Active substanceKetorolacKetorolac
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  • Dosage form: & nbspsolution for intravenous and intramuscular administration
    Composition:

    In 1 ml of the drug contains:

    active substance: ketorolac trometamol 30.0 mg;

    Excipients: ethanol 96% 100.0 mg, sodium chloride 4.35 mg, disodium edetate dihydrate 0.50 mg, 1M sodium hydroxide solution or hydrochloric acid solution to pH = 7.4-7.5, water for injection up to 1 ml.

    Description:

    Transparent light yellow liquid.

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

    M.01.A.B.15   Ketorolac

    Pharmacodynamics:

    Ketorolaka trometamol refers to non-steroidal anti-inflammatory drugs. Ketorolaka trometamol has a pronounced analgesic effect, has also an anti-inflammatory and moderate antipyretic effect. The mechanism of action is associated with nonselective inhibition of cyclooxygenase 1 (COX1) and cyclooxygenase 2 (COX2) activity catalyzing the formation of prostaglandins (Pg) from arachidonic acid, which play an important role in the pathogenesis of pain, inflammation and fever. By the strength of the analgesic effect comparable to morphine, it significantly exceeds other NSAIDs.

    The beginning of the analgesic effect is observed respectively after 0.5 h, the maximum effect is achieved in 1-2 hours.

    Pharmacokinetics:

    Bioavailability is complete and fast. The maximum concentration after intramuscular injection (Cmax) - 1.74-3.1 mcg / ml, the time to reach the maximum concentration (TCmah) - 15-73 minutes; FROMmah after intravenous administration - 3.69-5.61 mcg / ml. The connection with plasma proteins is 99%. Time to reach equilibrium concentration (Css) - 24 hours when administered 4 times a day (more than the recommended daily dose) and is intramuscular injection - 1,29-2,47 mcg / ml, with intravenous injection - 1,68-2,76 mcg / ml.

    The volume of distribution is 0.15-0.33 l / kg. In patients with renal insufficiency, the volume of ketorolac distribution may increase 2-fold, and the volume of distribution of ketorolac R-enantiomer by 20%.

    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 was 5: 3 hours on average (3.5-9.2 hours after intramuscular injection, 4-7.9 hours after intravenous administration).T1 / 2 increases in elderly patients and is shortened in young patients. The liver function does not affect T1 / 2. In patients with impaired renal function with a creatinine concentration in the plasma of 19-50 mg / l (168-442 μmol / l) T1 / 2 - 10,3-10,8 h, with more pronounced renal failure - more than 13.6 hours.

    The total clearance is at intramuscular injection - 0.023 l / h / kg (0.019 l / h / kg in elderly patients), intravenous administration - 0.03 l / h / kg, in patients with renal failure at a creatinine concentration in the plasma of 19-50 mg / l - 0.015 l / h / kg.

    It is not excreted by hemodialysis.

    Indications:

    Pain syndrome of strong and moderate severity: trauma, toothache, pain in the postoperative period, oncological diseases, myalgia, arthralgia, neuralgia, sciatica, dislocations, sprains, rheumatic diseases.

    It is intended for symptomatic therapy, reducing pain and inflammation at the time of application, the progression of the disease is not affected.

    Contraindications:

    Hypersensitivity, a complete or incomplete combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses and intolerance to acetylsalicylic acid (ASA) or other NSAIDs (incl.in the anamnesis), a urticaria, a rhinitis caused by reception of NSAIDs (in the anamnesis); intolerance to medicines (drugs) pyrazolone series, hypovolemia (regardless of the cause), erosive and ulcerative lesions of the gastrointestinal tract in the acute stage, hypocoagulation (including hemophilia), bleeding or a high risk of their development, severe renal failure 30 ml / min), severe hepatic impairment or active liver disease, condition after aortocoronary shunting (ASCh), confirmed hyperkalemia, inflammatory bowel disease, labor, lactation, children's recovery ast to 16 years (safety and efficacy not established).

    Carefully:

    Bronchial asthma; presence of factors that increase gastrointestinal toxicity: alcoholism, tobacco smoking and cholecystitis; postoperative period, chronic heart failure (CHF), edematous syndrome, hypertension, impaired renal function (plasma creatinine below 50 mg / l), cholestasis, sepsis, systemic lupus erythematosus (SLE), simultaneous administration with other NSAIDs, ischemic heart disease IHD), cerebrovascular disease, dyslipidemia / hyperlipidemia, diabetes mellitus,diseases of peripheral arteries, chronic renal failure (CRF) (KK 30-60 ml / min), ulcerative lesions of the gastrointestinal tract (GI) in the anamnesis, the presence of infection H.pylori, long-term use of NSAIDs, severe somatic diseases, simultaneous administration of oral glucocorticosteroid (GCS) (including prednisolone), anticoagulants (including warfarin), antiaggregants (including clopidogrel), selective inhibitors of re-uptake serotonin (including citalopram, fluoxetine, paroxetine, sertraline), elderly age (over 65 years).

    Pregnancy and lactation:

    Contraindicated in pregnancy.

    For the duration of treatment, breastfeeding should be discontinued.

    Dosing and Administration:

    Intramuscularly (in / m), intravenously (iv).

