relief by reducing inflammation and fever.
Uses & Indications
Dosage
Adults
Initial dose: 30-60 mg IM or IV. Maintenance: 15-30 mg every 6 hours as needed. Maximum daily dose: 120 mg. Duration of treatment not to exceed 5 days.
Elderly
For patients ≥65 years, a lower initial dose of 15 mg IM or IV may be considered. Maximum daily dose: 60 mg. Duration not to exceed 5 days.
Renal_impairment
Reduced dosage (e.g., 15 mg every 6 hours, max 60 mg/day) is required. Contraindicated in severe renal impairment.
How to Take
Administer intramuscularly (IM) slowly and deeply into a large muscle or intravenously (IV) slowly over at least 15 seconds. IV administration should be done by a healthcare professional, possibly diluted.
Mechanism of Action
Ketorolac primarily acts by inhibiting the synthesis of prostaglandins by blocking the cyclooxygenase (COX-1 and COX-2) enzymes. Prostaglandins are lipid compounds that mediate inflammation, pain, and fever. By inhibiting their synthesis, ketorolac reduces these symptoms.
Pharmacokinetics
Onset
Analgesia typically begins within 30 minutes, with peak effect in 1-2 hours.
Excretion
Approximately 92% of the dose is excreted in the urine (60% as metabolites, 40% as unchanged drug) and 6% in the feces.
Half life
The elimination half-life is approximately 4-6 hours in adults with normal renal function.
Absorption
Rapid and complete absorption after intramuscular (IM) administration. Peak plasma concentrations achieved within 30-60 minutes.
Metabolism
Primarily metabolized in the liver via glucuronidation and hydroxylation. Minor amounts are metabolized to inactive polar metabolites.
Side Effects
Contraindications
- Hypersensitivity to ketorolac or other NSAIDs, or aspirin-sensitive asthma.
- Active peptic ulcer disease, recent gastrointestinal (GI) bleeding or perforation.
- Advanced renal impairment or risk of renal failure due to volume depletion.
- Concomitant use with other NSAIDs, aspirin, anticoagulants (e.g., warfarin), or probenecid.
- Cerebrovascular bleeding or patients with a hemostatic disorder.
- Pregnancy (especially third trimester) and lactation.
- As prophylactic analgesic before major surgery or during surgery with high risk of hemorrhage.
- Spinal or epidural administration.
Drug Interactions
SSRIs
Increased risk of GI bleeding.
Lithium
Reduced renal clearance of lithium, leading to increased lithium levels and toxicity.
Probenecid
Increased plasma levels and half-life of ketorolac.
Methotrexate
Reduced clearance of methotrexate, leading to increased toxicity.
ACE Inhibitors/ARBs
Reduced antihypertensive effect and increased risk of renal impairment.
Diuretics (e.g., Furosemide)
Reduced diuretic and antihypertensive effect.
Other NSAIDs or Corticosteroids
Increased risk of GI adverse effects.
Anticoagulants (e.g., Warfarin, Heparin)
Increased risk of bleeding.
Antiplatelet agents (e.g., Aspirin, Clopidogrel)
Increased risk of bleeding.
Storage
Store below 30°C. Protect from light. Do not freeze.
Overdose
Symptoms of overdose may include abdominal pain, nausea, vomiting, lethargy, drowsiness, headache, tinnitus, and gastric irritation. Severe cases may involve GI bleeding, acute renal failure, respiratory depression, and coma. Treatment is supportive and symptomatic; there is no specific antidote. Gastric lavage and activated charcoal may be considered if oral ingestion (not applicable for injection) is recent.
Pregnancy & Lactation
Ketorolac is contraindicated in the third trimester of pregnancy due to the risk of premature closure of the fetal ductus arteriosus. It is not recommended during early pregnancy unless the potential benefit outweighs the risk. Ketorolac is excreted in breast milk and is contraindicated during breastfeeding.
Side Effects
Contraindications
- Hypersensitivity to ketorolac or other NSAIDs, or aspirin-sensitive asthma.
