A review of intranasal ketorolac tromethamine for the short-term management of moderate to moderately severe pain that requires analgesia at the opioid level

He, Andy; Hersh, Elliot V.

doi:10.1185/03007995.2012.744302

Cited by 15 publications

(13 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incidence of adverse events was similar to that of placebo group. Notably, gastrointestinal bleeding was not associated with ketorolac group …”

Section: Intranasal Ketorolacmentioning

confidence: 88%

“…The recommended dosage of ketorolac tromethamine (oral, IM, IV) for subjects aged > 65 years is half of the dosage used for patients aged < 65 years of age (typically 30 mg for single doses), and a total daily dose should not exceed 60 mg when multiple doses are used . Ketorolac is not recommended for use in pediatric patient age group.…”

Section: Chemical Structure and Pharmacologymentioning

confidence: 99%

See 1 more Smart Citation

Ketorolac Tromethamine – Routes and Clinical Implications

et al. 2014

View full text Add to dashboard Cite

Opioids have long been used for analgesic purposes for a wide range of procedures. However, the binding of these drugs to opiate receptors has created various challenges to the clinician due to unfavorable side effect profiles and the potential for tolerance and abuse. In 1989, ketorolac became an approved nonsteroidal inflammatory drug (NSAID) for injectable use as an analgesic. Over the last 20 years, numerous studies have been conducted involving ketorolac. These studies have provided additional information about various routes of administration and their effect on the efficacy and the side effect profile of ketorolac. Moreover, ketorolac has been compared with several widely used analgesics. This review evaluates both the potential benefits and potential drawbacks of ketorolac generally, and specifically discusses routes of administration, including their advantages and disadvantages when compared to several traditional analgesics in both inpatient and outpatient settings.

show abstract

“…The incidence of adverse events was similar to that of placebo group. Notably, gastrointestinal bleeding was not associated with ketorolac group …”

Section: Intranasal Ketorolacmentioning

confidence: 88%

Section: Chemical Structure and Pharmacologymentioning

confidence: 99%

Ketorolac Tromethamine – Routes and Clinical Implications

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Ketorolac is a mixed cyclooxygenase 1/2‐inhibitor. It is FDA approved for moderate to severe pain in an oral, intravenous, and more recently, a nasal spray (NS) formulation . NS formulations in general offer several advantages to migraine patients; these include faster absorption than oral agents as well as the ability to utilize such medication formulations even when patients are nauseated and cannot or do not want to swallow a tablet or use more invasive parenteral therapies .…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial of Ketorolac vs Sumatripan vs Placebo Nasal Spray (KSPN) for Acute Migraine

et al. 2016

View full text Add to dashboard Cite

Objective To compare the efficacy of ketorolac nasal spray (NS) vs placebo and sumatriptan NS for the acute treatment of migraine. Methods This was a randomized, double-blind, placebo and active-comparator, crossover study. Adult migraineurs were randomized to ketorolac NS 31.5 mg, sumatriptan NS 20 mg, or placebo to treat three moderate to severe migraine attacks and switched treatments with each attack. Patients seeking headache care at a headache center or in response to community advertisement were recruited. Adult participants with episodic migraine who experienced ≥2 migraine attacks per month were eligible for the Ketorolac vs Sumatriptan vs Placebo Nasal Spray migraine study. Participants were randomized to treatment arms by a research pharmacist, in a 1:1:1 ratio using computer-generated lists. The primary outcome was 2-hour pain relief. Secondary outcomes included 2-hour pain freedom and absence of migraine associated symptoms, and 24-hour sustained pain relief and pain freedom. Results Of the 72 randomized participants, 54 (75%) treated at least one attack and 49 (68%) completed all three treatments, for a total of 152 treated migraine attacks. Both ketorolac NS (72.5%, P < .001) and sumatriptan NS (69.4%, P=.001) were more effective than placebo (38.3%) for 2-hour pain relief and 2-hour pain freedom (ketorolac: 43.1%, P=.004; sumatriptan: 36.7%, P=.046; placebo: 18.4%). Ketorolac NS, but not sumatriptan NS, was more effective than placebo in 2-hour absence of nausea. Both ketorolac NS and sumatriptan NS were more effective than placebo for 24-hour sustained pain relief (ketorolac: 49%, P < .001; sumatriptan: 31%, P=.01, placebo: 20%). Only ketorolac NS was superior to placebo for 24-hour (ketorolac: 35.3%, P=.003; sumatriptan: 22.4%, P=.18, placebo: 12.2%) sustained pain freedom. Nasal burning and dysgeusia were the most common adverse effects for active treatments. Conclusions This study supports that ketorolac NS is superior to placebo and that it is non-inferior to sumatriptan NS for the acute abortive treatment of migraine.

show abstract

“…In addition, patients received less opioids (11). He et al (15) in a systematic review in 2012, reported that using intranasal ketorolac spray can significantly reduce postoperative pain of patients. Yet, no comprehensive study is available on the application of intravenous and intranasal ketorolac in patients undergoing maxillofacial fracture surgeries.…”

Section: Introductionmentioning

confidence: 99%

Comparison of analgesic effects of intravenous and intranasal ketorolac in patients with mandibular fracture-A Randomized Clinical Trial

et al. 2019

View full text Add to dashboard Cite

BackgroundSimilarity of pharmacokinetics of intranasal ketorolac to the intravenous form and other advantages have promoted its application. This study compared the analgesic effects of intravenous and intranasal ketorolac in patients undergoing mandibular fracture surgery.Material and MethodsIn this clinical trial study, Sixty-four patients with unilateral mandibular fracture were divided randomly into two groups. In group 1, 30 mg of intravenous (IV) ketorolac was injected every 8 hours and in group 2, intranasal (IN) ketorolac spray was used as a 100-µL puff in each nostril (31.5 mg) every 6 hours. After each patient regained consciousness, pain intensity was measured based on visual analogue scale for 48 hours. Finally, the total dose of the opioid analgesic agent (pethidine) and the time for the first request for an analgesic agent were recorded for each patient, and their means were compared in each group with proper statistical tests.ResultsMean pain intensity of patients at baseline was significantly higher than that at other intervals and then, it decreased significantly (P<0.001). Furthermore, 2, 4, 6 and 8 hours after surgery, mean pain intensity in the IN group was significantly lower than that in the IV group (P<0.05). In the IN group, dose of antinociceptive medicine was slightly higher and the time to request it was shorter than the other group, but it was not statistically significant (P >0.05).ConclusionsApplication of intranasal ketorolac spray decreased pain after mandibular fracture surgery, especially at 8-hour interval after surgery, decreasing the need for opioids. Key words:Ketorolac, intranasal, intravenous, mandibular fracture.

show abstract

A review of intranasal ketorolac tromethamine for the short-term management of moderate to moderately severe pain that requires analgesia at the opioid level

Abstract: Based on the clinical trials reviewed, IN ketorolac was associated with significant pain reduction in patients with various post-operative procedures, with good tolerability.

Cited by 15 publications

References 17 publications

Ketorolac Tromethamine – Routes and Clinical Implications

Ketorolac Tromethamine – Routes and Clinical Implications

A Randomized Trial of Ketorolac vs Sumatripan vs Placebo Nasal Spray (KSPN) for Acute Migraine

Comparison of analgesic effects of intravenous and intranasal ketorolac in patients with mandibular fracture-A Randomized Clinical Trial

Contact Info

Product

Resources

About