Torax
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 |
|---|---|---|
| torax 60 mg injection | ৳ 100.00 | N/A |
Description
Overview of the medicine
Torax 60 mg Injection contains Ketorolac Tromethamine, a potent Non-steroidal Anti-inflammatory Drug (NSAID). It is used for the short-term management of moderately severe acute pain that requires opioid-level analgesia, typically in a post-operative setting.
Uses & Indications
Dosage
Adults
Single IM dose: 60 mg. Multiple IM doses: 30 mg every 6 hours (max 120 mg/day). Single IV dose: 30 mg. Multiple IV doses: 15-30 mg every 6 hours (max 120 mg/day). Total treatment duration should not exceed 5 days.
Elderly
Lower doses recommended. Single IM/IV dose: 30 mg. Multiple IM/IV doses: 15 mg every 6 hours (max 60 mg/day). Total treatment duration should not exceed 5 days.
Renal_impairment
Reduced dosage (e.g., 15 mg every 6 hours, max 60 mg/day). Contraindicated in severe renal impairment. Close monitoring of renal function is essential.
How to Take
Administer slowly by deep intramuscular injection or by intravenous bolus injection over at least 15 seconds. Ensure aseptic technique.
Mechanism of Action
Ketorolac works by inhibiting prostaglandin synthesis through non-selective inhibition of cyclooxygenase (COX-1 and COX-2) enzymes. Prostaglandins are key mediators of pain, inflammation, and fever.
Pharmacokinetics
Onset
Analgesic effect usually begins within 30-60 minutes after IM/IV administration.
Excretion
Mainly excreted by the kidneys (approximately 91% as unchanged drug and metabolites), with a small amount excreted in feces (approximately 6%).
Half life
Approximately 5 to 6 hours in healthy adults, slightly prolonged in elderly or renally impaired patients.
Absorption
Rapid and complete absorption after intramuscular (IM) administration, reaching peak plasma concentrations within 30-60 minutes.
Metabolism
Primarily hepatic, mainly through glucuronidation and some hydroxylation. Metabolites are largely inactive.
Side Effects
Contraindications
- Hypersensitivity to ketorolac, aspirin, or other NSAIDs.
- Active peptic ulcer, recent gastrointestinal bleeding or perforation, or history of these conditions.
- Advanced renal impairment or risk of renal failure due to dehydration.
- Coagulation disorders or patients receiving anticoagulants (e.g., warfarin).
- Confirmed or suspected cerebrovascular bleeding.
- Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
- During pregnancy, labor and delivery, or lactation.
- Children under 16 years of age.
Drug Interactions
Lithium
Increased plasma lithium levels, leading to toxicity.
Methotrexate
Increased methotrexate toxicity.
Other NSAIDs
Increased risk of adverse effects, avoid concomitant use.
Corticosteroids
Increased risk of gastrointestinal ulceration and bleeding.
Diuretics (e.g., furosemide) and ACE inhibitors
Reduced efficacy of these drugs and increased risk of renal impairment.
Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin)
Increased risk of bleeding.
Storage
Store below 30°C. Protect from light. Do not freeze. Keep out of reach of children.
Overdose
Symptoms of overdose may include nausea, vomiting, epigastric pain, lethargy, drowsiness, and gastrointestinal bleeding. Management is primarily supportive. Gastric lavage is not effective for injection overdose. Hemodialysis does not significantly remove ketorolac from the blood.
Pregnancy & Lactation
Contraindicated in late pregnancy, labor, and delivery due to potential for premature closure of the fetal ductus arteriosus and inhibition of uterine contractions. Not recommended during lactation as ketorolac is excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to ketorolac, aspirin, or other NSAIDs.
- Active peptic ulcer, recent gastrointestinal bleeding or perforation, or history of these conditions.
- Advanced renal impairment or risk of renal failure due to dehydration.
- Coagulation disorders or patients receiving anticoagulants (e.g., warfarin).
- Confirmed or suspected cerebrovascular bleeding.
- Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
- During pregnancy, labor and delivery, or lactation.
- Children under 16 years of age.
Drug Interactions
Lithium
Increased plasma lithium levels, leading to toxicity.
Methotrexate
Increased methotrexate toxicity.
Other NSAIDs
Increased risk of adverse effects, avoid concomitant use.
Corticosteroids
Increased risk of gastrointestinal ulceration and bleeding.
Diuretics (e.g., furosemide) and ACE inhibitors
Reduced efficacy of these drugs and increased risk of renal impairment.
Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin)
Increased risk of bleeding.
Storage
Store below 30°C. Protect from light. Do not freeze. Keep out of reach of children.
Overdose
Symptoms of overdose may include nausea, vomiting, epigastric pain, lethargy, drowsiness, and gastrointestinal bleeding. Management is primarily supportive. Gastric lavage is not effective for injection overdose. Hemodialysis does not significantly remove ketorolac from the blood.
Pregnancy & Lactation
Contraindicated in late pregnancy, labor, and delivery due to potential for premature closure of the fetal ductus arteriosus and inhibition of uterine contractions. Not recommended during lactation as ketorolac is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date, refer to packaging for specific expiry date.
Availability
Pharmacies, Hospitals
Approval Status
Approved (DGDA, FDA)
Patent Status
Expired
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established Ketorolac's efficacy and safety for acute pain management. Ongoing research explores its role in multimodal analgesia and specific patient populations.
Lab Monitoring
- Renal function (serum creatinine, BUN) before and during treatment, especially in elderly or renally impaired patients.
- Liver function tests (ALT, AST) periodically, particularly with prolonged use.
- Complete Blood Count (CBC) with differential, especially for prolonged use or if bleeding is suspected.
Doctor Notes
- Strictly adhere to the 5-day maximum treatment duration to minimize risk of serious adverse events.
- Carefully assess patient's renal function, cardiovascular risk, and history of GI disorders before and during treatment.
- Consider Ketorolac as part of a multimodal analgesia regimen, particularly in post-operative settings.
Patient Guidelines
- Do not exceed the prescribed dose or duration of treatment (maximum 5 days).
- Report any signs of gastrointestinal bleeding (e.g., black, tarry stools, vomiting blood) or allergic reactions immediately.
- Stay well-hydrated during treatment, especially if you have risk factors for renal impairment.
- Avoid alcohol while on this medication.
Missed Dose Advice
Since Torax Injection is typically administered in a hospital or clinical setting, missed doses are unlikely. If a scheduled dose is missed, contact your healthcare provider immediately.
Driving Precautions
Torax Injection may cause dizziness, drowsiness, or visual disturbances. Patients should be cautioned against driving or operating machinery if they experience these effects.
Lifestyle Advice
- Maintain adequate hydration.
- Avoid or limit alcohol consumption to minimize GI risks.
- Follow your doctor's instructions regarding rest and activity.
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