- Active peptic ulcer disease, recent gastrointestinal (GI) bleeding or perforation.
- Advanced renal impairment or risk of renal failure due to volume depletion.
- Concomitant use with other NSAIDs, aspirin, anticoagulants (e.g., warfarin), or probenecid.
- Cerebrovascular bleeding or patients with a hemostatic disorder.
- Pregnancy (especially third trimester) and lactation.
- As prophylactic analgesic before major surgery or during surgery with high risk of hemorrhage.
- Spinal or epidural administration.
Drug Interactions
SSRIs
Increased risk of GI bleeding.
Lithium
Reduced renal clearance of lithium, leading to increased lithium levels and toxicity.
Probenecid
Increased plasma levels and half-life of ketorolac.
Methotrexate
Reduced clearance of methotrexate, leading to increased toxicity.
ACE Inhibitors/ARBs
Reduced antihypertensive effect and increased risk of renal impairment.
Diuretics (e.g., Furosemide)
Reduced diuretic and antihypertensive effect.
Other NSAIDs or Corticosteroids
Increased risk of GI adverse effects.
Anticoagulants (e.g., Warfarin, Heparin)
Increased risk of bleeding.
Antiplatelet agents (e.g., Aspirin, Clopidogrel)
Increased risk of bleeding.
Storage
Store below 30°C. Protect from light. Do not freeze.
Overdose
Symptoms of overdose may include abdominal pain, nausea, vomiting, lethargy, drowsiness, headache, tinnitus, and gastric irritation. Severe cases may involve GI bleeding, acute renal failure, respiratory depression, and coma. Treatment is supportive and symptomatic; there is no specific antidote. Gastric lavage and activated charcoal may be considered if oral ingestion (not applicable for injection) is recent.
Pregnancy & Lactation
Ketorolac is contraindicated in the third trimester of pregnancy due to the risk of premature closure of the fetal ductus arteriosus. It is not recommended during early pregnancy unless the potential benefit outweighs the risk. Ketorolac is excreted in breast milk and is contraindicated during breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from manufacturing date.
Availability
Pharmacies, hospitals, clinics
Approval Status
Approved by regulatory authorities (e.g., DGDA, FDA)
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Ketorolac has undergone extensive clinical trials demonstrating its efficacy in acute pain management. Ongoing research may explore new formulations or specific patient populations.
Lab Monitoring
- Renal function (serum creatinine, BUN) before and during treatment, especially in elderly or patients with pre-existing renal impairment.
- Liver function tests (ALT, AST) if treatment exceeds 5 days or if symptoms of hepatic dysfunction occur.
- Complete Blood Count (CBC) if used for more than a few days, to monitor for bleeding or blood dyscrasias.
- Blood pressure monitoring.
Doctor Notes
- Strictly adhere to the maximum 5-day treatment duration.
- Careful patient selection is crucial, especially regarding GI, renal, and cardiovascular risk factors.
- Monitor renal function regularly in at-risk patients.
- Avoid concomitant use with other NSAIDs or anticoagulants.
- Administer with caution in elderly patients, using the lowest effective dose.
Patient Guidelines
- Inform your doctor about all medical conditions and medications you are taking.
- Report any signs of gastrointestinal bleeding (e.g., black, tarry stools, coffee-ground vomit) immediately.
- Avoid taking other NSAIDs or aspirin while on Ketolab injection.
- Do not exceed the prescribed dose or duration of treatment (maximum 5 days).
Missed Dose Advice
As Ketolab injection is typically administered by a healthcare professional in a hospital or clinic setting, a missed dose is unlikely. If you are receiving it as an outpatient, contact your doctor for advice.
Driving Precautions
Ketorolac may cause dizziness, drowsiness, or visual disturbances. Patients should be advised to exercise caution when driving or operating machinery until they know how the medicine affects them.
Lifestyle Advice
- Avoid alcohol consumption during treatment as it may increase the risk of gastrointestinal side effects.
- Maintain adequate hydration.
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