Ketorolac

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat moderate to severe pain. It is commonly available in oral, injectable, and ophthalmic formulations.

Mechanism of Action: Ketorolac works by inhibiting the production of prostaglandins, substances in the body that contribute to pain, fever, and inflammation. It primarily inhibits the cyclooxygenase (COX) enzymes, specifically COX-1 and COX-2, which are responsible for catalyzing the conversion of arachidonic acid into prostaglandins.

Indications: Ketorolac is indicated for the short-term (up to 5 days) management of moderate to severe pain. It is often used postoperatively, for musculoskeletal pain, and for renal colic. Ophthalmic formulations are used for the relief of ocular itching caused by seasonal allergic conjunctivitis and for the reduction of pain and photophobia following refractive surgery.

Contraindications: Ketorolac is contraindicated in patients with a history of hypersensitivity to ketorolac or other NSAIDs. It is also contraindicated in patients with active peptic ulcer disease, recent gastrointestinal bleeding or perforation, advanced renal impairment, and during labor and delivery due to its potential to inhibit uterine contractions and increase the risk of bleeding. Concurrent use with other NSAIDs is generally not recommended due to increased risk of adverse effects. It should be used with caution in patients with bleeding disorders or who are taking anticoagulants.

Adverse Effects: Common adverse effects of ketorolac include gastrointestinal upset (nausea, dyspepsia, abdominal pain), headache, drowsiness, and dizziness. Serious adverse effects can include gastrointestinal ulceration, bleeding, and perforation; renal impairment; hepatic dysfunction; and cardiovascular events. Prolonged use of ketorolac increases the risk of these serious adverse effects.

Dosage and Administration: The dosage and route of administration of ketorolac depend on the indication and the formulation used. Oral ketorolac is typically administered for a maximum of 5 days. Injectable ketorolac is also limited to short-term use. Careful consideration should be given to renal function, age, and other risk factors before prescribing ketorolac.

Drug Interactions: Ketorolac can interact with a number of other medications, including other NSAIDs, anticoagulants (such as warfarin), aspirin, selective serotonin reuptake inhibitors (SSRIs), angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, and methotrexate. Careful monitoring is required when ketorolac is used concomitantly with these medications.

Pregnancy and Lactation: Ketorolac should be avoided during pregnancy, especially during the third trimester, due to the risk of premature closure of the ductus arteriosus in the fetus and the potential for prolonged labor. It is also excreted in breast milk and should be used with caution in breastfeeding women.