Solution for injection Ketanov: characteristics and purpose of the drug. Ketanov tablets: instructions for the use of Ketanov for severe pain

The drug Ketanov appeared on the market for a long time, but has not lost its popularity. Tablets are recommended for relieving headaches, reducing discomfort during menstruation and for a number of other indications.

Ketanov - description of the drug

Many Ketanov tablets are available in the medicine cabinet. This medicine is inexpensive ( the price is about 260 rubles / 100 tablets), while the effectiveness and safety exceeds that of Aspirin.

The medicine belongs to non-steroidal anti-inflammatory drugs (NSAIDs). The main active substance - ketorolac(ketorolac tromethamine), an acetic acid derivative, a "relative" with a powerful analgesic effect. is included in the list of vital drugs, in terms of effectiveness it is very strong - only 30 mg of the drug is equivalent to 12 mg of morphine with intramuscular injection. Additional components of the tablets are:


The tablets can be recognized even when they fall out of the package. Each has a "KVT" engraving on the front.

Also, the drug is available in solution (ampoules) and is intended for intramuscular injections. The solution is pale yellow, does not have a pronounced odor. Solution cost - 120 rubles / 10 ampoules.

Action of the medicine

The drug helps against severe pain, gives analgesic and anti-inflammatory effects, while the antipyretic effect of treatment is moderate. Like other NSAIDs, the action of the drug is based on inhibition of the production of special enzymes (cyclooxygenase 1,2). These substances help the synthesis of arachidonic acid, which is the basis for the production of mediators of pain, inflammation (prostaglandins, leukotrienes and several others).

After reducing the release of inflammatory mediators into the body, fever, pain, edema and other signs of the pathological process quickly reduce the severity.

Ketans are better than a number of similar drugs in many ways.

It is stronger in effectiveness, it is one of the most powerful among the non-narcotic analgesics. Also, the difference is that Ketanov:

  • does not contribute to the development of tolerance;
  • does not inhibit the work of the nervous system;
  • does not affect respiratory function;
  • does not impair motor skills;
  • does not lead to the development of thrombocytopenia.

Pain reduction is achieved after 15-20 minutes, a pronounced effect is observed after 30-40 minutes from the moment of administration. The maximum plasma concentration is reached after 2 hours.

The presence of fatty foods in the stomach delays the absorption of the drug.

Indications for use

The drug can be used against various types of pain, inflammation as a symptomatic agent.

The tablets do not have a pathogenetic effect, that is, they do not treat the cause that led to the pain syndrome. After the end of the action of the drug, pain may return if the prerequisites for its appearance are not eliminated.

According to the instructions, Ketanov tablets help against the following conditions:

  • toothache, including from pulpitis, periodontitis, after surgery, tooth extraction;
  • pain from pathologies of the gums, flux;
  • renal colic caused by pyelonephritis or the movement of a stone along the ureter;
  • pain from cystitis, gynecological inflammatory pathologies;
  • otitis media, inflammation of the outer ear (twitching pains);
  • hepatic colic;
  • pain against the background of malignant processes;
  • sinusitis (acute or chronic);
  • severe sore throat with angina;
  • migraine.

The drug is also indicated for various diseases of the musculoskeletal system, which are accompanied by pain. These include arthrosis, arthritis, osteochondrosis, pain attacks, lumbago, gouty pain. The tablets will help reduce the symptoms of soft tissue injury, bones, which are not accompanied by bleeding. They are especially often prescribed for bruises.

Instructions for use

For an adult, a single dosage of the drug is 10 mg, or 1 tablet. The daily dose is not more than 4 tablets (40 mg). It is recommended to interval between doses of the medication at least 4-6 hours.

In severe cases, under the supervision of a doctor, you can take 20 mg of the medicine (2 tablets), but only as a one-time measure.

In case of diseases accompanied by severe pain syndrome, it is recommended to give intramuscular injections of Ketans (instead of taking pills).

The dosage and the order of administration are chosen by the doctor. Usually, 10-30 mg is administered at a time every 6 hours, the daily dose is not more than 90 mg.

There are a number important rules during treatment with Ketanov:

  • the duration of therapy should not be more than 5 days, otherwise the decay products of the active substance may accumulate in the body;
  • the use of the drug simultaneously with other NSAIDs is prohibited - this threatens a high risk of bleeding (only local application of ointments, gels with NSAIDs is allowed as a one-time measure to reduce pain);
  • you can not use the drug on your own, if there are any chronic diseases prone to exacerbations.

If you exceed the dose indicated above, signs of an overdose appear - weakness, vomiting, nausea, severe pain in the gastrointestinal tract, impaired renal function, vasospasm. You should urgently seek medical help, rinse the stomach, take enterosorbents.

Contraindications of the drug

Reception bans are age up to 16 years, recent childbirth (postpartum period until complete cessation of uterine bleeding). You can not take pills during lactation, pregnancy. Other contraindications are as follows:


You cannot use medication to relieve pain from the gastrointestinal tract - this can worsen it. If the pain syndrome is moderate and caused by minor external injuries, it is better to replace Ketanov with analogues for external use. Ketanov is contraindicated for use as anesthesia in obstetrics - with his participation, the first birth period is lengthened, blood circulation in the fetus is impaired. Usually they relate to the gastrointestinal tract - nausea, pain in the epigastrium, abdomen, flatulence, thirst, constipation, in susceptible people - gastritis can occur, erosion, ulcer.

Liver function tests may change upward, similar to medicinal hepatitis. The heart and blood vessels can respond to the treatment with bradycardia, a drop or increase in pressure, and palpitations.

In a number of patients, while taking Ketanov tablets, anxiety, insomnia, headaches, disturbances in sensitivity, taste, and vision were observed. In rare cases, breathing disorders, renal failure, hyperhidrosis, hemorrhagic rash, urticaria, itching of the skin, bronchospasm, Quincke's edema appeared. Any side effects require urgent discontinuation of the drug!

Ketorolac tromethamine is a non-steroidal anti-inflammatory drug that exhibits analgesic activity. The mechanism of action of ketorolac (like other NSAIDs) is not fully understood, but it may consist in inhibiting the synthesis of prostaglandins.

The biological activity of ketorolac tromethamine is associated with the S-form. Ketorolac tromethamine has no sedative or anxiolytic properties.

The maximum analytical effect of ketorolac is achieved within 2-3 hours. This effect is not statistically significant over the recommended dosage range. The biggest difference between high and low doses of ketorolac is the duration of analgesia. An analytical dose of ketorolac also has an anti-inflammatory effect. Pharmacokinetics. Ketorolac tromethamine is a racemic mixture of [-] S- and [+] R- enantiometric forms, with the analytical activity due to the S-form. After intramuscular administration, ketorolac is rapidly and completely absorbed. The average maximum plasma concentration of 2.2 μg / ml is reached, on average, 50 minutes after the administration of a single dose of 30 mg.

Linear pharmacokinetics.

In adults, after intramuscular administration of ketorolac tromethamine in the recommended dosage ranges, the clearance of the racemate does not change. This indicates that the pharmacokinetics of ketorolac tromethamine in adults after a single or multiple intramuscular administration of ketorolac tromethamine is linear. At the higher recommended doses, a proportional increase in the concentration of free and bound racemate is observed.

The drug poorly penetrates the blood-brain barrier. Ketorolac crosses the placenta and, in small amounts, into breast milk. More than 99% of ketorolac in plasma is bound to proteins within a wide range of concentrations.

Ketorolac tromethamine is extensively metabolized in the liver. Metabolic products are hydroxylated and conjugated forms of the derivative. Metabolic products and some of the unchanged drug are excreted in the urine.

Excretion.

The main route of elimination of ketorolac and its metabolites is renal. Approximately 92% of the administered dose is determined in urine: 40% - in the form of metabolites and 60% - in the form of unchanged ketorolac. Approximately 6% of the dose is excreted in the feces. In a study of a single dose of ketorolac 10 mg (n = 9), it was demonstrated that the S-enantiomer is excreted twice as fast as the R-enantiomer, and clearance does not depend on the route of administration. This means that the ratio of the plasma concentration of the B-enantiomer / K-enantiomer after each dose decreases with time. Differences between S- and R-forms in the human body are insignificant or absent.

