Active substanceKetorolacKetorolac
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  • Dosage form: & nbspfilm coated tablets
    Composition:

    1 tablet, coated, contains:

    active substance: ketorolac trometamol 10.00 mg;

    Excipients: corn starch 44.76 mg, microcrystalline cellulose 122.41 mg, silicon dioxide colloid 1.83 mg, magnesium stearate 1.00 mg;

    film sheath: hypromellose 2.91 mg, macrogol-400- 0.68 mg, talc purified 0.16 mg, titanium dioxide 1.25 mg.

    Description:

    Round biconvex tablets covered with a shell, white or almost white with an engraving "KVT"on one side.

    Pharmacotherapeutic group:non-steroidal anti-inflammatory drug (NSAID)
    ATX: & nbsp

    M.01.A.B.15   Ketorolac

    Pharmacodynamics:

    Ketorolac has a pronounced analgesic effect, it also has an anti-inflammatory and moderate antipyretic effect.

    The mechanism of action is associated with the non-selective inhibition of the activity of the enzyme cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), mainly in peripheral tissues, resulting in inhibition of biosynthesis of prostaglandins - modulators of pain sensitivity, thermoregulation and inflammation. Ketorolac is a racemic mixture [-]S and [+]R enantiomers, while the analgesic effect is due to [-]S form.

    The drug does not affect opioid receptors, does not depress respiration, does not cause drug dependence, does not have sedative and anxiolytic effects.

    By the strength of the analgesic effect comparable to morphine, it is much superior to other non-steroidal anti-inflammatory drugs.

    After oral administration, the beginning of the analgesic effect is noted after 1 h, respectively, the maximum effect is achieved in 1-2 hours.

    Pharmacokinetics:

    After oral administration ketorolac well absorbed in the gastrointestinal tract - maximum concentration (CmOh) in blood plasma (0.7-1.1 μg / ml) is achieved 40 minutes after taking an empty stomach at a dose of 10 mg. Fat-rich food reduces the maximum concentration of the drug in the blood and delays its achievement by 1 hour. 99% of the drug binds to blood plasma proteins, and with hypoalbuminemia, the amount of free substance in the blood increases. Bioavailability is 80-100%. Time to reach equilibrium concentration (Css) with oral administration - 24 hours when administered 4 times a day (above the sub-therapeutic) and is 10 mg 0.39-0.79 μg / ml after oral administration. The volume of distribution is 0.15-0.33 l / kg.In patients with renal insufficiency, the volume of distribution of the drug may increase by a factor of 2, and the volume of its distribution R-enantiomer by 20%.

    Penetrates into breast milk: after the mother receives the first and second dose of ketorolac 10 mg CmOh in milk is achieved after 2 hours and is 7.3 ng / ml and 7.9 g / l, respectively.

    More than 50% of the administered dose is metabolized in the liver with the formation of pharmacologically inactive metabolites. The main metabolites are glucuronides, which are excreted by the kidneys, and p-hydroxycetorolac. It is excreted 91% by the kidneys, 6% by the intestine.

    The half-life (T1/2) in patients with normal renal function is 2.4-9 hours after oral administration of 10 mg. T1/2 lengthens in elderly patients and is shortened in young patients. The function of the liver does not affect T1/2. In patients with impaired renal function with a creatinine concentration in the blood plasma of 19-50 mg / l (168-442 μmol / l) T1/2 is 10.3-10.8 h, with more pronounced renal failure - more than 13.6 hours. The total clearance is 10 mg - 0.025 l / kg / h when administered orally; with renal insufficiency with a concentration of creatinine in the blood plasma of 19-50 mg / l with oral administration of 10 mg - 0.016 l / kg / h.

    It is not excreted by hemodialysis.

    Indications:

    Pain syndrome of moderate and strong intensity of various genesis (including in the postoperative period, with cancer, etc.).

