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

    1 tablet contains:

    active substance: ketorolac trometamol (ketorolac tromethamine) 10 mg;

    auxiliary substances (core): microcrystalline cellulose, anhydrous lactose, sodium carboxymethyl starch, silicon dioxide colloid, magnesium stearate;

    auxiliary substances (shell): hypromellose, talc, titanium dioxide, macrogol, silicon dioxide colloidal.

    Description:

    Round biconvex tablets covered with a film coat, white or almost white.

    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 a nonselective inhibition of the activity of the enzyme cyclooxygenase 1 and 2, mainly in peripheral tissues, resulting in inhibition of the biosynthesis of prostaglandins - modulators 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 significantly exceeds other NSAIDs.

    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:

    Ingestion 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 the hypoalbuminemia increases the amount of free substance in the blood.

    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 can be increased 2-fold, and the volume of its distribution R-enantiomer by 20%.

    Penetrates into breast milk: when the mother receives 10 mg of ketorolac CmOh in milk is achieved 2 hours after the first dose and is 7.3 ng / ml, 2 hours after the second dose of ketorolac (using the drug 4 times a day) - is 7.9 ng / ml.

    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 averagely 5.3 hours. 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 hours, with more pronounced renal failure - more than 13.6 hours.

    It is not excreted during hemodialysis.

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

    Hypersensitivity to the active substance or ancillary components; anamnestic data on an attack of bronchial obstruction, rhinitis, urticaria after taking acetylsalicylic acid or other NSAIDs (complete or incomplete acetylsalicylic acid intolerance syndrome - rhinosinusitis, urticaria, polyps of the nasal mucosa, bronchial asthma); angioedema, hypovolemia (regardless of the cause that caused it), dehydration.

    Erosive and ulcerative changes in the gastric mucosa or duodenum, active gastrointestinal bleeding; inflammatory bowel disease; hypocoagulation (including hemophilia).

    Severe hepatic impairment or active liver disease; severe renal failure (plasma creatinine above 50 mg / L), progressive kidney disease; confirmed hyperkalemia.

    Hemorrhagic stroke (confirmed or suspected), hemorrhagic diathesis, simultaneous administration with other NSAIDs, a high risk of developing or recurring bleeding (including after surgery), a violation of hematopoiesis.

    Pregnancy, childbirth and lactation.

    Children under 16 years of age (efficacy and safety not established).

    The period after aortocoronary bypass surgery.

    The drug is not used for anesthesia before and during surgery due to high risk of bleeding, as well as for the treatment of chronic pain.

    Carefully:

    Bronchial asthma; cholecystitis; chronic heart failure; ischemic heart disease, cerebrovascular disease, hypertension; dyslipidemia / hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, impaired renal function (plasma creatinine below 50 mg / L); cholestasis; active hepatitis; ­sepsis; systemic lupus erythematosus; old age (over 65 years); polyps of the nasal mucosa and nasopharynx.

    Anamnestic data on the development of gastrointestinal lesions, the presence of infection Helicobacter pylori, long-term use of NSAIDs, frequent use of alcohol, severe somatic diseases, concomitant therapy with the following drugs:

    - anticoagulants (for example, warfarin), antiplatelet agents (e.g., acetylsalicylic acid, clopidogrel), oral glucocorticosteroids (for example, prednisolone), selective serotonin reuptake inhibitors (for example, citalopram, fluoxetine, paroxetinesertraline).

    To reduce the risk of developing adverse events on the part of the gastrointestinal tract, a minimum effective dose should be used with the minimum possible short course.

    Dosing and Administration:

    Ketofril ® 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.

    When administered, the duration of the course should not exceed 5 days.
    Side effects:

    Often - more than 3%, less often - 1-3%, rarely - less than 1%.

    From the digestive system: often (especially in elderly patients, over 65 years of age, having a history of erosive and ulcerative lesions of the gastrointestinal tract) - gastralgia, diarrhea; less often - 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.

    Co the side of 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, impaired vision (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, convulsions, neck and / or neck stiffness), hyperactivity (mood changes, anxiety), hallucinations, depression, psychosis.

    From the side of the cardiovascular system: less often - increased blood pressure; rarely - pulmonary edema, fainting.

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

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

    From the skin: less often - skin rash (including maculopapular rash), purpura; rarely - exfoliative dermatitis (fever with chills or without, redness, densification or flaking of the skin, swelling and / or tenderness of the tonsils), hives, Stevens-Johnson syndrome, Lyell's syndrome.

    Allergic reactions: rarely anaphylaxis or anaphylactoid reactions (skin color change of the face, skin rash, hives, skin itch, tachypnea or dyspnea, edema of the eyelids, periorbital edema, shortness of breath, shortness of breath, chest pain, wheezing).

    Other: often - swelling (face, legs, ankles, fingers, feet, weight gain); less often - excessive 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 body functions). 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 full absorption of the drug.

    The hypoglycemic action of insulin and oral hypoglycemic agents increases (a dose recalculation is necessary).

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

    At appointment with other nefrotoksicnymi medical products (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.

    Do not use simultaneously with paracetamol for more than 5 days.Patients with blood clotting disorder are prescribed a drug only with a constant control of the number of platelets, it is especially important in the post-operation period, which requires careful control of the hemostasis.

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

    As a significant part of patients with the administration of ketorolac develop side effects from the central nervous system (drowsiness, dizziness, headache), it is recommended to avoid performing work that requires increased attention and quick response (driving vehicles, working with mechanisms, etc.).

    Form release / dosage:Tablets, film-coated, 10 mg.
    Packaging:

    10 tablets per strip of aluminum foil.

    1 or 2 strips in a cardboard box together with instructions for use.

    Sample not for sale: 10 tablets per strip of aluminum foil. 1 strip with instructions for use in a cardboard box.

    Storage conditions:

    At a temperature of no higher than 30 ° C, in a dry, protected from light place.

    Keep out of the reach of children.

    Shelf life:

    3 years.

    Do not use after the expiration date printed on the package.

    Terms of leave from pharmacies:On prescription
    Registration number:LSR-007323/08
    Date of registration:12.09.2008
    The owner of the registration certificate:Torrent Pharmaceuticals Co., Ltd.Torrent Pharmaceuticals Co., Ltd. India
    Manufacturer: & nbsp
    Representation: & nbspTORRENT PHARMACEUTICALS LTD. TORRENT PHARMACEUTICALS LTD. India
    Information update date: & nbsp02.12.2009
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