The half-life of the S-enantiomer of ketorolac tromethamine is approximately 2.5 hours (SD ± 0.4), and the half-life of the R-enantiomer is 5 hours (SD ± 1.7). Other studies have reported that the half-life of the racemate is 5-6 hours.

Accumulation.

Ketorolac tromethamine, which was administered as an intravenous bolus every 6 hours for 5 days to healthy volunteers (n = 13), showed no significant difference on the 1st and 5th day. The trough levels averaged 0.29 μg / ml (SD ± 0.13) on day 1 and 0.55 μg / ml (SD ± 0.23) on day 6. Equilibrium was reached after the fourth dose. The accumulation of ketorolac tromethamine in certain groups of patients (elderly patients, children, patients with renal failure or liver disease) was not investigated.

Pharmacokinetics

Elderly patients.

Based only on the data obtained after a single administration, the half-life of the racemate ketorolac tromethamine increased from 5 to 7 hours in elderly patients (65-78 years) compared with young healthy volunteers (24-35 years).

Children. There are no pharmacokinetic data regarding intramuscular administration of ketorolac tromethamine to children.

Renal failure

Based only on the data obtained after a single administration of the drug, the average half-life of ketorolac tromethamine in patients with impaired renal function is 6-19 hours and depends on the severity of the impairment. There is practically no correlation between creatinine clearance and total clearance of ketorolac tromethamine in elderly patients and patients with impaired renal function (r = 0.5). In patients with kidney disease, the AUCg value of each of the enantiomers increases by almost 100% compared to healthy volunteers. The volume of distribution doubles for the S-enantiomer and increases by 1/5 for the R-enantiomer. An increase in the volume of distribution of ketorolac tromethamine indicates an increase in the unbound fraction.

Liver failure.

The elimination half-life, AUCg and C touch in 7 patients with liver disease did not differ significantly from those of healthy volunteers.

Indications for use

Relief of moderate to severe postoperative pain for a short time.

Contraindications

Hypersensitivity to ketorolac or any component of the drug;

Patients with active peptic ulcer, with recent gastrointestinal bleeding or perforation, with a history of peptic ulcer or gastrointestinal bleeding;

Bronchial asthma, rhinitis, angioedema or urticaria caused by the use of acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (due to the possibility of severe anaphylactic reactions);

History of bronchial asthma;

Do not use as an analgesic before and during surgery;

Severe heart failure;

Complete or partial nasal polyp syndrome, Quincke's edema or bronchospasm;

Do not use in patients who have had surgery with a high risk of hemorrhage or incomplete control of bleeding and in patients receiving anticoagulants, including low doses heparin (2500 - 5000 units every 12 hours);

Hepatic or moderate and severe renal failure (serum creatinine clearance greater than 160 μmol / L);

Suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, including bleeding disorders and high risk of bleeding;

Concomitant treatment with other non-steroidal anti-inflammatory drugs (NSAIDs) (including selective cyclooxygenase inhibitors), acetylsalicylic acid, warfarin, pentoxifylline, probenecid or lithium salts;

Hypovolemia, dehydration;

The period of pregnancy, labor, childbirth and breastfeeding;

Children under the age of 16.

Pregnancy and lactation

Due to the known effects of non-steroidal anti-inflammatory drugs on the cardiovascular system of the fetus, ketorolac should not be used during pregnancy (especially in the third trimester). The use of ketorolac tromethamine is contraindicated during pregnancy, during labor and childbirth.

Do not use during lactation due to the possible negative effect of inhibitors of prostaglandin synthesis on infants.

Method of administration and dosage

After intramuscular administration, the analgesic effect is observed after about 30 minutes, and the maximum pain relief occurs after 1-2 hours. In general, the average duration of analgesia is 4-6 hours. The dose should be adjusted depending on the degree of pgjeeti-eoli and the patient's response to treatment. Continuous intramuscular administration of multiple daily doses of ketorolac should not last more than 2 days, since long-term use increases the risk of adverse reactions. Experience with long-term use is limited, since the vast majority of patients were switched to oral administration of the drug or after a period of intramuscular administration, patients no longer needed anesthetic therapy. Probability of occurrence side effects can be minimized by using the lowest effective dose for the shortest amount of time necessary to control symptoms. The drug should not be administered epidurally or intraspinally.

Adults

The recommended initial dose of ketorolac tromethamine, a solution for intramuscular injection, is 10 mg followed by 10-30 mg every 4-6 hours (if necessary). In the initial postoperative period of ketorolac, tromethamine, if necessary, can be administered every 2 hours. The minimum effective dose should be prescribed. The total daily dose should not exceed 90 mg for young patients, 60 mg for elderly patients, patients with renal failure and weighing less than 50 kg. The maximum duration of treatment should not exceed 2 days. In patients weighing less than 50 kg, the dose must be reduced. Concomitant use of opioid analgesics (morphine, pethidine, etc.) is possible. ^ etorolac does not have a negative effect on the binding of opioid receptors and does not increase respiratory depression or the sedative effect of opioid drugs. For patients who parenterally receive the drug Ketanov for injection and who are transferred to oral administration of ketorolac tromethamine, tablets, the total combined daily dose should not exceed 90 mg (60 mg for elderly patients, patients with impaired renal function and weighing less than 50 kg) , and on the day when the dosage form is changed, the dose of the oral component should not exceed 40 mg. Patients should be transferred to the oral form as soon as possible. Poe / strong age patients

Patients with impaired renal function

Ketorolac is contraindicated in moderate to severe renal impairment. For less severe disorders, it is necessary to reduce the dosage (no more than 60 mg / day intramuscularly).

Side effect

On the part of the digestive tract: peptic ulcer, perforation or gastrointestinal "juvenile flow, sometimes fatal (especially in the elderly), nausea, dyspepsia, / gastrointestinal pain, abdominal discomfort, bloody vomiting, gastritis, esophagitis, diarrhea, belching, constipation, flatulence, a feeling of fullness in the stomach, melena, rectal bleeding, ulcerative stomatitis, vomiting, hemorrhage, perforation, pancreatitis, exacerbation of colitis and Crohn's disease.

From the side of the central nervous system: anxiety, visual impairment, neuritis optic nerve, drowsiness, dizziness, headache, increased sweating, dry mouth, nervousness, paresthesia, functional disturbances, depression, euphoria, convulsions, increased thirst, inability to concentrate, insomnia, malaise, increased fatigue, agitation, vertigo, impaired taste and vision , myalgia, unusual dreams, confusion, hallucinations, hyperkinesia, hearing loss, ringing in the ears, symptomatic aseptic meningitis, psychotic reactions, thought disorders.

From the urinary system, increased frequency of urination, oliguria, acute renal failure, hyponatremia, hyperkalemia, hemolytic uremic syndrome, flank pain (with / without hematuria), increased serum urea and creatinine, interstitial nephritis, urinary retention, nephrotic syndrome , infertility, renal failure.

On the part of the liver, impaired liver function, hepatitis, jaundice and liver failure.

From the side of cardio-vascular system: flushing of the face, bradycardia, pallor, arterial hypertension, palpitation, chest pain, edema, heart failure.

Data from clinical and epidemiological studies indicate that the use of some NSAIDs, especially in high doses and for a long time, may be associated with an increased risk of arterial thromboembolic complications (myocardial infarction or stroke).

From the respiratory system: shortness of breath, asthma, pulmonary edema.

From the side of the blood system: purpura, thrombocytopenia, neutropenia, agranulocytosis, aplastic and hemolytic anemia, postoperative hemorrhages, hematomas, epistaxis, bleeding, prolonged bleeding time.

Skin disorders: itching, urticaria, skin photosensitivity, Lyell's syndrome, bullous reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis (very rare), exfoliative dermatitis, maculopapular rash.

