Details
| Stereochemistry | RACEMIC |
| Molecular Formula | C15H13NO3 |
| Molecular Weight | 255.2686 |
| Optical Activity | ( + / - ) |
| Defined Stereocenters | 0 / 1 |
| E/Z Centers | 0 |
| Charge | 0 |
SHOW SMILES / InChI
SMILES
OC(=O)C1CCN2C1=CC=C2C(=O)C3=CC=CC=C3
InChI
InChIKey=OZWKMVRBQXNZKK-UHFFFAOYSA-N
InChI=1S/C15H13NO3/c17-14(10-4-2-1-3-5-10)13-7-6-12-11(15(18)19)8-9-16(12)13/h1-7,11H,8-9H2,(H,18,19)
Ketorolac is a pyrrolizine carboxylic acid derivative structurally related to indomethacin. It is an NSAID and is used principally for its analgesic activity and has been shown to decrease opioid requirements in post-operative patients. It does not affect consciousness or respiration but does have effects on gastric mucosa, renal perfusion, and platelet function. Ketorolac tromethamine ophthalmic solution is sold under brand name acular LS and is indicated for the reduction of ocular pain and burning/stinging following corneal refractive surgery. Ketorolac tromethamine is a racemic mixture of [-]S- and [ ]R-enantiomeric forms, with the S-form having analgesic activity. Its antiinflammatory effects are believed to be due to inhibition of both cylooxygenase-1 (COX-1) and cylooxygenase-2 (COX-2) which leads to the inhibition of prostaglandin synthesis leading to decreased formation of precursors of prostaglandins and thromboxanes from arachidonic acid. The resultant reduction in prostaglandin synthesis and activity may be at least partially responsible for many of the adverse, as well as the therapeutic, effects of these medication. Analgesia is probably produced via a peripheral action in which blockade of pain impulse generation results from decreased prostaglandin activity.
Approval Year
Targets
| Primary Target | Pharmacology | Condition | Potency |
|---|---|---|---|
Target ID: CHEMBL2094253 Sources: https://www.ncbi.nlm.nih.gov/pubmed/11695255 |
Conditions
| Condition | Modality | Targets | Highest Phase | Product |
|---|---|---|---|---|
| Primary | ACULAR LS Approved UseACULAR LS ophthalmic solution is indicated for the reduction of ocular pain and burning/stinging following corneal refractive surgery. Launch Date2003 |
Cmax
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
2382.2 ng/mL |
30 mg single, intramuscular dose: 30 mg route of administration: Intramuscular experiment type: SINGLE co-administered: |
KETOROLAC plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
|
1805.8 ng/mL |
31.5 mg single, nasal dose: 31.5 mg route of administration: Nasal experiment type: SINGLE co-administered: |
KETOROLAC plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
AUC
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
11152.8 ng × h/mL |
30 mg single, intramuscular dose: 30 mg route of administration: Intramuscular experiment type: SINGLE co-administered: |
KETOROLAC plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
|
7477.3 ng × h/mL |
31.5 mg single, nasal dose: 31.5 mg route of administration: Nasal experiment type: SINGLE co-administered: |
KETOROLAC plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
T1/2
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
4.8 h |
30 mg single, intramuscular dose: 30 mg route of administration: Intramuscular experiment type: SINGLE co-administered: |
KETOROLAC plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
|
5.24 h |
31.5 mg single, nasal dose: 31.5 mg route of administration: Nasal experiment type: SINGLE co-administered: |
KETOROLAC plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
Doses
| Dose | Population | Adverse events |
|---|---|---|
2 mg single, intrathecal Highest studied dose Dose: 2 mg Route: intrathecal Route: single Dose: 2 mg Sources: |
healthy, 18-50 |
|
30 mg single, intramuscular Highest studied dose Dose: 30 mg Route: intramuscular Route: single Dose: 30 mg Sources: |
healthy, 19-45 |
|
30 mg single, intranasal Highest studied dose Dose: 30 mg Route: intranasal Route: single Dose: 30 mg Sources: |
healthy, 19-45 |
|
31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
Other AEs: Nausea, Constipation... Other AEs: Nausea (58%) Sources: Constipation (29%) Vomiting (28%) Nasal passage irritation (24%) Headache (24%) Flatulence (23%) Anemia (19%) Tachycardia (14%) Pruritis (11%) Dizziness (6%) |
90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
Other AEs: Anaemia, Thrombocytopenia... Other AEs: Anaemia (below serious, 7 patients) Sources: Thrombocytopenia (below serious, 3 patients) Hyponatraemia (below serious, 3 patients) Hypokalaemia (below serious, 2 patients) Leucopenia (below serious, 1 patient) |
90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
Other AEs: Hypercapnia, Thrombocytopenia... Other AEs: Hypercapnia (below serious, 12 patients) Sources: Thrombocytopenia (below serious, 12 patients) Leukocytosis (below serious, 38 patients) Hypokalaemia (below serious, 20 patients) Hyperkalaemia (below serious, 3 patients) Hyponatraemia (below serious, 10 patients) |
