Instructions for use of KETANOV
The maximum duration of treatment should not exceed 5 days.
Gastrointestinal bleeding, ulceration and perforation
Gastrointestinal bleeding, ulceration or perforation, which may be fatal, has been reported with the use of NSAIDs at any time during treatment, with or without warning symptoms or in the case of a history of severe gastrointestinal disorders. The risk of severe gastrointestinal bleeding depends on the dosage of the drug. This particularly applies to elderly patients who use ketorolac at an average daily dose of more than 60 mg. For these patients, as well as for patients who are concomitantly using low doses of acetylsalicylic acid or other drugs that may increase gastrointestinal risk, combination treatment with protective agents (eg, misoprostol or proton pump inhibitors) should be considered. Ketanov is used with caution in patients who are concomitantly receiving drugs that may increase the risk of ulceration or bleeding, such as oral corticosteroids, selective serotonin reuptake inhibitors, or antiplatelet agents such as acetylsalicylic acid. If gastrointestinal bleeding or ulceration occurs in patients receiving Ketanov, treatment should be discontinued.
Respiratory dysfunction
Caution is required when using the drug in patients with bronchial asthma (or with a history of asthma), since NSAIDs have been reported to accelerate the onset of bronchospasm in such patients.
Effect on kidney function
Prostaglandin biosynthesis inhibitors (including NSAIDs) have been reported to have nephrotoxic effects. The drug should be prescribed with caution to patients with impaired renal, cardiac, or liver function, since the use of NSAIDs may lead to deterioration of renal function. Patients with minor renal impairment are prescribed lower doses of ketorolac (those that do not exceed 60 mg/day IM or IV), and the renal condition of such patients should also be carefully monitored. As with other drugs that inhibit prostaglandin synthesis, increases in serum urea, creatinine and potassium have been reported during use of ketorolac tromethamine, which may occur after a single dose.
Cardiovascular, renal and liver disorders
The drug is prescribed with caution to patients with conditions that lead to a decrease in blood volume and/or a decrease in renal blood flow, when renal prostaglandins play a supporting role in ensuring renal perfusion. In these patients, renal function should be monitored. The volume reduction should be corrected and serum urea and creatinine levels and the volume of urine excreted carefully monitored until the patient becomes normovolemic. In patients on renal dialysis, the clearance of ketorolac was reduced by approximately half the normal rate, and the final T1/2 increased approximately threefold. Patients with impaired liver function due to cirrhosis did not have any clinically significant changes in ketorolac clearance or terminal T1/2. Borderline elevated values on one or more liver function tests may occur. 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, Ketanov should be discontinued.
Fluid retention and swelling
Fluid retention and edema have been reported during use of ketorolac, so the drug should be administered with caution to patients with cardiac decompensation, hypertension, or similar conditions.
Cardiovascular and cerebrovascular effects
There is currently insufficient information to assess such a risk for ketorolac tromethamine. Patients with uncontrolled hypertension, congestive heart failure, diagnosed coronary artery disease, peripheral arterial disease and/or cerebrovascular disease should be under medical supervision.
Systemic lupus erythematosus and mixed connective tissue diseases
In patients with systemic lupus erythematosus and various mixed connective tissue diseases, the risk of developing aseptic meningitis increases.
Dermatological reactions
Ketanov should be discontinued at the first signs of a skin rash, damage to the mucous membranes or any other signs of hypersensitivity.
Anaphylactic (anaphylactoid) reactions
As with the use of other NSAIDs, anaphylactic (anaphylactoid) reactions (including anaphylaxis, bronchospasm, flushing, rash, hypotension, laryngeal edema, angioedema) may occur in patients who have no or no history of hypersensitivity reactions to aspirin, other NSAIDs or ketorolac. This set of symptoms may also occur in individuals with a history of bronchospastic reactivity (eg, asthma) and nasal polyps. Anaphylactoid reactions, such as anaphylaxis, can be fatal. Therefore, ketorolac should not be taken by patients with a history of asthma and patients with a complete or incomplete combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses, and Quincke's edema. If anaphylactoid reactions occur, seek emergency medical attention.