Hypersensitivity: reported the development of hypersensitivity reactions, which include nonspecific allergic reactions and anaphylaxis, respiratory tract reactivity, including asthma, worsening asthma, bronchospasm, laryngeal edema or shortness of breath, as well as a variety of skin disorders that include rash of different types, itching , urticaria, purpura, angioedema, and, in isolated cases, exfoliative and bullous dermatitis (including epidermal necrolysis and erythema multiforme).

Such reactions can occur in patients with or without known hypersensitivity to ketorolac or other non-steroidal anti-inflammatory drugs. They can also be observed in individuals with a history of angioedema, bronchospastic reactivity (for example, asthma and nasal polyps). Anaphylactoid reactions such as anaphylaxis can be fatal.

Reproductive system: female infertility.

Others: edema, weight gain, fever.


Overdose

Symptoms: lethargy, drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, arterial hypertension, acute renal failure, respiratory depression and coma. It has been reported about the development of anaphylactoid reactions, which can occur with overdose. Treatment: symptomatic and supportive therapy.

There is no specific antidote. Patients no later than 4 hours after taking the drug with overdose chmptoms or after a large overdose (when taking an oral dose that is 5-10 times more than usual) is shown to induce vomiting, take activated charcoal (60-100 g for adults) and / or take an osmotic laxative. The use of forced diuresis, alkalization of urine, hemodialysis or blood transfusion are ineffective due to the high binding of the drug to blood plasma proteins. A single overdose of ketorolac at different times led to abdominal pain, nausea, vomiting, hyperventilation, peptic ulcers and / or erosive gastritis and renal dysfunction, which disappeared after the drug was discontinued.

Interaction with other medicinal products

Ketorolac binds to a significant extent with blood plasma proteins (on average, 99.2%). Ketorolac tromethamine does not alter the pharmacokinetics of other drugs due to the induction or inhibition of enzymes.

Warfarin, digoxin, salicylates, and heparin.

Does ketorolac tromethamine slightly reduce the binding of warfarin to blood plasma proteins? vitro and did not change the binding of digoxin to blood plasma proteins. In vitro studies indicate that at therapeutic concentrations of salicylates (300 μg / ml), ketorolac binding decreased from approximately 99.2% to 97.5%, indicating a potential twofold increase in unbound ketorolac plasma levels. Therapeutic concentrations of digoxin, warfarin, ibuprofen, naproxen, piroxicam, acetaminophen, phenytoin and tolbutamide do not alter the binding of ketorolac tromethamine to blood plasma proteins.

Acetylsalicylic acid.

When used with acetylsalicylic acid, the binding of ketorolac to blood plasma proteins decreases, although the clearance of free ketorolac does not change. The clinical significance of this type of interaction is unknown, although, as with other NSAIDs, it is not recommended to simultaneously prescribe ketorolac tromethamine and acetylsalicylic acid due to the potential increase in the incidence of side effects.

Diuretics

In some patients, ketorolac is able to reduce the natriuretic effect of furosemide and thiazides. During concomitant therapy with NSAIDs, the patient should be closely monitored for the appearance of signs of renal failure, as well as to ensure the effectiveness of diuretic drugs.

Run

Concomitant administration of ketorolac tromethamine and probenecid "led to a decrease in ketorolac clearance and a significant increase in its plasma levels and half-life. Therefore, the simultaneous use of ketorolac tromethamine and probenecid is contraindicated.

With the simultaneous use of NSAIDs and lithium preparations, patients should be closely monitored for signs of lithium toxicity.

Anticoagulants.

Ketorolac tromethamine should be carefully prescribed together with anticoagulants, since concomitant administration may increase the anticoagulant effect.

Cardiac glycosides.

NSAIDs can worsen heart failure, decrease glomerular filtration rate and increase plasma levels of cardiac glycosides when used concomitantly with the latter. Methotrexate.

At the same time, it is prescribed with caution.

ACE inhibitors.

The simultaneous use of ACE inhibitors increases the risk of developing renal dysfunction, in particular in patients with a reduced volume of intercellular fluid.

NPVS can reduce the hypotensive effect of ACE inhibitors. This interaction should be kept in mind when prescribing NSAIDs together with ACE inhibitors.

Anticonvulsants.

Reported single cases of seizures during the simultaneous use of ketorolac tromethamine and anticonvulsants (phenytoin, carbamazepine).

Psychotropic drugs.

With the simultaneous use of ketorolac and psychotropic drugs (fluoxetine, thioxene, alprazolam), hallucinations have been reported.

Pentoxifylline.

The simultaneous use of ketorolac tromethamine and pentoxifylline increases the risk of bleeding.

Non-polarizing m irelaksayty.

There have been no formal studies of the concomitant use of ketorolac tromethamine and muscle relaxants.

Cyclosporine. As with all NSAIDs, cyclosporine should be administered concurrently with caution due to the increased risk of nephrotoxicity.

Mifepristone. NSAIDs should not be used after mifepristone has been used for 8-12 days, as they may weaken the effects of mifepristone.

Corticosteroids.

As with all NSAIDs, corticosteroids should be administered concomitantly with caution due to the increased risk of gastrointestinal bleeding.

Patients who take quinoline may have an increased risk of seizures.

3 blockers.

Ketorolac and other NSAIDs weaken the hypotensive effect of β-blockers.

Zidovudine.

The simultaneous use of NSAIDs with zidovudine leads to an increased risk of hematological toxicity. There is an increased risk of hemarthrosis and hematoma in HIV-infected people with hemophilia who are treated with zidovudine and ibuprofen at the same time.

Application features

The likelihood of side effects can be minimized by using the lowest effective dose for the shortest amount of time necessary to control symptoms. Physicians should be aware that in some patients, pain relief occurs only 30 minutes after intramuscular injection.

The combined use of ketorolac tromethamine intramuscularly and orally in adult patients should not exceed 5 days.

Impact on fertility.

For women who cannot become pregnant and are therefore being examined, the use of ketorolac tromethamine should be canceled. Women with reduced fertility should avoid using Ketanov.

Effects on the digestive tract.

Ketorolac tromethamine can cause severe gastrointestinal side reactions. These side effects can occur in patients who use ketorolac tromethamine at any time after or without precursor symptoms and can be fatal. The risk of clinically serious gastrointestinal bleeding is dose-dependent. But side effects can occur even with short therapy. In addition to a history of peptic ulcer disease, provoking factors are the simultaneous use of oral corticosteroids, anticoagulants, long-term therapy with non-steroidal anti-inflammatory drugs, smoking, alcohol consumption, old age and poor health in general. Most of the spontaneous reports of gastrointestinal events related to elderly or debilitated patients, therefore, in the treatment of this category of patients, special attention should be paid to it, and if suspicion arises, ketorolac should be canceled. Patients at risk are prescribed an alternative form of therapy that does not include non-steroidal anti-inflammatory drugs (NSAIDs).

Effects on the circulatory system.

With the concomitant use of ketorolac tromethamine in patients receiving anticoagulant therapy, the risk of bleeding may increase. Detailed studies of the simultaneous use of ketorolac and prophylactic low doses of heparin (25005000 IU every 12 hours) have not been carried out, therefore this regimen can also increase the risk of bleeding. Patients who are already taking anticoagulants or need low-dose heparin should not receive ketorolac tromethamine. The condition of patients who take other drugs that negatively affect hemostasis should be closely monitored with the introduction of ketorolac tromethamine. Ketorolac inhibits platelet aggregation and prolongs bleeding time. In patients with normal bleeding function, its time increased, but did not exceed the normal range, which is 2-11 minutes. In contrast to the prolonged action after taking acetylsalicylic acid, platelet function returns to normal within 24-48 hours after ketorolac is discontinued. In patients who underwent surgery with a high risk of bleeding or incomplete hemostasis, ketorolac tromethamine should not be used. Ketorolac tromethamine is not an anesthetic and has no sedative or anxiolytic properties.

Use in patients with impaired renal function (see "Contraindications"). Patients with less severe renal impairment should receive low doses of ketorolac (no more than 60 mg per day intramuscularly). The kidney condition of such patients should be closely monitored. Patients should be well hydrated before starting treatment. In patients who underwent hemodialysis, the clearance of ketorolac was reduced by approximately half of the normal rate, and the terminal half-life was increased by almost three times.

