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Inj ketorpal

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Inj Ketorolac injection uses dose mechanism side effects

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Here is a complete profile of Injection Ketorolac (Toradol):

Injection Ketorolac (Toradol)

Class & Mechanism

Ketorolac is a parenteral NSAID (acetic acid derivative) that provides analgesia by inhibiting COX-1 and COX-2, thereby reducing prostaglandin synthesis. It is primarily a peripherally acting analgesic - it does not cross the blood-brain barrier to any significant degree, which explains its lack of CNS opioid-type side effects.
  • Goodman & Gilman's, p. 281: "Ketorolac is a potent analgesic but only a moderately effective anti-inflammatory drug."

Indications

  • Short-term (≤5 days) management of moderate-to-severe acute pain
  • Postoperative analgesia (opioid-sparing)
  • Post-trauma pain
  • Renal colic, biliary colic
  • Ophthalmic use: seasonal allergic conjunctivitis, postoperative ocular inflammation
  • Fixed-dose combination with phenylephrine: irrigation during cataract/IOL replacement surgery

Routes of Administration

RouteDose
Intramuscular (IM)30-60 mg loading dose
Intravenous (IV)15-30 mg loading dose
Oral (continuation only)10-20 mg
Intranasal31.5 mg
Maintenance: 15-30 mg every 6 hours (IM or IV) Maximum duration: 5 days (parenteral + oral combined)
Pediatric dose (2-16 years):
  • IM: 1 mg/kg (max 30 mg), single dose
  • IV: 0.5 mg/kg (max 15 mg), single dose
Elderly: Reduce dose (slower clearance).

Analgesic Equivalence

A standard dose of ketorolac provides analgesia equivalent to 6-12 mg of morphine by the same route. Onset is similar to morphine, but duration is longer (6-8 hours). It has a significant opioid-sparing effect - reduces postoperative opioid requirements.

Pharmacokinetics

  • Onset: Rapid (similar to morphine)
  • Duration: 6-8 hours
  • Elimination: Renal (do NOT use in kidney disease)
  • Protein binding: High

Side Effects

Common (1-10%):
  • GI: Nausea (>10%), dyspepsia, abdominal pain, GI ulcers/bleeding
  • CNS: Headache (17%), dizziness (7%), somnolence (6%)
  • Injection site pain (2%)
  • Edema, hypertension
Serious:
  • GI ulceration, perforation, bleeding
  • Renal toxicity (papillary necrosis with prolonged use)
  • Platelet inhibition - prolongs bleeding time (COX-1 effect)
  • Hypersensitivity/anaphylaxis
  • Cardiovascular events (MI, stroke)

Contraindications

  • Renal disease (drug is renally eliminated)
  • Aspirin/NSAID allergy
  • Perioperative CABG pain management
  • Routine obstetric analgesia (affects fetal ductus arteriosus)
  • Probenecid co-administration (triples ketorolac AUC, doubles t1/2)
  • Active GI ulceration/bleeding
  • Patients at high risk for postoperative hemorrhage (use with caution)
Caution in asthmatics - ~10% have aspirin sensitivity; higher (~20%) if nasal polyps are also present.

Key Advantages Over Opioids

  • No respiratory depression
  • No sedation
  • No nausea/vomiting from the drug itself
  • No addiction potential
  • Ideal for patients at risk for opioid-related side effects

Drug Interactions

  • Aspirin: Decreases protein binding of ketorolac → increases free (active) drug levels
  • Probenecid: Triples AUC - avoid combination
  • Other NSAIDs: Additive toxicity - avoid
  • Anticoagulants: Additive bleeding risk
  • Does not affect minimum alveolar concentration (MAC) of inhalation agents
Sources: Goodman & Gilman's Pharmacological Basis of Therapeutics, p. 281-284; Morgan and Mikhail's Clinical Anesthesiology 7e, p. 525-526
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