Hematological effects
Patients with bleeding 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 who are receiving other drugs that can affect the rate of bleeding control 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 prolongs 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. In contrast to the long-term effects resulting from the use of acetylsalicylic acid, platelet function returns to normal within 24-48 hours after discontinuation of ketorolac. Ketorolac should not be prescribed to patients who have undergone surgery with a high risk of bleeding or incomplete control of bleeding. Caution should be used if mandatory bleeding control is critical. Ketanov is not an anesthetic agent and does not have sedative or anxiolytic properties; therefore, it is not recommended as a pre-operative sedative to maintain anesthesia.
Use in pediatrics
The drug is not used in children and adolescents under 16 years of age.
Impact on the ability to drive vehicles and operate machinery
Some patients may experience drowsiness, dizziness, vertigo, insomnia, fatigue, blurred vision, or depression when using ketorolac. If the patient experiences the above or other similar side effects, you should not drive or operate machinery.
Ketanov 10 mg 100 pcs. film-coated tablets
pharmachologic effect
NSAID, derivative of pyrrolysine-carboxylic acid. It has a pronounced analgesic effect, and also has anti-inflammatory and moderate antipyretic effects. The mechanism of action is associated with inhibition of the activity of COX, the main enzyme in the metabolism of arachidonic acid, which is a precursor of prostaglandins, which play a major role in the pathogenesis of inflammation, pain and fever.
Composition and release form Ketanov 10 mg 100 pcs. film-coated tablets
Tablets - 1 tablet: ketorolac tromethamine 10 mg.
10 pieces. — contour cell packaging (10) — cardboard packs.
Description of the dosage form
Film-coated tablets.
Directions for use and doses
For adults, when taken orally - 10 mg every 4-6 hours, if necessary - 20 mg 3-4 times a day.
For intramuscular administration, a single dose is 10-30 mg, the interval between injections is 4-6 hours. The maximum duration of use is 2 days.
Maximum doses: when taken orally or intramuscularly - 90 mg/day; for patients weighing up to 50 kg, with impaired renal function, as well as for persons over 65 years of age - 60 mg/day.
Pharmacodynamics
The analgesic effect occurs after approximately 30 minutes, the maximum analgesic effect develops after 1-2 hours. The duration of the analgesic effect is 4-6 hours or more, depending on the dose. Does not have a sedative or anxiolytic effect, does not affect opioid receptors. It does not have a depressant effect on the respiratory center and does not enhance respiratory depression and sedation caused by opioid analgesics. Does not cause drug dependence. No withdrawal symptoms occur after abrupt cessation of use. Suppresses platelet aggregation and may cause prolongation of bleeding time. Restoration of platelet function occurs 24-48 hours after discontinuation of the drug.
Pharmacokinetics
When taken orally, it is absorbed from the gastrointestinal tract. Cmax in blood plasma is achieved 40-50 minutes after both oral and intramuscular administration. Eating does not affect absorption. Plasma protein binding is more than 99%.
T1/2 ;- 4-6 hours both after oral administration and after intramuscular administration.
More than 90% of the dose is excreted in the urine, unchanged - 60%; the remaining amount is through the intestines.
In patients with impaired renal function and the elderly, the elimination rate decreases, T1/2 increases.
Indications for use Ketanov 10 mg 100 pcs. film-coated tablets
For short-term relief of moderate and severe pain of various origins.
Contraindications
Erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, the presence or suspicion of gastrointestinal bleeding and/or cerebral hemorrhage, a history of blood coagulation disorders, conditions with a high risk of bleeding or incomplete hemostasis, hemorrhagic diathesis, moderate and severe renal dysfunction ( serum creatinine content more than 50 mg/l), the risk of developing renal failure due to hypovolemia and dehydration; “aspirin triad”, bronchial asthma, nasal polyps, history of angioedema, preventive pain relief before and during surgery, childhood and adolescence up to 16 years of age, pregnancy, childbirth, lactation, hypersensitivity to ketorolac, acetylsalicylic acid and other NSAIDs .