    Contraindications:

    - Hypersensitivity (including other non-steroidal anti-inflammatory drugs);

    - complete or incomplete combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses and intolerance to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (including in history);

    - erosive and ulcerative lesions of the gastrointestinal tract and duodenum, active gastrointestinal bleeding, inflammatory bowel diseases;

    - severe renal failure (creatinine clearance less than 30 ml / min), progressive kidney disease;

    - liver disease (exacerbation);

    - Thyroid gland diseases;

    - confirmed hyperkalemia;

    - acute myocardial infarction;

    - period after aortocoronary shunting;

    - acute disorders of cerebral circulation (ischemic, hemorrhagic stroke);

    - diseases of bone marrow and blood (leukopenia, including history, thrombocytopenia, hemophilia), myelosuppression;

    - severe myopathy, severe myasthenia gravis;

    - pregnancy, lactation period, children's age (up to 16 years).

    Carefully:

    Stomach and duodenal ulcer, ulcerative colitis, Crohn's disease, history of liver disease, hepatic porphyria, chronic renal failure (creatinine clearance 30-60 ml / min), chronic heart failure, arterial hypertension, a significant decrease in the volume of circulating blood (including number after surgical intervention), elderly patients (including those receiving diuretics, weakened patients and low body weight), bronchial asthma, simultaneous reception of glucocorticosteroids (including e prednisolone), anticoagulants (including warfarin), antiplatelet agents (including acetylsalicylic acid, clopidogrel), selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline), coronary heart disease, cerebrovascular disease, dyslipidemia / hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, infection Helicobacter pylori, long-term use of non-steroidal anti-inflammatory drugs, tuberculosis, severe osteoporosis, alcoholism, severe somatic diseases, hypotension, hypertension.

    Pregnancy and lactation:

    Safety of use during pregnancy of this drug is not proven. The effect of delayed synthesis of prostaglandins on embryogenesis during the first two trimesters of pregnancy is not clear.

    In the last trimester of pregnancy, the mechanism of action of ketorolac is characterized by inhibition of labor, premature closure Ductus arteriosus Botalli in the fetus, the predisposition to bleeding in the mother and child rises.

    Dosing and Administration:

    In the form of tablets, Ketanov® is administered orally once or repeatedly, depending on the severity of the pain syndrome.

    A single dose of 10 mg, with repeated admission is recommended to take 10 mg to 4 times a day, depending on the severity of the pain; the maximum daily dose should not exceed 40 mg.

    If administered orally, the duration of the course should not exceed 5 daysher.

    Side effects:

    The classification of side effects is presented: often - 1-10%; infrequently, 0.1-1%; rarely - 0,01-0,1%; very rarely - less than 0.001%, including individual cases.

    From the digestive system: often (especially in elderly patients over 65 years of age who have a history of erosive and ulcerative lesions of the gastrointestinal tract) - gastralgia, diarrhea; infrequently - stomatitis, flatulence, constipation, vomiting, sensation of stomach overflow; rarely - nausea, erosive and ulcerative lesions of the gastrointestinal tract (including with perforation and / or bleeding - abdominal pain, spasm or burning in the epigastric region, melena, vomiting like "coffee grounds", nausea, heartburn, etc. ), cholestatic jaundice, hepatitis, hepatomegaly, acute pancreatitis.

    From the urinary system: rarely - acute renal failure, back pain with or without hematuria and / or azotemia, hemolytic uremic syndrome (hemolytic anemia, renal failure, thrombocytopenia, purpura), frequent urination, increased or decreased urine volume, nephritis, edema of renal genesis.

    From the sense organs: rarely - Hearing loss, ringing in the ears, visual impairment (including blurred vision).

    From the respiratory system: rarely - bronchospasm or dyspnea, rhinitis, laryngeal edema (shortness of breath, difficulty breathing).

    From the side of the central nervous system: often - headache, dizziness, drowsiness; rarely - aseptic meningitis (fever, severe headache, cramps, stiffness in the neck muscles and / or back), hyperactivity (mood changes, anxiety), hallucinations, depression, psychosis.

    From the cardiovascular system: infrequently - Increased blood pressure; rarely - Pulmonary edema, fainting.

    On the part of the organs of hematopoiesis: rarely - anemia, eosinophilia, and leukopenia.

    From the side of the hemostasis system: rarely - bleeding from a postoperative wound, epistaxis, rectal bleeding.

    From the skin: infrequently - skin rash (including maculopapular rash), purpura; rarely - exfoliative dermatitis (fever, chills or without redness, induration or skin peeling, swelling and / or tenderness of the tonsils), rash, Stevens-Johnson syndrome, Lyell syndrome.

