Torosic
Generic Name
Ketorolac Tromethamine
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| torosic 30 mg injection | ৳ 60.00 | N/A |
Description
Overview of the medicine
Ketorolac is a potent non-steroidal anti-inflammatory drug (NSAID) primarily used for the short-term management of moderate to severe acute pain. It reduces pain, inflammation, and fever.
Uses & Indications
Dosage
Adults
Initial dose 30 mg IM or IV, followed by 30 mg every 6 hours as needed. Maximum daily dose should not exceed 120 mg. Treatment duration should not exceed 5 days.
Elderly
Lower doses are recommended, e.g., 15 mg IM or IV every 6 hours. Maximum daily dose should not exceed 60 mg. Adjust based on renal function.
Renal_impairment
Significant dose reduction is required for patients with mild to moderate renal impairment. Contraindicated in advanced renal impairment.
How to Take
Torosic 30 mg injection can be administered intramuscularly (IM) or intravenously (IV). For IV administration, it should be given as a bolus over at least 15 seconds. Do not use for epidural or intrathecal administration.
Mechanism of Action
Ketorolac works by inhibiting prostaglandin synthesis through the non-selective blocking of cyclooxygenase (COX-1 and COX-2) enzymes. Prostaglandins are key mediators of pain and inflammation.
Pharmacokinetics
Onset
Analgesia usually begins within 30-60 minutes after administration.
Excretion
Primarily excreted by the kidneys (approximately 91%), with a small amount excreted in feces.
Half life
Approximately 5-6 hours in healthy adults.
Absorption
Rapid and complete absorption after intramuscular (IM) administration, reaching peak plasma concentrations within 30-60 minutes.
Metabolism
Primarily hepatic metabolism via glucuronidation and hydroxylation.
Side Effects
Contraindications
- Active peptic ulcer disease, recent gastrointestinal bleeding or perforation, or a history of these conditions.
- Known hypersensitivity to ketorolac, aspirin, or other NSAIDs (e.g., history of asthma, urticaria, or allergic reactions).
- Advanced renal impairment or patients at risk of renal failure due to dehydration.
- Patients with coagulopathy, patients receiving anticoagulants (e.g., warfarin), or those at high risk of bleeding.
- During labor and delivery.
- As prophylactic analgesic before major surgery or intra-operatively when hemostasis is critical.
- Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
Drug Interactions
Lithium
Increased plasma lithium levels, potentially leading to toxicity.
Methotrexate
Increased methotrexate toxicity.
Other NSAIDs or aspirin
Increased risk of gastrointestinal adverse effects.
Diuretics and ACE inhibitors
Reduced antihypertensive and diuretic effects, increased risk of renal impairment.
Anticoagulants (e.g., warfarin, heparin)
Increased risk of serious 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 involves symptomatic and supportive measures. Gastric lavage and activated charcoal may be considered if ingestion was recent. Hemodialysis is not effective for removing ketorolac.
Pregnancy & Lactation
Not recommended during the third trimester of pregnancy due to potential for premature closure of the fetal ductus arteriosus. Use with caution in early pregnancy if benefits outweigh risks. Use with caution during lactation as ketorolac is excreted in breast milk.
Side Effects
Contraindications
- Active peptic ulcer disease, recent gastrointestinal bleeding or perforation, or a history of these conditions.
- Known hypersensitivity to ketorolac, aspirin, or other NSAIDs (e.g., history of asthma, urticaria, or allergic reactions).
- Advanced renal impairment or patients at risk of renal failure due to dehydration.
- Patients with coagulopathy, patients receiving anticoagulants (e.g., warfarin), or those at high risk of bleeding.
- During labor and delivery.
- As prophylactic analgesic before major surgery or intra-operatively when hemostasis is critical.
- Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
Drug Interactions
Lithium
Increased plasma lithium levels, potentially leading to toxicity.
Methotrexate
Increased methotrexate toxicity.
Other NSAIDs or aspirin
Increased risk of gastrointestinal adverse effects.
Diuretics and ACE inhibitors
Reduced antihypertensive and diuretic effects, increased risk of renal impairment.
Anticoagulants (e.g., warfarin, heparin)
Increased risk of serious 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 involves symptomatic and supportive measures. Gastric lavage and activated charcoal may be considered if ingestion was recent. Hemodialysis is not effective for removing ketorolac.
Pregnancy & Lactation
Not recommended during the third trimester of pregnancy due to potential for premature closure of the fetal ductus arteriosus. Use with caution in early pregnancy if benefits outweigh risks. Use with caution during lactation as ketorolac is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture, specific details are on the packaging.
Availability
Pharmacies, hospitals
Approval Status
Approved
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Ketorolac has undergone extensive clinical trials demonstrating its efficacy and safety for the short-term treatment of acute moderate to severe pain. Studies have compared its analgesic effect to opioids and other NSAIDs, confirming its potent pain-relieving properties.
Lab Monitoring
- Renal function tests (serum creatinine, BUN) before and during treatment, especially in elderly or those with impaired renal function.
- Liver function tests (ALT, AST) periodically, particularly with prolonged use.
- Complete blood count (CBC) if used for more than 5 days, to monitor for signs of bleeding.
Doctor Notes
- Ketorolac injection is a potent analgesic. Careful patient selection and close monitoring are essential due to potential for severe gastrointestinal, renal, and cardiovascular adverse effects.
- The duration of treatment should not exceed 5 days. Transition to oral analgesics as soon as possible.
- Avoid concomitant use with other NSAIDs, aspirin, or anticoagulants due to increased risk of adverse effects.
- Assess renal function prior to initiation, especially in elderly or at-risk patients.
Patient Guidelines
- Do not exceed the recommended dose or duration (maximum 5 days) to minimize the risk of serious side effects.
- Report any signs of gastrointestinal bleeding immediately, such as black or tarry stools, or vomiting blood.
- Inform your doctor about all other medications you are taking, especially anticoagulants or other NSAIDs.
- Stay well-hydrated during treatment, especially if you are elderly or have pre-existing kidney conditions.
Missed Dose Advice
If a dose is missed, administer it as soon as you remember, unless it is almost time for the next scheduled dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Ketorolac may cause dizziness, drowsiness, visual disturbances, or headache in some patients. Patients should be cautioned about engaging in activities requiring mental alertness, such as driving or operating machinery, if these side effects occur.
Lifestyle Advice
- Avoid alcohol consumption while on ketorolac, as it may increase the risk of gastrointestinal bleeding.
- If you experience dizziness or drowsiness, avoid driving or operating machinery.
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