Application of Ketanov 10 mg 100 pcs. film-coated tablets during pregnancy and breastfeeding
Contraindicated during pregnancy, during childbirth and during lactation (breastfeeding).
Ketorolac is contraindicated for use as a premedication, maintenance of anesthesia and for pain relief in obstetric practice, since its influence may increase the duration of the first stage of labor. In addition, ketorolac may inhibit uterine contractility and fetal circulation.
Use with caution in patients with impaired renal function.
Use in children
Contraindicated in children and adolescents under 16 years of age.
special instructions
Use with caution in patients with impaired liver and kidney function, chronic heart failure, arterial hypertension, in patients with erosive and ulcerative lesions of the gastrointestinal tract and a history of bleeding from the gastrointestinal tract.
Ketorolac should be used with caution in the postoperative period in cases where particularly careful hemostasis is required (including after resection of the prostate gland, tonsillectomy, in cosmetic surgery), as well as in elderly patients, because The half-life of ketorolac is prolonged and plasma clearance may be reduced. In this category of patients, it is recommended to use ketorolac in doses close to the lower limit of the therapeutic range. If symptoms of liver damage, skin rash, or eosinophilia appear, ketorolac should be discontinued. Ketorolac is not indicated for use in chronic pain syndrome.
Impact on the ability to drive vehicles and operate machinery
If drowsiness, dizziness, insomnia or depression appear during treatment with ketorolac, special care must be taken when engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions.
Overdose
Symptoms: (with a single dose) abdominal pain, nausea, vomiting, peptic ulcers, impaired renal function (these symptoms disappeared after discontinuation of the drug). Treatment: symptomatic therapy. Dialysis does not significantly remove ketorolac from the blood.
Side effects of Ketanov 10 mg 100 pcs. film-coated tablets
From the cardiovascular system: rarely - bradycardia, changes in blood pressure, palpitations, fainting.
From the digestive system: nausea, abdominal pain, diarrhea are possible; rarely - constipation, flatulence, feeling of gastrointestinal fullness, vomiting, dry mouth, thirst, stomatitis, gastritis, erosive and ulcerative lesions of the gastrointestinal tract, liver dysfunction.
From the central nervous system and peripheral nervous system: anxiety, headache, drowsiness are possible; rarely - paresthesia, depression, euphoria, sleep disturbances, dizziness, changes in taste, visual disturbances, motor disorders.
From the respiratory system: rarely - respiratory failure, attacks of suffocation.
From the urinary system: rarely - increased frequency of urination, oliguria, polyuria, proteinuria, hematuria, azotemia, acute renal failure.
From the blood coagulation system: rarely - nosebleeds, anemia, eosinophilia, thrombocytopenia, bleeding from postoperative wounds.
From the metabolic side: ;possible increased sweating, swelling; rarely - oliguria, increased levels of creatinine and/or urea in the blood plasma, hypokalemia, hyponatremia.
Allergic reactions: possible skin itching, hemorrhagic rash; in isolated cases - exfoliative dermatitis, urticaria, Lyell's syndrome, Stevens-Johnson syndrome, anaphylactic shock, bronchospasm, Quincke's edema, myalgia.
Other: ;possible fever.
Local reactions: pain at the injection site.
Drug interactions
When ketorolac is used concomitantly with other NSAIDs, additive side effects may develop; with pentoxifylline, anticoagulants (including heparin in low doses) - the risk of bleeding may increase; with ACE inhibitors - there may be an increased risk of developing renal dysfunction; with probenecid - the plasma concentration of ketorolac and its half-life increase; with lithium preparations - a decrease in the renal clearance of lithium and an increase in its concentration in plasma is possible; with furosemide - reducing its diuretic effect.
When using ketorolac, the need for the use of opioid analgesics for pain relief is reduced.
Ketanov®
The classification of side effects is presented: often - 1-10%; infrequently - 0.1-1%; rarely - 0.01-0.1%; very rarely - less than 0.001%, including isolated cases.