Effect on the cardiovascular system and cerebral vessels.

The condition of patients with arterial hypertension and / or a history of minor and moderate heart failure should be closely monitored.

To minimize the potential risk of developing side cardiovascular complications in patients who use NSAIDs, the lowest effective dose should be used for the shortest possible period of time. Ketorolac tromethamine is prescribed to patients with uncontrolled arterial hypertension, congestive heart failure, established ischemic disease heart, diseases of peripheral arteries and / or blood vessels of the brain, only after careful weighing of all the advantages and disadvantages of such treatment. They also assess the feasibility of prescribing ketorolac before starting long-term treatment of patients at risk for the development of cardiovascular diseases (for example, with arterial hypertension, hyperlipidemia, diabetes mellitus, as well as smokers). Respiratory system.

The patient's condition should be monitored in connection with the likelihood of developing bronchospasm. Use in patients with impaired liver function.

Ketorolac tromethamine should be used with caution in patients with a history of liver dysfunction or liver disease. Significant increases (more than three times the norm) in serum AJIT and ACT were observed in controlled clinical trials in less than 1% of patients. In addition, there have been reports of isolated cases of severe hepatic reactions, including jaundice and fatal fulminant hepatitis, liver necrosis and liver failure, in some cases fatal. Ketorolac is discontinued if clinical symptoms of liver disease or systemic manifestations appear (eg, eosinophilia, rash).

The ability to influence the reaction rate when driving or operating other mechanisms.

Keep out of the reach of children.

Name:

Ketanov

Pharmacological
action:

pharmacodynamics: Ketorolac acts on the cyclooxygenase pathway of arachidonic acid metabolism, inhibiting the biosynthesis of prostaglandins. Ketorolac has analgesic and anti-inflammatory effects, but its systemic analgesic effect significantly exceeds the anti-inflammatory effect. Like other NSAIDs, ketorolac inhibits platelet aggregation caused by arachidonic acid and collagen, and does not affect ATP-induced platelet aggregation. Ketorolac lengthens the mean bleeding time, but does not affect platelet count, prothrombin time, or partial thromboplastin time.
Unlike narcotic analgesics, ketorolac does not have a depressing effect on the respiratory center and does not cause an increase in the final RSO. Unlike morphine, ketorolac does not affect the state of the heart muscle and does not cause hemodynamic disturbances. Ketorolac does not affect psychomotor functions, in contrast to the centrally acting analgesics - morphine, pethidine and buprenorphen.

Pharmacokinetics: In humans, after intramuscular administration of the drug, maximum plasma concentrations are reached within 45-50 minutes. Ketorolac does not lend itself to significant first-pass metabolism. It was revealed that the peak plasma concentrations in healthy volunteers after intramuscular administration of the drug at a dose of 30 mg are equal to 3 mg / l. Cumulation of the drug is not observed when administered at a dose of 10-90 mg. Like other NSAIDs, ketorolac significantly binds to blood plasma proteins (more than 99%). Ketorolac reaches high concentrations in the aqueous humor of the eye. The main metabolic pathway of ketorolac is binding to glucuronic acid, 10% of the dose of the drug is excreted in the feces, more than 90% is excreted in the urine, and 60% is in unchanged form. The average half-life is approximately 4-6 hours after parenteral administration. In the elderly, the rate of administration decreases, the half-life increases, on average to 7.01 hours after parenteral administration of a dose of 30 mg. In patients with renal insufficiency, ketorolac excretion is slow, as evidenced by a decrease in total plasma clearance, and the half-excretion period increases (up to 9.62 - 9.91 hours), which indicates the need for dose adjustment.
According to the available data, ketorolac is supplied from the maternal circulation to the fetal circulation (ratio 0.116). It is also excreted in milk.

Indications for
application:

Ketanov tablets and solution for injection recommended for short-term use in order to relieve moderate to severe pain of the following genesis and localization:
- postoperative pain- general surgery, gynecological, orthopedic, urological, dental, otolaryngological operations and other surgical interventions;
- acute muscle injury, bones and soft tissues, including sprains, dislocations, fractures and so on.

A drug also effective for short-term pain relief for conditions such as painful drug withdrawal, toothache (pericoronitis, pulpitis, caries, etc.), renal and hepatic colic (in combination with antispasmodics), postpartum pain, otitis media, sciatica, fibromyalgia, chronic tissue pathology , osteoarthritis, cancer pain, sciatica, osteoarthritis, osteochondrosis.

Mode of application:

Tablets... Inside, once or repeatedly, depending on the severity of the pain syndrome. A single dose - 10 mg, with repeated administration, it is recommended to take 10 mg up to 4 times a day, depending on the severity of the pain; the maximum daily dose should not exceed 40 mg.

When taken orally, the duration of the course should not exceed 5 days.

Injection... In / m (deep), in the lowest effective doses, selected in accordance with the intensity of pain and the patient's response. If necessary, you can additionally prescribe opioid analgesics in reduced doses at the same time.

Single doses with a single intramuscular injection:
- for patients under 65 years of age - 10-30 mg, depending on the severity of the pain syndrome;
- Patients over 65 years of age or with impaired renal function - 10-15 mg.

Doses for repeated intramuscular administration:
- for patients under 65 years of age - 10-30 mg, then - 10-30 mg every 4-6 hours;
- for patients over 65 years of age or with impaired renal function - 10-15 mg every 4-6 hours.

The maximum daily dose for intramuscular administration for patients under 65 years of age should not exceed 90 mg, and for patients over 65 years of age or with impaired renal function - 60 mg.

With parenteral administration the duration of the course of treatment should not exceed 5 days.

When switching from parenteral administration of the drug to oral administration, the total daily dose of both dosage forms on the day of transfer should not exceed 90 mg for patients under 65 years of age and 60 mg for patients over 65 years of age or with impaired renal function. In this case, the dose of the drug in tablets on the day of the transition should not exceed 30 mg.

Side effects:

The incidence of side effects is determined as follows: 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 with a history of erosive and ulcerative lesions of the gastrointestinal tract) - gastralgia, diarrhea; less often - stomatitis, flatulence, constipation, vomiting, a feeling of fullness in the stomach; rarely - nausea, erosive and ulcerative lesions of the gastrointestinal tract (including with perforation and / or bleeding - abdominal pain, spasm or burning sensation in the epigastric region, melena, vomiting like "coffee grounds", nausea, heartburn, etc.), cholestatic jaundice, hepatitis, hepatomegaly, acute pancreatitis.
From 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, renal edema.
From the senses: rarely - hearing loss, ringing in the ears, visual impairment (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, cramps, stiff neck and / or back muscles), hyperactivity (mood changes, anxiety), hallucinations, depression, psychosis.
On the part of the cardiovascular system: less often - increased blood pressure; rarely - pulmonary edema, fainting.
On the part of the hematopoietic organs: rarely - anemia, eosinophilia, leukopenia.
From the hemostatic system: rarely - bleeding from a postoperative wound, nosebleeds, rectal bleeding.
From the side skin : less often - skin rash(including maculopapular rash), purpura; rarely - exfoliative dermatitis (fever with or without chills, redness, thickening or peeling of the skin, swelling and / or soreness of the palatine tonsils), urticaria, Stevens-Johnson syndrome, Lyell's syndrome.
Local reactions: less often - burning or pain at the injection site.
Allergic reactions: rarely - anaphylaxis or anaphylactoid reactions (discoloration of the skin of the face, skin rash, urticaria, itching of the skin, tachypnea or dyspnea, edema of the eyelids, periorbital edema, shortness of breath, shortness of breath, heaviness in the chest, wheezing).
Other: often - edema (of the face, legs, ankles, fingers, feet, weight gain); less often - increased sweating; rarely - swelling of the tongue, fever.

