Ketora
Generic Name
Ketorolac Tromethamine
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ketora 10 mg tablet | ৳ 10.00 | ৳ 100.00 |
Description
Overview of the medicine
Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used for the short-term (up to 5 days) management of moderate to severe acute pain that requires opioid-level analgesia.
Uses & Indications
Dosage
Adults
10 mg orally every 4-6 hours as needed for pain. Do not exceed 40 mg/day. Maximum treatment duration is 5 days.
Elderly
Lower doses (e.g., 10 mg every 6-8 hours) may be required. Closely monitor renal function.
Renal_impairment
Contraindicated in severe renal impairment. Dose reduction or avoidance in moderate impairment. Monitor creatinine clearance.
How to Take
Take orally, preferably with food or milk to minimize gastrointestinal upset. Swallow the tablet whole with a full glass of water.
Mechanism of Action
Ketorolac inhibits prostaglandin synthesis by non-selectively inhibiting cyclooxygenase (COX-1 and COX-2) enzymes. This action reduces inflammation, pain, and fever.
Pharmacokinetics
Onset
Analgesic effect typically begins within 30-60 minutes.
Excretion
Mainly renal (approximately 90%), with a small amount excreted in feces.
Half life
Approximately 4-6 hours (ranges from 2.5 to 9 hours depending on age and renal function).
Absorption
Rapidly and completely absorbed orally. Peak plasma levels usually occur within 30-60 minutes.
Metabolism
Primarily hepatic via hydroxylation and conjugation with glucuronic acid.
Side Effects
Contraindications
- Active peptic ulcer disease or recent gastrointestinal bleeding/perforation
- Severe renal impairment or advanced renal disease
- History of aspirin/NSAID-induced asthma, urticaria, or allergic-type reactions
- Prior to major surgery or during CABG surgery
- Pregnancy (third trimester) and labor/delivery
- Breastfeeding
- Concomitant use with other NSAIDs, aspirin, anticoagulants (e.g., warfarin), pentoxifylline, or probenecid
Drug Interactions
Lithium
Increased plasma lithium levels and risk of toxicity.
Probenecid
Reduced clearance of ketorolac, significantly increasing its plasma levels and half-life.
Methotrexate
Increased methotrexate levels and toxicity.
Pentoxifylline
Increased risk of bleeding.
Diuretics (e.g., Furosemide, Thiazides)
Reduced diuretic and antihypertensive effects, increased risk of renal failure.
Warfarin, Heparin, other Anticoagulants
Increased risk of bleeding.
ACE Inhibitors, Angiotensin Receptor Blockers (ARBs)
Reduced antihypertensive effect and increased risk of renal impairment.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include drowsiness, nausea, vomiting, epigastric pain, and gastrointestinal bleeding. Management is primarily supportive and symptomatic. Gastric lavage and/or activated charcoal may be considered within an hour of ingestion. Monitor renal and hepatic function.
Pregnancy & Lactation
Contraindicated in the third trimester of pregnancy and during labor/delivery due to potential effects on fetal cardiovascular system and inhibition of uterine contractions. Not recommended for breastfeeding mothers as ketorolac is excreted in breast milk.
Side Effects
Contraindications
- Active peptic ulcer disease or recent gastrointestinal bleeding/perforation
- Severe renal impairment or advanced renal disease
- History of aspirin/NSAID-induced asthma, urticaria, or allergic-type reactions
- Prior to major surgery or during CABG surgery
- Pregnancy (third trimester) and labor/delivery
- Breastfeeding
- Concomitant use with other NSAIDs, aspirin, anticoagulants (e.g., warfarin), pentoxifylline, or probenecid
Drug Interactions
Lithium
Increased plasma lithium levels and risk of toxicity.
Probenecid
Reduced clearance of ketorolac, significantly increasing its plasma levels and half-life.
Methotrexate
Increased methotrexate levels and toxicity.
Pentoxifylline
Increased risk of bleeding.
Diuretics (e.g., Furosemide, Thiazides)
Reduced diuretic and antihypertensive effects, increased risk of renal failure.
Warfarin, Heparin, other Anticoagulants
Increased risk of bleeding.
ACE Inhibitors, Angiotensin Receptor Blockers (ARBs)
Reduced antihypertensive effect and increased risk of renal impairment.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include drowsiness, nausea, vomiting, epigastric pain, and gastrointestinal bleeding. Management is primarily supportive and symptomatic. Gastric lavage and/or activated charcoal may be considered within an hour of ingestion. Monitor renal and hepatic function.
Pregnancy & Lactation
Contraindicated in the third trimester of pregnancy and during labor/delivery due to potential effects on fetal cardiovascular system and inhibition of uterine contractions. Not recommended for breastfeeding mothers as ketorolac is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
2 to 3 years from manufacturing date
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Patent expired
Clinical Trials
Extensive clinical trials have demonstrated Ketorolac's efficacy and safety for short-term management of moderate to severe acute pain. Studies have focused on its use in post-operative settings and for various acute pain conditions.
Lab Monitoring
- Renal function tests (serum creatinine, BUN) periodically, especially in elderly or patients with pre-existing renal impairment.
- Liver function tests (ALT, AST) if treatment is prolonged or liver dysfunction is suspected.
- Complete blood count (CBC) to monitor for signs of gastrointestinal bleeding.
Doctor Notes
- Emphasize the strict 5-day maximum duration of treatment for Ketorolac tablets due to significant risk of adverse effects.
- Caution in elderly patients and those with pre-existing cardiovascular, renal, or gastrointestinal conditions.
- Always assess patient's risk factors for GI bleeding and cardiovascular events before prescribing.
- Concomitant use with other NSAIDs or anticoagulants is contraindicated.
Patient Guidelines
- Take this medicine exactly as prescribed by your doctor and for the shortest duration necessary, not exceeding 5 days.
- Do not exceed the recommended dose.
- Report any signs of unusual bleeding, black/tarry stools, or severe stomach pain immediately.
- Avoid taking other NSAIDs (e.g., ibuprofen, naproxen) or aspirin concurrently without consulting your doctor.
- Avoid alcohol while taking this medicine.
- Do not crush or chew the tablet; swallow it whole.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take your next dose at the regular time. Do not double the dose.
Driving Precautions
Ketorolac may cause dizziness, drowsiness, or visual disturbances. Exercise caution when driving or operating machinery until you know how this medicine affects you.
Lifestyle Advice
- Limit alcohol intake to reduce the risk of stomach upset and bleeding.
- Stay adequately hydrated.
- If experiencing dizziness or drowsiness, avoid activities requiring mental alertness such as driving or operating machinery.
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