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; infrequently - stomatitis, flatulence, constipation, vomiting, feeling of fullness of the stomach; rarely - nausea, erosive and ulcerative lesions of the gastrointestinal tract (including with perforation and/or bleeding - abdominal pain, spasm or burning 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, lower 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, edema of renal origin.
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, convulsions, stiffness of the neck and/or back muscles), hyperactivity (mood changes, anxiety), hallucinations, depression, psychosis.
From the cardiovascular system:
infrequently - increased blood pressure; rarely - pulmonary edema, fainting.
From the hematopoietic organs
: rarely - anemia, eosinophilia, leukopenia.
From the hemostasis system
: rarely - bleeding from a postoperative wound, nosebleeds, rectal bleeding.
From the skin:
uncommon - skin rash (including maculopapular rash), purpura; rarely - exfoliative dermatitis (fever with or without chills, redness, thickening or peeling of the skin, swelling and/or tenderness of the tonsils), urticaria, Stevens-Johnson syndrome, Lyell's syndrome.
Allergic reactions
: rarely - anaphylaxis or anaphylactoid reactions (change in facial skin color, skin rash, urticaria, skin itching, tachypnea or dyspnea, swelling of the eyelids, periorbital edema, shortness of breath, difficulty breathing, heaviness in the chest, wheezing).
Others
: often - swelling (face, legs, ankles, fingers, feet, weight gain); less often - increased sweating; rarely - swelling of the tongue, fever.
KETANOV MD
Concomitant use of ketorolac with acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (including cyclooxygenase-2 inhibitors), calcium preparations, glucocorticosteroids, ethanol, corticotropin can lead to a significant increase in the risk of adverse reactions, including the formation of gastrointestinal ulcers and the development of gastrointestinal bleeding. Concomitant use with non-steroidal anti-inflammatory drugs is contraindicated.
Simultaneous use with paracetamol increases nephrotoxicity, and with methotrexate - hepato- and nephrotoxicity. The simultaneous use of ketorolac and methotrexate is possible only when using low doses of the latter (monitor the concentration of methotrexate in the blood plasma).
Probenecid reduces the plasma clearance and volume of distribution of ketorolac, increases its concentration in the blood plasma and increases its half-life.
Concomitant use with indirect anticoagulants, heparin, thrombolytics, antiplatelet agents, cefoperazone, cefotetan and pentoxifylline increases the risk of bleeding. Concomitant use with anticoagulants (including warfarin and heparin) and pentoxifylline is contraindicated. Reduces the effect of antihypertensive and diuretic drugs (the synthesis of prostaglandins in the kidneys decreases).
When combined with opioid analgesics, the doses of the latter can be significantly reduced.
Antacids do not affect the absorption of the drug.
Ketorolac enhances the hypoglycemic effect of insulin and oral hypoglycemic drugs (dose recalculation is necessary).
Concomitant use with sodium valproate causes disruption of platelet aggregation.
Increases the plasma concentration of verapamil and nifedipine.
When used with other nephrotoxic drugs (including gold preparations), the risk of developing nephrotoxicity increases. Drugs that block tubular secretion reduce the clearance of ketorolac and increase its concentration in the blood plasma.
Concomitant use with probenecid leads to an increase in the plasma concentration and half-life of ketorolac. Concomitant use with probenecid is contraindicated. The simultaneous use of lithium salts and certain drugs that suppress the synthesis of prostaglandins leads to impaired excretion and an increase in the plasma concentration of lithium salts. Simultaneous use with lithium salts is contraindicated.
When using cyclosporine, tacrolimus with ketorolac (as with other NSAIDs), caution is recommended due to the increased risk of nephrotoxicity. Cases of hematoma formation have been reported in HIV-infected patients with hemophilia receiving concomitant zidovudine and ibuprofen. Therefore, caution should be exercised when using NSAIDs and zidovudine simultaneously. Ketorolac does not affect the binding of digoxin to blood proteins.
According to animal studies, the concomitant use of NSAIDs with quinolone antibiotics increases the risk of seizures.
It is not recommended to use NSAIDs for 8-12 days after using mifepristone, as the effect of mifepristone may be reduced.