Contraindications:

Hypersensitivity to ketorolac or other NSAIDs, "aspirin asthma", bronchospasm, angioedema, hypovolemia (regardless of the cause that caused it), dehydration;
- erosive and ulcerative lesions of the gastrointestinal tract in the acute stage, peptic ulcers, hypocoagulation (including hemophilia);
- hepatic and / or renal failure (plasma creatinine above 50 mg / l);
- hemorrhagic stroke (confirmed or suspected), hemorrhagic diathesis, concomitant use with other NSAIDs, high risk of developing or recurrent bleeding (including after surgery), impaired hematopoiesis;
- pregnancy, childbirth and lactation;
- childhood up to 16 years (efficacy and safety have not been established);
- pain relief before and during surgical operations(due to the high risk of bleeding);
- treatment of chronic pain.

Carefully- bronchial asthma; cholecystitis; chronic heart failure; arterial hypertension; impaired renal function (plasma creatinine below 50 mg / l); cholestasis; active hepatitis; sepsis; systemic lupus erythematosus; advanced age (over 65); polyps of the mucous membrane of the nose and nasopharynx.

Interaction
other medicinal
by means of:

Concomitant use of ketorolac with acetylsalicylic acid or other NSAIDs, calcium preparations, GCS, ethanol, corticotropin can lead to the formation of gastrointestinal ulcers and the development of gastrointestinal bleeding.

Joint appointment with paracetamol increases nephrotoxicity, with methotrexate - hepato- and nephrotoxicity. The joint appointment of ketorolac and methotrexate is possible only when using low doses of the latter (monitor the concentration of methotrexate in the blood plasma).

Probenicid reduces plasma clearance and volume of distribution of ketorolac, increases its concentration in blood plasma and increases its half-life. Against the background of the use of ketorolac, it is possible to reduce the clearance of methotrexate and lithium and increase the toxicity of these substances. Simultaneous appointment with indirect anticoagulants, heparin, thrombolytics, antiplatelet agents, cefoperazone, cefotetan, and pentoxifylline increase the risk of bleeding. Reduces the effect of antihypertensive and diuretic drugs (decreases the synthesis of PG in the kidneys). When combined with opioid analgesics, the doses of the latter can be significantly reduced.

Antacids do not affect the completeness of drug absorption.

The hypoglycemic effect of insulin increases and oral hypoglycemic drugs (dose recalculation is necessary).

Co-administration with sodium valproate causes a violation of platelet aggregation. Increases plasma concentration of verapamil and nifedipine.

When appointing with other nephrotoxic drugs(including with gold preparations) the risk of developing nephrotoxicity increases. Medicines that block tubular secretion reduce the clearance of ketorolac and increase its concentration in blood plasma.

Injection should not be mixed in the same syringe with morphine sulfate, promethazine and hydroxyzine due to precipitation. Pharmaceutical incompatible with tramadol solution, lithium preparations.

Solution for injection is compatible with saline, 5% dextrose solution, Ringer's and Ringer's lactate solution, Plasmalit solution, as well as infusion solutions containing aminophylline, lidocaine hydrochloride, dopamine hydrochloride, short-acting human insulin and heparin sodium salt. should be stored in a cool, dry place protected from direct sunlight at a temperature of 0-25 ° C. The shelf life of the drug is 2 years from the date of manufacture.
Tablets store at a temperature not exceeding 25 ° C out of the reach of children. Shelf life is 3 years. Do not use the drug after the expiration date indicated on the package. Terms of dispensing from pharmacies - by prescription.

Ketanov tablets, coated:
1 tablet contains ketorolac tromethamine 10 mg;
10 or 100 pcs. packaged.

Ketanov solution for injection:
1 ampoule contains ketorolac tromethamine 30 mg, sodium chloride 4.35 mg, alcohol 10% w / v, sterile water for injection 1 ml;
in ampoules of 1 ml; in a box 10 pcs.

Compound

active substance: ketorolac tromethamine;

1 coated tablet contains ketorolac tromethamine 10 mg

Excipients: microcrystalline cellulose, corn starch, colloidal silicon dioxide, magnesium stearate, polyethylene glycol 400, talc, titanium dioxide (E 171).

Dosage form

Film-coated tablets.

Basic physical and chemical properties: white or off-white, round, biconvex film-coated tablets, marked "KVT" on one side.

Pharmacological group

Non-steroidal anti-inflammatory and antirheumatic drugs. ATX code M01A B15.

Pharmacological properties

Pharmacological .

The pain reliever Ketorolac tromethamine is a non-narcotic analgesic. It is an NSAID that exhibits anti-inflammatory and weak antipyretic activity. Ketorolac tromethamine inhibits prostaglandin synthesis and is considered a peripheral analgesic. It has no known effect on opiate receptors. After the use of ketorolac tromethamine in controlled clinical trials, no phenomena were observed that would indicate respiratory depression. Ketorolac tromethamine does not cause pupillary constriction.

Pharmacokinetics .

Ketorolac tromethamine is rapidly and completely absorbed after oral administration with a peak concentration of 0.87 mg / kg in blood plasma 50 minutes after taking a single dose of 10 mg. In healthy volunteers, the terminal plasma half-life averages 5.4 hours. In the elderly (average age 72 years), it is 6.2 hours. 99% of ketorolac in blood plasma binds to proteins. In humans, after taking a single or multiple doses, the pharmacokinetics of ketorolac is linear. Stationary level in blood plasma is achieved after 1 day when applied 4 times a day. With long-term dosing, no changes were observed. After the administration of a single dose, the volume of distribution is 0.25 l / kg, the half-life is 5:00, and the clearance is 0.55 ml / min / kg. The main route of elimination of ketorolac and its metabolites (conjugates and p-hydroxymetabolites) is urine (91.4%), and the rest is excreted in the feces. A diet rich in fat decreases absorption rate but not volume, while antacids do not interfere with the absorption of ketorolac.

Indications

Short-term treatment of moderate pain, including postoperative pain.

Contraindications

Hypersensitivity to ketorolac or other components of the drug.

  • Active ulcer, recent gastrointestinal bleeding or perforation, peptic ulcer, or history of gastrointestinal bleeding
  • bronchial asthma, rhinitis, angioedema or urticaria caused by the use of acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (due to the possibility of severe anaphylactic reactions)
  • history of bronchial asthma
  • do not use as an analgesic before and during a major surgical intervention and after manipulations on the coronary vessels;
  • severe heart failure
  • complete or partial syndrome of nasal polyps, Quincke's edema or bronchospasm;
  • do not use in patients who have had surgery with a high risk of hemorrhage or incomplete stop of bleeding and in patients receiving anticoagulants, including low doses of heparin (2500-5000 units every 12:00)
  • hepatic or moderate severe renal failure (serum creatinine level more than 160 μmol / l);
  • suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, including bleeding disorders and high risk of bleeding;
  • concomitant treatment with other non-steroidal anti-inflammatory drugs (NSAIDs) (including selective cyclooxygenase inhibitors), acetylsalicylic acid, warfarin, pentoxifylline, probenecid or lithium salts;
  • hypovolemia, dehydration;
  • the risk of renal failure due to a decrease in fluid volume.

Interaction with other medicinal products and other types of interactions

Ketorolac readily binds to blood plasma proteins (average value 99.2%), and the degree of binding depends on the concentration.

Cannot be used concurrently with ketorolac.

Due to the possibility of side effects, ketorolac should not be administered with other NSAIDs, including selective COX-2 inhibitors, or in patients receiving acetylsalicylic acid, warfarin, lithium, probenecid, cyclosporin. NSAIDs should not be prescribed within 8-12 days after mifepristone is used, as NSAIDs can weaken the effect of mifepristone.

Medicines in combination with ketorolac should be prescribed with caution.

In healthy individuals with normovolemia, ketorolac reduces the diuretic effect of furosemide by about 20%. With extreme caution, the drug should be prescribed to patients with cardiac decompensation. NSAIDs can exacerbate heart failure, decrease the glomerular filtration rate and increase the level of cardiac glycosides in the blood plasma when administered simultaneously with cardiac glycosides. Ketorolac and other non-steroidal anti-inflammatory drugs can weaken the effect of antihypertensive drugs. In the case of the simultaneous use of ketorolac with ACE inhibitors, there is an increased risk of impaired renal function, especially in patients with reduced blood volume in the body. There is a possible risk of nephrotoxicity if NSAIDs are co-administered with tacrolimus. Simultaneous administration with diuretics can lead to a weakening of the diuretic effect and an increase in the risk of nephrotoxicity of NSAIDs. As with all NSAIDs, corticosteroid medications are used concomitantly with caution because of an increased risk of gastrointestinal ulcers or bleeding. There is an increased risk of gastrointestinal bleeding if NSAIDs are given in combination with antiplatelet agents and selective serotonin reuptake inhibitors. Caution is advised to concurrently prescribe methotrexate, since some inhibitors of prostaglandin synthesis have been reported to decrease the clearance of methotrexate and therefore possibly increase its toxicity.