    With iv administration, the dose should be administered at least 15 seconds (for dosage forms containing ethanol).

    Patients from 16 to 64 years of age with a body weight exceeding 50 kg, in / m for 1 administration, administer not more than 60 mg (taking into account oral administration); usually 30 mg every 6 hours; in / in - 30 mg (not more than 15 doses for 5 days).

    In / m adults with a body weight of less than 50 kg or with CRF for 1 administration is administered no more than 30 mg (including oral dose); usually - 15 mg (no more than 20 doses per 5 days); in / in - no more than 15 mg every 6 hours (no more than 20 doses in 5 days).

    The maximum daily doses for IM and IV administration are for patients from 16 to 64 years with a body weight exceeding 50 kg, 90 mg / day; adult patients with a body weight of less than 50 kg or with CRF, as well as elderly patients (over 65 years of age) for intravenous and / or 60 mg injections.

    The duration of treatment should not exceed 5 days.

    Side effects:

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

    From the digestive system: often - gastralgia, diarrhea; less often - stomatitis, flatulence, constipation, vomiting, sensation of stomach overflow; rarely - decreased appetite, nausea, erosive and ulcerative lesions of the digestive tract (including with perforation and / or bleeding - abdominal pain, spasm or burning in the epigastric region, blood in the feces or melena, vomiting with blood or the type of "coffee thick, "nausea, heartburn, etc.), cholestatic jaundice, hepatitis, hepatomegaly, acute pancreatitis.

    From the urinary system: rarely acute renal failure, back pain, hematuria, azotemia, hemolytic-uremic syndrome (hemolytic anemia, renal failure, thrombocytopenia, purpura), increased frequency of urination, increased or decreased volume urine, 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, pulmonary edema, laryngeal edema (difficulty breathing).

    From the central nervous system (CNS): often - headache, dizziness, drowsiness; rarely - aseptic meningitis (fever, severe headache, seizures, neck and / or neck stiffness), hyperactivity (mood changes, anxiety), hallucinations, depression, psychosis, fainting.

    From the side of the cardiovascular system (SSS): less often - an increase in blood pressure (BP).

    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, hyperemia, densification or flaking of the skin, enlargement and / or soreness of palatine tonsils), urticaria, malignant exudative erythema (Stevens-Johnson syndrome ), toxic epidermal necrolysis (Lyell's syndrome).

    Local Reactions: less often - burning or pain at the injection site.

    Allergic reactions: rarely - anaphylaxis or anaphylactoid reactions (skin discoloration, skin rash, hives, skin itch, tachypnea, edema of the eyelids, periorbital edema, heaviness in the chest, wheezing).

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

    Overdose:

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

    Treatment: symptomatic therapy (maintenance of vital body functions). It is not excreted sufficiently by dialysis.

    Interaction:

    Simultaneous application of ketorolac with acetylsalicylic acid, or other NSAIDs, calcium preparations, glucocorticoids, 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.

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

    Probenecid reduces plasma clearance and the volume of ketorolac distribution, increases its concentration in blood plasma and increases T1 / 2.

    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 (reduced synthesis Pg in the kidneys).

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

    The hypoglycemic effect of insulin and oral hypoglycemic drugs is increased (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.

    When appointed with other nephrotoxic drugs (LS) (incl.with preparations of gold) the risk of development of nephrotoxicity increases.

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

    Solution for injection should not be mixed in one syringe with morphine, promethazine and hydroxyzine due to precipitation.

    Pharmaceutically incompatible with a solution of tramadol, lithium preparations.

    Solution Ketorolac Rhompharm should not be mixed in one syringe with other medications.

    Special instructions:

    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.

    Hypovolemia increases the risk of adverse reactions from the kidneys. If necessary, you can prescribe in combination with narcotic analgesics. The effect on platelet aggregation stops after 24-48 hours.

    Ketorolac Rhompharm 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 violation of blood clotting drug prescribed only with a constant control of the number of platelets; This is especially important inpostoperative period and requires careful monitoring of hemostasis.

    Effect on the ability to drive transp. cf. and fur:Since a significant part of patients with Ketorolac Rhompharm develop side effects from the CNS (drowsiness, dizziness, headache), it is recommended to avoid performing work requiring increased attention and quick response (driving vehicles, working with mechanisms, etc.).
    Form release / dosage:

    Solution for intravenous and intramuscular injection 30 mg / ml.

    Packaging:

    For 1.0 ml of the drug in ampoules of dark glass of hydrolytic class I with a capacity of 1 ml with a ring for kink. A label is affixed to each ampoule.

    For 5 ampoules are placed in contour cell packs.

    For 1 or 2 contour packagings together with the instructions for use are placed in a cardboard box.

    Storage conditions:

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

    In a place inaccessible to children.

    Shelf life:

    3 years.

    Do not use after the expiration date.

    Terms of leave from pharmacies:On prescription
    Registration number:LP-000936
    Date of registration:18.10.2011
    The owner of the registration certificate:K.O. Ромфарм Компани С.Р.Л.K.O. Ромфарм Компани С.Р.Л. Romania
    Manufacturer: & nbsp
    Representation: & nbspРомфарма ОООРомфарма ООО
    Information update date: & nbsp18.10.2011
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