Ketorolac Tromethamine is a member of the pyrrolo-pyrrole group of nonsteroidal anti-inflammatory drugs (NSAIDs). The chemical name for ketorolac tromethamine is (±)-5-benzoyl-2,3- dihydro-1 H-pyrrolizine-1-carboxylic acid, compound with 2-amino-2-(hydroxymethyl)-1,3- propanediol (1:1)
Ketorolac tromethamine is a racemic mixture of [-] S and [+] R ketorolac tromethamine. Ketorolac tromethamine may exist in three crystal forms. All forms are equally soluble in water. Ketorolac tromethamine has a pKa of 3.5 and an n-octanol/water partition coefficient of 0.26. The molecular weight of ketorolac tromethamine is 376.41. Its molecular formula is C19H24N2O6.
Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic activity in animal models. The mechanism of action of ketorolac, like that of other NSAIDs, is not completely understood but may be related to prostaglandin synthetase inhibition. The biological activity of ketorolac tromethamine is associated with the S-form. Ketorolac tromethamine possesses no sedative or anxiolytic properties.
When a NSAID is required but other routes than injectable are not available or the pain is not responding
• History of gastric ulceration/bleeds
• History of cerebrovascular bleeds
• Clotting disorder/on anticoagulation
• On lithium
• Use with caution in renal or hepatic impairment
• Gastrointestinal bleeding, especially if given for more than 7 days
• 60mg over 24 hrs via syringe driver
• Do not increase dose if patient is less than 50kg or is over 65 years.
• Otherwise, increase if necessary in increments of 15mg/24hrs to 90mg/24hrs
• Co-prescribe lansoprazole 30mg od
• There is an oral preparation, but it may be safer to use a different NSAID if oral conversion becomes necessary, in view of the risk of gastrointestinal bleeding.
Syringe driver compatibility
• Ketorolac has a high risk of incompatibility
• Should be diluted in as high a volume of normal saline as possible
• Compatible with diamorphine and oxycodone.