Patients taking NSAIDs and quinolones may have an increased risk of developing seizures.

The simultaneous use of NSAIDs with zidovudine leads to an increased risk of hematological toxicity. There is an increased risk of hemarthrosis and hematoma in HIV-infected people with hemophilia and who are being treated with zidovudine and ibuprofen at the same time.

The following drugs are unlikely to interact with ketorolac.

Ketorolac did not affect the binding of digoxin to blood plasma proteins. Research in vitro indicate that at therapeutic concentrations of salicylate (300 μg / ml) and higher, the binding of ketorolac decreased from about 99.2% to 97.5%. Therapeutic concentrations of digoxin, warfarin, paracetamol, phenytoin and tolbutamide did not affect the binding of ketorolac to blood plasma proteins. Since ketorolac is a highly active drug and its available plasma concentration is low, it is not expected to significantly replace other drugs that bind to blood proteins. There has been no evidence in animal and human studies that ketorolac tromethamine induces or inhibits liver enzymes that metabolize it or other drugs. Therefore, ketorolac is not expected to alter the pharmacokinetics of other drugs through a mechanism of induction or inhibition of enzymes.

Antiepileptic drugs.

Reported isolated cases of epileptic seizures during the simultaneous use of ketorolac and antiepileptic drugs (phenytoin, carbamazepine).

Psychotropic drugs.

With the simultaneous use of ketorolac and psychotropic drugs (fluoxetine, thioxene, alprazolam), hallucinations have been reported.

Influence on the results of laboratory tests.

Ketorolac inhibits platelet aggregation and may prolong bleeding time.

Application features

The maximum duration of treatment should not exceed 5 days.

Impact on fertility .

The use of ketorolac, like any drug, inhibits the synthesis of cyclooxygenase / prostaglandin, may impair fertility and is not recommended for women planning pregnancy. For women who cannot get pregnant or are being screened for fertility, ketorolac should be discontinued.

Gastrointestinal bleeding, ulceration and perforation.

Gastrointestinal bleeding, ulceration or perforation, which can be fatal, have been reported with the use of NSAIDs at any time during treatment with or without precursor symptoms or in the case of a history of severe digestive tract disorders. The risk of developing severe gastrointestinal bleeding depends on the dosage of the drug. This, in particular, concerns elderly patients, ketorolac is used in an average daily dose of over 60 mg. For these patients, as well as for patients simultaneously taking low doses of acetylsalicylic acid or other drugs that may increase the risk to the digestive tract, combination treatment with protective agents (for example, misoprostol or proton pump inhibitors) should be considered. Ketanov should be used with caution in patients receiving concomitant medications that may increase the risk of ulceration or bleeding, such as oral corticosteroids, selective serotonin reuptake inhibitors, or antiplatelet agents such as acetylsalicylic acid. In case of gastrointestinal bleeding or ulceration in patients receiving Ketanov, the course of treatment should be discontinued.

Respiratory dysfunction.

Caution is required when using the drug in patients with bronchial asthma (or a history of asthma), since it has been reported that NSAIDs in such patients accelerate the onset of bronchospasm.

Effects on the kidneys.

Inhibitors of prostaglandin biosynthesis (including NSAIDs) have been reported to have nephrotoxic effects. Prescribe with caution to patients with impaired renal, heart, liver function, since the use of NSAIDs can lead to a deterioration in renal function. Patients with minor impairment of renal function should be prescribed smaller doses of ketorolac (which do not exceed 60 mg intramuscularly or intravenously), and the condition of the kidneys in such patients should also be carefully monitored. As with other drugs that inhibit the synthesis of prostaglandins, there have been reports of increases in serum urea, creatinine and potassium while taking ketorolac tromethamine, which may occur after a single dose.

On the part of the cardiovascular system, kidneys and liver.

Use with caution in patients with conditions that result in decreased blood volume and / or renal blood flow when renal prostaglandins play a supportive role in providing renal perfusion. In such patients, it is necessary to monitor renal function. The volume reduction should be corrected and the serum urea and creatinine levels should be carefully monitored, and the volume of urine is excreted until the patient develops normovolemia. In patients on renal dialysis, creatinine clearance was reduced by about half compared with the norm, and the half-life increased by about three times. Patients with impaired liver function due to cirrhosis did not have any clinically important changes in ketorolac clearance or residual half-life. There may be marginal increases in values ​​on one or more liver function tests. These abnormalities may be temporary, may remain unchanged, or may progress with continued treatment. If Clinical signs and symptoms indicate the development of liver disease or if systemic manifestations are observed, Ketans should be canceled.

Use ketorolac with caution in patients with a history of cardiovascular disorders.

Fluid retention and edema.

Fluid retention and edema have been reported with ketorolac, so it should be used with caution in patients with cardiac decompensation, hypertension, or similar conditions.

Cardiovascular and cerebrovascular effects.

There is not yet sufficient information to assess the risk for ketorolac tromethamine. Patients with uncontrolled arterial hypertension, congestive heart failure diagnosed with coronary artery disease, peripheral arterial disease and / or cerebrovascular disease should be monitored by a physician.

Systemic lupus erythematosus and mixed connective tissue diseases.

Patients with systemic lupus erythematosus and various mixed connective tissue diseases increase the risk of developing aseptic meningitis.

Dermatological.

Ketans should be canceled at the first signs of skin rashes, mucosal lesions, or any other signs of hypersensitivity.

Hematological effects.

Patients with blood clotting disorders should not be prescribed Ketanov. Patients receiving anticoagulant therapy may have an increased risk of bleeding if ketorolac is used concomitantly. The condition of patients receiving other drugs that may affect the rate of stopping bleeding should be carefully monitored when prescribing ketorolac. In controlled clinical trials, the incidence of significant postoperative bleeding was less than 1%. Ketorolac inhibits platelet aggregation and increases bleeding time. In patients with normal bleeding time, the duration of bleeding increased, but did not go beyond the normal range of 2-11 minutes. Unlike long-term exposure due to the use of acetylsalicylic acid, platelet function returns to normal within 24-48 hours after ketorolac is discontinued. Ketorolac should not be prescribed to patients who have undergone surgery with a high risk of bleeding or incomplete stopping. Care should be taken if mandatory stopping of bleeding is critical. Hypovolemia should be corrected before starting ketorolac.

Increasing the dose of ketorolac tablets higher than the daily dose of 40 mg does not increase its effectiveness, but increases the risk of adverse reactions.

Ketorolac does not cause dependence; in case of discontinuation of the drug, no withdrawal syndrome was recorded.

Use during pregnancy or lactation

The safety of ketorolac during pregnancy in humans has not been established. Given the known effect of NSAIDs on the fetal cardiovascular system (risk of premature closure of the ductus arteriosus), ketorolac is contraindicated during pregnancy, labor and childbirth. The onset of labor can be delayed, and the duration is lengthened, with an increased tendency for bleeding in both the mother and the baby.

Ketorolac passes into breast milk at low levels, therefore Ketanov is contraindicated during breastfeeding.

The ability to influence the reaction rate when driving or driving other mechanisms

Some patients in the case of using ketorolac may feel drowsiness, dizziness, insomnia, fatigue, visual impairment or depression. If patients feel the above or other similar effects, they should not drive or operate machinery.