    Allergic reactions: rarely - anaphylaxis or anaphylactoid reaction (change in skin color, skin rash, hives, itchy skin, tachypnea and dyspnea, edema of the eyelids, periorbital edema, dyspnea, wheezing, heaviness in the chest, wheezing).

    Other: often - edema (face, legs, ankles, fingers, feet, weight gain); less often - increased sweating; rarely swelling of the tongue, fever.

    Overdose:

    Symptoms: abdominal pain, nausea, vomiting, the occurrence of peptic ulcers of the stomach or erosive gastritis, impaired renal function, metabolic acidosis.

    Treatment: gastric lavage, administration of adsorbents (Activated carbon) and the conduct of symptomatic therapy (maintenance of vital functions in the body).

    It is not excreted sufficiently by dialysis.

    Interaction:

    Simultaneous use of ketorolac with acetylsalicylic acid or other non-steroidal anti-inflammatory drugs, calcium preparations, glucocorticosteroids, ethanol, corticotropin can lead to the formation of gastrointestinal ulcers and the development of gastrointestinal bleeding.

    Co-administration with paracetamol increases nephrotoxicity, with methotrexate-hepato- and nephrotoxicity.

    Co-administration of ketorolac and methotrexate is possible only with the use of low doses of ketorolac (control the concentration of methotrexate in the blood plasma).

    Probenecid reduces plasma clearance and the volume of ketorolac distribution, increases its concentration in blood plasma and increases its half-life.

    Against the background of the use of ketorolac, a decrease in the clearance of methotrexate and lithium and the increased toxicity of these substances are possible.

    Simultaneous administration with indirect anticoagulants, heparin, thrombolytic agents, antiaggregants, cefoperazone, cefotetan and pentoxifylline increases the risk of bleeding.

    Reduces the effect of antihypertensive and diuretic drugs (decreases the synthesis of prostaglandins in the kidneys).

    When combined with opioid analgesics, the doses of the latter can be significantly reduced.

    Antacids do not affect the absorption of the drug.

    Ketorolac enhances hypoglycemic action of insulin and oral hypoglycemic drugs (dose recalculation is necessary).

    Co-administration with sodium valproate causes disruption of platelet aggregation. Increases the concentration in the blood plasma of verapamil and nifedipine.

    At appointment with other nephrotoxic medicines (including with preparations of gold) the risk of development nefrotoksichnosti raises.

    Drugs that block tubular secretion, reduce the clearance of ketorolac and increase its concentration in the blood plasma.

    Special instructions:

    The effect on platelet aggregation stops after 24-48 hours.

    Hypovolemia increases the risk of adverse reactions from the kidneys.

    If necessary, you can prescribe in combination with narcotic analgesics.

    Ketanov® is not recommended for use as a means for premedication, which supports anesthesia and anesthesia in obstetric practice.

    Do not use simultaneously with paracetamol for more than 5 days.

    Patients with a blood clotting disorder are prescribed a drug only with a constant control of the number of platelets, which is especially important in the post-operation period when careful monitoring of hemostasis is required.

    Effect on the ability to drive transp. cf. and fur:

    During the period of treatment, it is possible to develop side effects from the central nervous system (drowsiness, dizziness, headache), which reduces the speed of mental and motor reactions and, therefore, it is necessary to refrain from driving and doing other potentially hazardous activities,requiring increased concentration of attention and speed of psychomotor reactions.

    Form release / dosage:

    Tablets, film-coated, 10 mg.

    Packaging:

    10 tablets in a blister of aluminum foil and PVC film or blister ORA-A1- PVC/A1.

    1, 2, 3 or 10 blisters together with instructions for use in a cardboard box.

    Storage conditions:

    In a dry, the dark place at a temperature of no higher than 25 ° C.

    Keep out of the reach of children.

    Shelf life:

    3 years.

    Do not use after expiry date.

    Terms of leave from pharmacies:On prescription
    Registration number:П N012170 / 01
    Date of registration:02.06.2011
    The owner of the registration certificate:Ranbaxy Laboratories LimitedRanbaxy Laboratories Limited India
    Manufacturer: & nbsp
    Representation: & nbspRABBAYS LABORATORY LIMITEDRABBAYS LABORATORY LIMITED
    Information update date: & nbsp13.09.2013
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