AEs
| AE | Significance | Dose | Population |
|---|---|---|---|
| Pruritis | 11% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Tachycardia | 14% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Anemia | 19% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Flatulence | 23% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Headache | 24% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Nasal passage irritation | 24% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Vomiting | 28% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Constipation | 29% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Nausea | 58% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Dizziness | 6% | 31.5 mg 3 times / day multiple, intranasal Recommended Dose: 31.5 mg, 3 times / day Route: intranasal Route: multiple Dose: 31.5 mg, 3 times / day Sources: |
unhealthy, 51.7 |
| Leucopenia | below serious, 1 patient | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Hypokalaemia | below serious, 2 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Hyponatraemia | below serious, 3 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Thrombocytopenia | below serious, 3 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Anaemia | below serious, 7 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Hyponatraemia | below serious, 10 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Hypercapnia | below serious, 12 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Thrombocytopenia | below serious, 12 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Hypokalaemia | below serious, 20 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Hyperkalaemia | below serious, 3 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
| Leukocytosis | below serious, 38 patients | 90 mg single, intravenous Dose: 90 mg Route: intravenous Route: single Dose: 90 mg Sources: |
unhealthy |
PubMed
| Title | Date | PubMed |
|---|---|---|
| A functional analysis of EP4 receptor-expressing neurons in mediating the action of prostaglandin E2 within specific nuclei of the brain in response to circulating interleukin-1beta. | 2000 May |
|
| Ketorolac entrapped in polymeric micelles: preparation, characterisation and ocular anti-inflammatory studies. | 2000 Nov 19 |
|
| Single-dose dipyrone for acute postoperative pain. | 2001 |
|
| Effects of nonsteroidal anti-inflammatory drugs on post-operative renal function in normal adults. | 2001 |
|
| Preemptive analgesic effects of ketorolac in ankle fracture surgery. | 2001 Apr |
|
| [Control of postoperative pain in heart surgery. Comparison of analgesics]. | 2001 Apr |
|
| New advances in the treatment of sickle cell disease: focus on perioperative significance. | 2001 Aug |
|
| Participation of the nitric oxide-cyclic GMP-ATP-sensitive K(+) channel pathway in the antinociceptive action of ketorolac. | 2001 Aug 24 |
|
| [Aortic stent: the anesthesiologist's point of view]. | 2001 Dec |
|
| Delayed diffuse lamellar keratitis after laser in situ keratomileusis. | 2001 Dec |
|
| A prospective study comparing i.m. ketorolac with i.m. meperidine in the treatment of acute biliary colic. | 2001 Feb |
|
| Using evidence from different sources: an example using paracetamol 1000 mg plus codeine 60 mg. | 2001 Jan 10 |
|
| A double-blind, randomized comparison of intramuscularly and intravenously administered parecoxib sodium versus ketorolac and placebo in a post-oral surgery pain model. | 2001 Jul |
|
| Headache in the emergency department. | 2001 Jun |
|
| Propacetamol versus ketorolac for treatment of acute postoperative pain after total hip or knee replacement. | 2001 Jun |
|
| Methadone in treatment of tenesmus not responding to morphine escalation. | 2001 Mar |
|
| In vitro based index of topical anti-inflammatory activity to compare a series of NSAIDs. | 2001 Mar |
|
| Antinociceptive effects of delta-opioid agonists in Rhesus monkeys: effects on chemically induced thermal hypersensitivity. | 2001 Mar |
|
| Precipitation in Manchester: ketorolac/cyclizine. | 2001 May |
|
| Determination of ketorolac in human plasma by reversed-phase high-performance liquid chromatography using solid-phase extraction and ultraviolet detection. | 2001 May 5 |
|
| Retrospective analysis of drug-induced urticaria and angioedema: a survey of 2287 patients. | 2001 Nov |
|
| Pain control after knee arthroplasty: intraarticular versus epidural anesthesia. | 2001 Nov |
|
| The effect of ketorolac and sevoflurane anesthesia on renal glomerular and tubular function. | 2001 Nov |
|
| Analgesia and COX-2 inhibition. | 2001 Nov-Dec |
|
| Nonsteroidal anti-inflammatory drugs for perioperative pain control. | 2001 Oct |
|
| Can standard open pediatric urological procedures be performed on an outpatient basis? | 2001 Sep |
|
| Postoperative pain management: morphine versus ketorolac. | 2002 Feb |
|
| Is the administration of ketorolac associated with preemptive analgesia? | 2002 Feb |