Method of administration and dosage

It is advisable to take the tablets during or after meals. The drug is recommended only for short-term use (up to 5 days). In order to minimize side effects, the drug should be used in the lowest effective dose for a short period of time necessary to control symptoms. Before starting treatment, it is necessary to achieve normovolemia. For adults, Ketanov should be prescribed 10 mg every 4-6 hours if necessary. It is not recommended to use the drug in doses exceeding 40 mg per day. Opioid analgesics (for example, morphine, pethidine) can be used in parallel, ketorolac does not affect the binding of opioid drugs and does not increase respiratory depression or sedation caused by opioids. It was demonstrated that in cases of postoperative pain - the simultaneous use of ketorolac with opioid analgesics reduced the need for the latter. For patients who receive parenteral ketorolac and who are destined to oral ketorolac in tablet form, the total combined daily dose should not exceed 90 mg (60 mg for the elderly, patients with impaired renal function and patients weighing less than 50 kg), and the dosage the oral form of the drug should not exceed 40 mg per day if the use of the form of release of the drug is changed. Patients should be switched to oral administration of the drug as early as possible.

Elderly patients.

Elderly patients have a greater risk of developing severe complications, in particular from the digestive tract. During treatment with NSAIDs, the patient's condition should be monitored regularly, usually a longer interval between the use of the drug, for example 6-8 hours, is recommended.

Children

Do not use in children under 16 years of age.

Overdose

Symptoms: headache, nausea, vomiting, epigastric pain, gastrointestinal bleeding; rarely - diarrhea, disorientation, agitation, coma, drowsiness, dizziness, ringing in the ears, loss of consciousness, convulsions. In cases of severe poisoning, acute renal failure and liver damage are possible.

Treatment: gastric lavage, intake of activated carbon. Adequate urine output must be ensured. Renal and liver function should be carefully monitored. Patients should be monitored for at least 4:00 after ingestion of a potentially toxic amount. Frequent or prolonged seizures should be treated with diazepam. Other measures may be prescribed depending on the clinical condition of the patient. SPECIAL. Dialysis does not remove ketorolac from the circulation.

Adverse Reactions

From the digestive tract: peptic ulcer, perforation or gastrointestinal bleeding, sometimes fatal (especially in the elderly), nausea, dyspepsia, gastrointestinal pain, abdominal discomfort, cramping or burning in the epigastric region, vomiting with blood, gastritis, esophagitis, diarrhea, belching, constipation, flatulence, a feeling of fullness in the stomach, ground, rectal bleeding, ulcerative stomatitis, vomiting, hemorrhages, perforation, pancreatitis, exacerbation of colitis and Crohn's disease.

From the side of the central nervous system: anxiety, drowsiness, dizziness, headache, nervousness, paresthesia, functional disorders, depression, euphoria, convulsions, inability to concentrate, insomnia, malaise, increased fatigue, agitation, vertigo, unusual dreams, confusion, hallucinations, hyperkinesia, aseptic symptomatology, psychotic reactions, impaired thinking.

On the part of the organ of vision: visual impairment, blurred vision, optic neuritis.

On the part of the hearing organs: hearing loss, tinnitus.

From the urinary system: increased frequency of urination, oliguria, acute renal failure, hyponatremia, hyperkalemia, hemolytic uremic syndrome, flank pain (with / without hematuria), increased serum urea and creatinine, interstitial nephritis, urinary retention, nephrotic syndrome, renal failure.

On the part of the reproductive system: female infertility.

From the digestive system: liver dysfunction, hepatitis, jaundice and liver failure, hepatomegaly.

On the part of the cardiovascular system: hot flashes, bradycardia, pallor, arterial hypertension, palpitation, chest pain, edema, heart failure.

Data from clinical and epidemiological studies indicate that the use of some NSAIDs, especially in high doses and for a long time, may be associated with an increased risk of arterial thromboembolic complications (myocardial infarction or stroke).

From the respiratory system: shortness of breath, asthma, pulmonary edema.

From the side of the blood: purpura, thrombocytopenia, neutropenia, agranulocytosis, aplastic and hemolytic anemia, eosinophilia.

On the part of the skin: itching, urticaria, photosensitivity of the skin, Lyell's syndrome, bullous reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis (very rare), exfoliative dermatitis, maculopapular rash.

Hypersensitivity: reported the development of hypersensitivity reactions, including nonspecific allergic reactions and anaphylaxis, respiratory tract reactivity, including asthma, worsening asthma, bronchospasm, laryngeal edema or shortness of breath, as well as various skin disorders, including rash of various types, pruritus, urticaria, purpura , angioedema and, in isolated cases, exfoliative and bullous dermatitis (including epidermal necrolysis and polymorphic erythema).

Such reactions can occur in patients with or without known hypersensitivity to ketorolac or other NSAIDs. They can also be seen in individuals with a history of angioedema, bronchospasm, reactivity (eg, asthma and nasal polyps). Anaphylactoid reactions such as anaphylaxis can be fatal.

When you need to quickly relieve headaches or toothaches, people often resort to the well-known drug ketans. So why does ketans help? It effectively reduces pain and even has antipyretic properties if the body temperature is low.

Ketanov is an Indian non-narcotic analgesic analgesic belonging to the group of non-steroidal anti-inflammatory drugs. This remedy has a pronounced analgesic effect, so it is most often used to reduce pain in trauma and in the postoperative period. For a more accurate acquaintance with ketane, you need to read the instructions for use.

In ketanov, ketorolac is the main component. It is contained both in solution in ampoules and in tablets. Ketorolac is added to ketans in different doses, this is influenced by the form of release. The tablet of this agent contains ten mg of ketorolac, and in one ampoule - thirty mg per ml.

In ketanov in the form of tablets, additional substances are:

  • Light yellow powder, which is extracted from natural raw materials (corn starch);
  • Silicon (IV) oxide;
  • Mineral from the silicate class (talc);
  • Water;
  • Polymer of ethylene glycol;
  • Magnesium salt;
  • Stearic acid:
  • Microcrystalline cellulose.

The following substances are used as additives in the composition of the injection ampoules:

  1. Table salt or sodium chloride;
  2. Water;
  3. Caustic soda;
  4. Ethanol;
  5. Edetate disodium.

After reading this list of ingredients, it becomes clear that certain substances can cause allergies.

Before using the tablets (injections), it is advisable to consult a doctor and carefully read the instructions for use, which are for ketanov in different forms of release.

Ketanov release form

The drug ketans is produced exclusively in two forms:

  • Ampoules for intramuscular injection;
  • Tablets.

Ketan tablets also differ: they are produced either in a conventional shell or in a film. The clinical effect of these types of tablets is almost identical, therefore, when prescribing tablets, the differences for patients are insignificant. Tablets are produced in ten, twenty and one hundred pieces per pack. The packaging itself is white with a yellow corner.

The solution for injection (into the muscle) is usually called ketans injections or ketans in ampoules. In fact, we are talking about the solution. A solution of ketans is produced in ampoules in a volume of 1 ml, 5 or 10 pieces each.

Ketans are not produced in the form of ointments or suppositories. In the form of ointments or gel, other medicines are produced containing the active substance ketorolac, for example, ketorol gel.

Indications for use

Ketanov in any form (tablets or ampoules) is used to relieve pain of various origins or nature. As a rule, the form of release of this drug does not affect the effectiveness of treatment, the patient most often chooses for himself whether it will be more convenient for him to use tablets or use ampoules intramuscularly.

The range of use of ketanov is very wide, because pain occurs with various diseases, therefore, the cases of using ketanov should be described in more detail. Ketanov is often prescribed for headaches.

Why does ketans help? Ketans medicine is used in the following cases:

  • For pain in the teeth (for example, removal of wisdom teeth);
  • For headaches;
  • With joint pain;
  • Reducing pain after various operations;
  • After various injuries in muscles, soft skin and bones (fractures, tears, bruises, sprains, dislocations);
  • With renal colic:
  • With otitis media;
  • After visiting the dentist;
  • With muscle pain;
  • In the postpartum period;
  • At pain from tumors;
  • Various disorders in the spine:
  • Osteochondrosis;
  • With painfully passing critical days;
  • Radicular syndrome.

It is undesirable to use the medicine ketans for discomfort in the gastrointestinal tract, because it can hide the signs of various dangerous diseases that require urgent surgical intervention.

