The Role of Subcutaneous Ketorolac for Pain Management

Abstract

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.

Comparison of the Pharmacokinetics of Ketorolac Tromethamine After Continuous Subcutaneous Infusion and Repeat Intramuscular Bolus Injections in Healthy Adult Subjects

“…Short‐term use of ketorolac lacks the respiratory depressant effects of opiate analgesics but shares the toxic potentials of other nonsteroidal anti‐inflammatories . The major AEs related to ketorolac tromethamine treatments involve gastrointestinal bleeding, peptic ulcers, and perforation of the stomach, as well as prolonged platelet aggregation and a decline in renal functions . In the study reported here, a total dose of 120 mg ketorolac tromethamine administered via continuous subcutaneous infusion appeared to be safe and well tolerated in this study.…”

“…The treatments were separated by a washout period of ≥4 days. The total daily dose of 120 mg ketorolac tromethamine administered as 4 × 30 mg/mL intramuscular bolus injections is the standard course of treatment, and in several studies the same dose has been reported to be well tolerated when administered in a continuous subcutaneous infusion regimen to patients, and as such was chosen for this study …”

“…The total daily dose of 120 mg ketorolac tromethamine administered as 4 × 30 mg/mL intramuscular bolus injections is the standard course of treatment, and in several studies the same dose has been reported to be well tolerated when administered in a continuous subcutaneous infusion regimen to patients, and as such was chosen for this study. 1 Blood samples for the determination of plasma ketorolac following continuous subcutaneous infusion (treatment A) were collected at the following times: predose (0 hours), 0.25, 0.5, 1, 1. 5,2,4,6,8,10,12,14,16,18,20,22,23,24 (2 blood samples were collected at the 24-hour point; 1 immediately prior to the end of infusion and 1 immediately following the end of infusion), 24.167, 24.33, 24.5, 25, 26, 28, 30, 32, 36, and 48 hours postdose.…”

“…The treatment consists of intravenous or intramuscular dosing of ketorolac tromethamine, followed by oral administration, if necessary. Adverse events (AEs) related to ketorolac tromethamine treatments include peptic ulcers, gastrointestinal bleeding, and/or perforation of the stomach or intestines as well as impact on platelet and renal function …”

“…Adverse events (AEs) related to ketorolac tromethamine treatments include peptic ulcers, gastrointestinal bleeding, and/or perforation of the stomach or intestines as well as impact on platelet and renal function. 1 The pharmacokinetics, pharmacodynamics, and therapeutic effect of intravenous, intramuscular, and oral ketorolac have been well characterized over the years. [2][3][4] Ketorolac tromethamine is a racemic mixture of [-]S (active) and [+]R (inactive) enantiomeric forms.…”