|
| Preemptive analgesic effect or short delay for inflammation? | 2002 Feb |
|
| Epidural hematoma after outpatient epidural anesthesia. | 2002 Jan |
|
| Opioid-free analgesia following total knee arthroplasty--a multimodal approach using continuous lumbar plexus (psoas compartment) block, acetaminophen, and ketorolac. | 2002 Jan-Feb |
|
| Multimodal analgesia and intravenous nutrition preserves total body protein following major upper gastrointestinal surgery. | 2002 Jan-Feb |
|
| Early hospital discharge for intravesical ureteroneocystostomy. | 2002 Jun |
|
| Intra-muscular ketorolac administered as a supplemental analgesic for removal of impacted third molar teeth: a prospective study. | 2002 Mar |
|
| Parenteral ketorolac and risk of myocardial infarction. | 2002 Mar |
|
| Morphological and pharmacological evidence for the role of peripheral prostaglandins in the pathogenesis of neuropathic pain. | 2002 Mar |
|
| Treatment patterns of isolated benign headache in US emergency departments. | 2002 Mar |
|
| Effect of topical diclofenac and ketorolac on patient discomfort and corneal sensitivity. | 2002 Mar-Apr |
|
| Comparison of the morphine-sparing effects of diclofenac sodium and ketorolac tromethamine after major orthopedic surgery. | 2002 May |
|
| The role of spinal neuropeptides and prostaglandins in opioid physical dependence. | 2002 May |
|
| Role for both spinal cord COX-1 and COX-2 in maintenance of mechanical hypersensitivity following peripheral nerve injury. | 2002 May 24 |
Sample Use Guides
The recommended dose of ACULAR LS (ketorolac tromethamine ophthalmic solution) is one drop four times a day in the operated eye as needed for pain and burning/stinging for up to 4 days following corneal refractive surgery. Ketorolac tromethamine ophthalmic solution has been safely administered in conjunction with other ophthalmic medications such as antibiotics, beta blockers, carbonic anhydrase inhibitors, cycloplegics, and mydriatics.
Route of Administration:
Other
In Vitro Use Guide
Sources: https://www.ncbi.nlm.nih.gov/pubmed/18324898
It was discovered, that ketorolac inhibition of stretch-induced ureteral contractility was concentration-dependent between 1 nM and 1 microM. Local administration of ketorolac at these doses may be useful during the management of stones while at the same time limiting the risk for adverse effects. Porcine ureter strips attached to force displacement transducers were suspended in organ tissue baths that contained aerated Krebs buffer. Tissues equilibrated for 1 hour, and a spontaneous contractility rate was established. Tissues were incubated with a concentration-response curve of ketorolac (0.1 nM-10 microM) for 90 minutes and compared with indomethacin (1 muM) and dimethyl sulfoxide (DMSO) 0.1%. Contractility rates were recorded on a polygraph and analyzed for changes over exposure time
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| Classification Tree | Code System | Code | ||
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NCI_THESAURUS |
C1323
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NDF-RT |
N0000000160
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WHO-ATC |
S01FB51
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NDF-RT |
N0000175721
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WHO-ATC |
S01BC05
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WHO-ATC |
M01AB15
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WHO-VATC |
QM01AB15
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NDF-RT |
N0000175722
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WHO-VATC |
QS01BC05
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LIVERTOX |
NBK548459
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NDF-RT |
N0000175939
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74103-06-3
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C1219
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35827
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DB00465
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6661
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DTXSID8023189
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D020910
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100000083097
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1529
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KETOROLAC
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5558
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6129
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CHEMBL469
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Ketorolac
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YZI5105V0L
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m6623
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PRIMARY | Merck Index |
ACTIVE MOIETY
METABOLITE INACTIVE (PARENT)
SALT/SOLVATE (PARENT)
SALT/SOLVATE (PARENT)