It is important not to forget that this medicinal product only masks pain and symptoms, but does not treat them, so if you have regular pain, you should see a doctor.

pharmachologic effect

Thanks to the active substance, ketorolac ketans has a different effect on the human body:

  • Slight antipyretic effect;
  • Pain reliever;
  • Moderate anti-inflammation effect.

When using tablets, all components are absorbed through the gastrointestinal tract. The intake of all components begins after about fifty minutes from the moment of taking the tablets.

The same duration is typical for ketan ampoules. The biological permeability of the substances of the ketan drug is 99% at different forms releases.

The medicine itself leaves the body through the intestines. Most of it is excreted through the urinary system, the rest is excreted through the intestines.

Due to the main substance, ketanes are ideal for reducing acute pain caused by trauma. This drug is also great for reducing joint pain.

Ketanov has a number of advantages in contrast to narcotic drugs:

  1. No sedation;
  2. Rarely there is nausea;
  3. Does not affect pressure;
  4. Does not retain urine.

Method of administration and dose of ketanov

The main symptom for using ketanov is pain of various origins. There are no fundamental differences in the use of tablets or ampoules in the instructions for use.

Injections or pills of ketans are allowed to be taken systematically for some days. If the patient has chosen a systematic solution, then the tablets are applied every five to six hours, as well as ampoules for injections.

If the patient chooses to take it as needed (during the onset of pain), then the pill is drunk once during the onset of pain. The duration of treatment with ketans should not exceed the following rate:

  • Adults are advised to use this treatment for no more than five days;
  • Children are recommended treatment for no more than two days.

When using tablets, they must be swallowed completely with a medium amount of water. It is advisable to use ketan tablets after meals, this will reduce the likelihood of a bad effect on the mucous membranes. After a fatty meal, the effect may come later. If the patient needs a quick effect, then ketan tablets should be used before meals.

Ketans can be used one-time (in case of pain) and on a schedule. The schedule is recommended to be no more than five days for an adult. A day you need to drink one tablet three or four times a day every 6-7 hours. In case of severe pain, you can use pills in a double dosage - two pills per dose.

People under 50 kilograms, over 65 years old and with kidney failure need to drink ketan tablets in halved doses.

The ampoules of ketanov during the injection should be injected deep into the muscle. The best places to inject into the muscle are the upper shoulder, abdomen, and thigh.

It is undesirable to inject into the buttocks, as they contain dense fatty tissue. With it, the solution does not always get into the muscle; this slows down and weakens the effect of the drug.

The selected injection site must be disinfected. Because there is 1 ml of solution in the ampoule, then for the correct dose it is advisable to use a small syringe of 0.5 - 1 ml. You need to use a needle for deep injection into the muscle.

The dose of ketanov for injection is prescribed personally due to the type and frequency of pain. The solution, like ketanov tablets, can be used once in connection with the onset of pain and on schedule.

For people aged less than 65 years and without renal failure, injections are prescribed in a dosage of 10-30 mg (0.1-1 ml). For people with impaired kidney function, the ketan dose is halved. The course of injections is equal to a week.

Contraindications

This ketan drug has various limitations that should be taken seriously.

Cases in which you should not use ketans:

  • With chronic diseases;
  • At the age of less than sixteen years;
  • If kidney function fails;
  • If you are intolerant of any substance in ketan;
  • When recovering from a stroke;
  • With gastritis;
  • With an increase in the pancreas.

With care, it is necessary to use ketans for erosive and ulcerative lesions of the gastrointestinal tract (especially during exacerbations). After consulting a doctor, you can carefully use ketans for pressure, asthma and heart failure.

Ketans should be discontinued three days before surgery to avoid increased bleeding. with the use of ketanov, a decrease in blood clotting is observed.

If a rash or other aggravation occurs while using ketanov, this remedy should be discontinued.

The drug ketans has various contraindications, so it is advisable to consult a doctor before using it.

Ketans in any form are prohibited during breastfeeding and pregnancy. If ketanov is recommended for a nursing woman, then she needs to switch to feeding with various mixtures.

Ketans should not be used during childbirth in order to relieve pain, because this will only increase the time of the labor act (the contractile activity of the uterus will weaken). There is a chance that during childbirth, ketans will provoke bleeding. If ketans were nevertheless prescribed during pregnancy for some individual reason, then it should be used under the supervision of a doctor.

You cannot combine ketans and alcohol. When they interact, they increase the chance of ulcers and internal bleeding from the digestive tract.

Alcoholic drinks increase the pain relieving effect of ketanov, because of this, you may not notice an increase in pain.

Side effects

At side effects ketanova, the following symptoms appear:

  • Diarrhea;
  • Stomatitis;
  • Pain in the stomach;
  • Bloating;
  • Nausea and vomiting;
  • Hepatitis;
  • Pancreatitis;
  • Enlarged liver;
  • Constipation;
  • Jaundice;
  • Bloody urine;
  • Frequent urination:
  • Anemia;
  • Renal failure;
  • Decrease in blood platelets;
  • Nephritis;
  • Painful sensations in the lower back;
  • Swelling of various parts of the body (fingers, feet, tongue, face);
  • Noise in ears;
  • Deterioration of vision;
  • Rhinitis;
  • Dyspnea:
  • Labored breathing;
  • Laryngeal edema;
  • Drowsiness;
  • Dizziness;
  • Mood swings;
  • Psychosis;
  • Bleeding from the nose;
  • Rash.

Ketan overdose

The use of high doses of ketanov inevitably leads to an overdose. In case of an overdose of the drug ketans, the following manifestations of symptoms may occur:

  1. Cardiopalmus;
  2. Anxiety and increased anxiety;
  3. Dry mouth;
  4. Vomiting and nausea;
  5. Drowsiness;
  6. Increased sweating;
  7. In rare cases, hallucinations may occur;
  8. Gastritis;
  9. Stomach ulcers;
  10. Violation of the kidneys.

When using ketan tablets during an overdose, pain in the abdomen can be observed, and with ampoules, pain in the muscles, at the injection sites.

In case of an overdose with ketan, symptomatic treatment is necessary. As a rule, in case of an overdose with this drug, gastric lavage and the use of sorbents are prescribed.

Where to buy ketans, price and storage conditions

After the decree of the Ministry of Health of the Russian Federation of 2012 medicine ketans should only be dispensed with a doctor's prescription, but most pharmacies sell this drug and without a prescription. This is due to the fact that ketanov is not a narcotic drug. Before using ketanov, it is still advisable to consult a doctor.

The drug ketans is widespread and is found in almost all pharmacies in Russia. The price of ketanov ranges from thirty rubles to one hundred and fifty rubles, its cost depends on the number of pieces in a package and on the form of release.

Ketanov's analogs

Ketanov's analogs are products that, like ketanov, contain ketorolac.

Such analogues of ketanov are:

  • Dolak;
  • Ketorol (gel, tablets, solution;
  • Dolomin;
  • Ketofril;
  • Ketorolac (tablets and solution)
  • Voltaren;
  • Panoxen;
  • Dicloran:
  • Diclogen;
  • Aertal;
  • Asinak;
  • Orthofer.



Which is better: ketanov or ketorol? What are the differences between ketorol and ketanov?

So, both drugs are positioned as well-known anti-inflammatory and pain relievers. They have similar names to each other. Both drugs have one main component, ketorolac. It is used in various doses. In ketan, the dose of the main component is higher than in ketorol. What is stronger and more effective: ketans or ketorol? Ketanov is the most serious remedy for pain relief.

Both of these drugs are available in tablet form. Due to the strong concentration of ketorolac ketans, it is suitable for the relief of the most severe pains. This medicine is often prescribed for joint pain. Ketanov is also effective for pain during critical days.

For headaches, it is advisable to use ketorol, because its effect is the mildest. For acute migraines, ketans are recommended. The advantage of ketorol is that it is most harmless to pregnant women and lactating mothers.

With the highest efficiency of ketans, it has more contraindications than ketorol.

So, what should you choose: ketans or ketorol? The choice depends on the type of pain. For acute sharp pains, it is recommended to use ketans, with minor injuries and pains - ketorol. It acts softer and has fewer contraindications.