Ketorolac

Hypersensitivity to ketorolac, aspirin, or other NSAIDs. History of bronchospasm, asthma, rhinitis, urticaria or other allergic-type reactions associated with aspirin or NSAID therapy; active or history of peptic ulcer disease or gastrointestinal haemorrhage (≥2 distinct episodes of proven ulceration or bleeding), recent gastrointestinal bleeding or perforation; confirmed or suspected cerebrovascular bleeding, haemorrhagic diathesis, incomplete haemostasis, high risk of bleeding, severe heart failure. Patient at risk of renal failure due to volume depletion or dehydration. Use in the setting of CABG surgery, during labour and delivery, or as a prophylactic analgesic prior to any major surgery. Patient currently receiving aspirin, anticoagulants, or other NSAIDs. Moderate to severe or advanced renal impairment; severe hepatic impairment (IV/IM). Pregnancy (3rd trimester). Concomitant use with probenecid, lithium, or pentoxifylline.

Patient with history of inflammatory bowel disease (e.g. ulcerative colitis, Crohn's disease), risk factors for gastrointestinal bleeding (e.g. smoking, alcohol use), hypertension, oedema, diabetes mellitus, SLE, mixed connective tissue disorders, other forms of asthma, recent MI, history of kidney disease, low body weight (<50 kg). Debilitated patients. Mild renal and hepatic impairment. Elderly. Pregnancy (1st and 2nd trimester) and lactation. Concomitant use of oral corticosteroids, SSRIs, other antiplatelets, diuretics, or ACE inhibitors. Ophthalmic: Patient with complicated ocular surgery or repeat ocular surgery (within a short timeframe), corneal epithelial defects, corneal denervation, ocular surface disease (e.g. dry eye syndrome), rheumatoid arthritis, predisposition to bleeding. Patient Counselling This drug may cause drowsiness, dizziness, and blurred vision, if affected, do not drive or operate machinery. Ophthalmic: Remove contact lenses prior to use and reinsert them after at least 15 minutes. Monitoring Parameters Monitor response (range of motion, grip strength, pain, mobility, inflammation), renal function (serum creatinine, BUN, urine output), LFTs, CBC and platelets, chemistry profile; blood pressure (prior to initiation and periodically during use). Observe for signs and symptoms of bleeding, gastrointestinal effects (e.g. bleeding, abdominal pain), allergic reactions, hepatotoxicity, weight gain.

Significant: Hypersensitivity reactions (e.g. bronchospasm); renal papillary necrosis (prolonged use), acute renal failure, interstitial nephritis, nephrotic syndrome, new onset or exacerbation of hypertension, Na and fluid retention, hyperkalaemia, prolonged bleeding time, elevated liver enzymes, anaemia. Ophthalmic: Keratitis, corneal thinning, erosion, ulceration, or perforation; delayed healing time, exacerbation of asthma. Blood and lymphatic system disorders: Purpura, thrombocytopenia. Rarely, agranulocytosis. Ear and labyrinth disorders: Tinnitus, hearing loss, vertigo. Eye disorders: Ophthalmic: Blurred vision, increased intraocular pressure, conjunctival hyperaemia, lacrimation, corneal infiltrates, iritis, retinal haemorrhage, cystoid macular oedema, eye or eyelid oedema; eye inflammation or infection; transient stinging and burning (on instillation). Gastrointestinal disorders: Abdominal pain or discomfort, taste abnormality, dyspepsia, nausea, flatulence, constipation, diarrhoea, heartburn, vomiting, stomatitis, gastrointestinal fullness. General disorders and administration site conditions: Inj site reactions (IV/IM). Nervous system disorders: Headache, drowsiness, dizziness, paraesthesia. Renal and urinary disorders: Increased urinary frequency, oliguria, urinary retention. Respiratory, thoracic and mediastinal disorders: Nasal: Nasal discomfort, rhinalgia, throat irritation, rhinitis. Skin and subcutaneous tissue disorders: Rash, pruritus.
Potentially Fatal: Gastrointestinal bleeding, ulceration, or perforation; CV thrombotic events (e.g. MI, stroke), anaphylactoid reactions, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms. Rarely, severe hepatic reactions (e.g. jaundice, fulminant hepatitis, hepatic necrosis or failure).

May increase the risk of bleeding with oral corticosteroids, SSRIs, and other antiplatelet agents. May increase the risk of renal impairment with ACE inhibitors, angiotensin II receptor blockers (ARBs), ciclosporin, and diuretics. May diminish the effects of ACE inhibitors, ARBs, diuretics, or β-blockers (e.g. propranolol). Increased risk of seizure with antiepileptic drugs (e.g. phenytoin, carbamazepine). Hallucinations may occur when used with psychoactive drugs (e.g. fluoxetine, tiotixene, alprazolam). Ketorolac IV/IM may enhance the adverse effect (particularly episodes of apnoea) of nondepolarising muscle relaxants. May increase the serum concentration of methotrexate and digoxin.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) / Ophthalmic Decongestants, Anesthetics, Anti-Inflammatories

M01AB15 - ketorolac ; Belongs to the class of acetic acid derivatives and related substances of non-steroidal antiinflammatory and antirheumatic products.
S01BC05 - ketorolac ; Belongs to the class of non-steroidal antiinflammatory agents. Used in the treatment of inflammation of the eye.