Sanoket
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 |
|---|---|---|
| sanoket 30 mg injection | ৳ 55.38 | N/A |
Description
Overview of the medicine
Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used for the short-term management of moderate to severe acute pain, usually post-operative. It provides potent analgesic effects by inhibiting prostaglandin synthesis.
Uses & Indications
Dosage
Adults
IM or IV: 30 mg every 6 hours, not to exceed 120 mg/day. Single dose: 30 mg IM or IV. Max treatment duration: 5 days for combined use.
Elderly
IM or IV: 15 mg every 6 hours, not to exceed 60 mg/day. Single dose: 15 mg IM or IV. Max treatment duration: 5 days.
Renal_impairment
Significant reduction in dosage or contraindication depending on the severity of renal impairment. Generally, 15 mg every 6 hours, maximum 60 mg/day for mild to moderate impairment. Contraindicated in severe impairment.
How to Take
For intramuscular administration, inject slowly and deeply into a large muscle. For intravenous administration, inject over 15 seconds or as a part of a slow infusion.
Mechanism of Action
Inhibits prostaglandin synthesis by non-selectively blocking cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing inflammation, pain, and fever.
Pharmacokinetics
Onset
Analgesia usually begins within 10 minutes of intravenous (IV) administration and 30 minutes of intramuscular (IM) administration.
Excretion
Primarily renal (approximately 92%), with a small amount excreted in feces (approximately 6%).
Half life
Approximately 5-6 hours in healthy adults.
Absorption
Rapidly and completely absorbed after intramuscular (IM) administration. Peak plasma concentrations are reached within 30-60 minutes.
Metabolism
Primarily hepatic via hydroxylation and conjugation. Main metabolite is p-hydroxyketorolac.
Side Effects
Contraindications
- Active peptic ulcer disease, recent gastrointestinal bleeding or perforation.
- Severe renal impairment or risk of renal failure due to dehydration.
- History of asthma, urticaria, or other allergic reactions to aspirin or other NSAIDs.
- Coronary Artery Bypass Graft (CABG) surgery.
- Labor and delivery, during pregnancy (especially third trimester).
- Patients with confirmed or suspected cerebrovascular bleeding or coagulation disorders.
Drug Interactions
Lithium
Increased plasma lithium levels, leading to toxicity.
Methotrexate
Increased methotrexate toxicity.
ACE inhibitors/ARBs
Increased risk of renal impairment, especially in dehydrated patients.
Other NSAIDs or Aspirin
Increased risk of gastrointestinal side effects.
Diuretics (e.g., Furosemide)
Reduced diuretic and antihypertensive effects.
Anticoagulants (e.g., Warfarin, Heparin)
Increased risk of bleeding.
Storage
Store at controlled room temperature (20°C to 25°C), excursions permitted to 15°C to 30°C. Protect from light. Do not freeze.
Overdose
Symptoms of overdose include abdominal pain, nausea, vomiting, lethargy, and sometimes acute renal failure. Management involves symptomatic and supportive care. Gastric lavage and activated charcoal are not typically indicated for injectable overdose.
Pregnancy & Lactation
Pregnancy: Contraindicated in the third trimester due to risk of premature closure of the ductus arteriosus and renal dysfunction in the fetus. Avoid use in first and second trimesters unless absolutely necessary. Lactation: Not recommended, as ketorolac is excreted in breast milk and may cause adverse effects in nursing infants.
Side Effects
Contraindications
- Active peptic ulcer disease, recent gastrointestinal bleeding or perforation.
- Severe renal impairment or risk of renal failure due to dehydration.
- History of asthma, urticaria, or other allergic reactions to aspirin or other NSAIDs.
- Coronary Artery Bypass Graft (CABG) surgery.
- Labor and delivery, during pregnancy (especially third trimester).
- Patients with confirmed or suspected cerebrovascular bleeding or coagulation disorders.
Drug Interactions
Lithium
Increased plasma lithium levels, leading to toxicity.
Methotrexate
Increased methotrexate toxicity.
ACE inhibitors/ARBs
Increased risk of renal impairment, especially in dehydrated patients.
Other NSAIDs or Aspirin
Increased risk of gastrointestinal side effects.
Diuretics (e.g., Furosemide)
Reduced diuretic and antihypertensive effects.
Anticoagulants (e.g., Warfarin, Heparin)
Increased risk of bleeding.
Storage
Store at controlled room temperature (20°C to 25°C), excursions permitted to 15°C to 30°C. Protect from light. Do not freeze.
Overdose
Symptoms of overdose include abdominal pain, nausea, vomiting, lethargy, and sometimes acute renal failure. Management involves symptomatic and supportive care. Gastric lavage and activated charcoal are not typically indicated for injectable overdose.
Pregnancy & Lactation
Pregnancy: Contraindicated in the third trimester due to risk of premature closure of the ductus arteriosus and renal dysfunction in the fetus. Avoid use in first and second trimesters unless absolutely necessary. Lactation: Not recommended, as ketorolac is excreted in breast milk and may cause adverse effects in nursing infants.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Usually 24 to 36 months from the date of manufacture, depending on the manufacturer.
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Generic
WHO Essential Medicine
YesClinical Trials
Ketorolac has undergone extensive clinical trials demonstrating its efficacy and safety for the short-term management of moderate to severe acute pain. Studies typically compare it to other NSAIDs or opioids.
Lab Monitoring
- Renal function tests (e.g., serum creatinine, BUN) especially in patients with pre-existing renal impairment or risk factors.
- Liver function tests (e.g., ALT, AST) if used for more than 5 days or in patients with liver disease.
- Complete Blood Count (CBC) if long-term use (though generally not recommended beyond 5 days).
Doctor Notes
- Emphasize the strict 5-day maximum treatment duration for all routes of administration combined.
- Carefully assess patient's cardiovascular and gastrointestinal risk factors before initiation.
- Ensure adequate hydration, especially in surgical patients, to mitigate renal risks.
- Avoid concomitant use with other NSAIDs, aspirin, or anticoagulants unless benefits outweigh risks and patient is closely monitored.
Patient Guidelines
- Inform your doctor about all medical conditions and medications before starting Sanoket.
- Do not exceed the prescribed dose or duration of treatment (maximum 5 days).
- Report any signs of unusual bleeding, severe stomach pain, black stools, or allergic reactions immediately.
- Stay adequately hydrated, especially during treatment.
Missed Dose Advice
If a dose is missed, administer it as soon as remembered, provided it is not close to the time for the next scheduled dose. Do not double the dose to catch up.
Driving Precautions
Sanoket may cause dizziness, drowsiness, or visual disturbances. If you experience these effects, avoid driving or operating heavy machinery.
Lifestyle Advice
- Avoid alcohol consumption while on Sanoket as it may increase the risk of gastrointestinal bleeding.
- Avoid smoking, as it can worsen gastrointestinal side effects.
- Follow any dietary restrictions recommended by your doctor.
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