Ketorol Dt use
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Ketorol DT is a brand of Ketorolac Tromethamine (dispersible tablet / DT formulation) — a potent NSAID analgesic.
Ketorolac (Ketorol DT) — Overview
What It Is
Ketorolac is a potent analgesic but only a moderately effective anti-inflammatory drug. It works by inhibiting prostaglandin synthesis via non-selective COX-1 and COX-2 inhibition.
The DT (Dispersible Tablet) form dissolves in water for oral administration, making it easier to swallow.
Indications
- Short-term (≤5 days) management of acute moderate-to-severe pain
- Post-operative pain (especially where opioids are to be avoided)
- Musculoskeletal pain, renal colic, dental pain
- Ophthalmic formulation: seasonal allergic conjunctivitis, postoperative ocular inflammation
Doses (Ketorol DT / Oral)
| Route | Typical Dose |
|---|---|
| Oral (tablet/DT) | 10 mg every 4–6 hours (max 40 mg/day) |
| Intramuscular | 30–60 mg |
| Intravenous | 15–30 mg |
| Intranasal | 31.5 mg |
Duration of use must not exceed 5 days by any route.
Key Pharmacological Properties
- Onset: Rapid (similar to morphine)
- Duration: 6–8 hours (longer than morphine)
- A standard dose provides analgesia equivalent to 6–12 mg of morphine
- Does NOT cause respiratory depression, sedation, nausea, or vomiting
- Does not cross the blood-brain barrier significantly → peripherally acting analgesic
Advantages Over Opioids
- No respiratory depression
- No sedation
- No dependence/addiction risk
- Opioid-sparing effect — reduces postoperative opioid requirement
- Useful in patients at high risk for postoperative respiratory depression or emesis
Side Effects
| System | Effects |
|---|---|
| GI | Dyspepsia (12%), nausea (12%), GI pain (13%), ulceration, bleeding |
| CNS | Headache (17%), dizziness (7%), somnolence (6%) |
| Renal | Papillary necrosis with long-term use; avoid in renal disease |
| Bleeding | Inhibits platelet aggregation → prolonged bleeding time |
| Local | Pain at injection site (2%) |
Contraindications
- Kidney disease (depends on renal elimination)
- Aspirin/NSAID allergy
- Asthma with nasal polyps (increased aspirin sensitivity ~20%)
- Perioperative pain in CABG surgery
- Routine obstetric analgesia
- Concomitant use with probenecid (probenecid triples AUC and doubles half-life → toxicity risk)
- Use beyond 5 days
Drug Interactions
- Aspirin: Decreases protein binding of ketorolac → increases free (active) drug
- Probenecid: Significantly increases ketorolac exposure (contraindicated)
- Other NSAIDs: Additive GI and renal toxicity risk
- Anticoagulants: Increased bleeding risk
Special Populations
- Elderly: Slower clearance → use reduced doses
- Pediatric (2–16 years): Single IM dose only (1 mg/kg up to 30 mg) or IV (0.5 mg/kg up to 15 mg) for severe acute pain
- Pregnancy/Lactation: Avoid (especially near term — affects fetal renal function and platelet aggregation)
Sources: Goodman & Gilman's The Pharmacological Basis of Therapeutics; Morgan and Mikhail's Clinical Anesthesiology, 7e
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