Ketorolac Tromethamine (Ophthalmic)
Generic Name: Ketorolac Tromethamine (Ophthalmic)
Therapeutic Class: Ophthalmic Non-Steroidal Anti-inflammatory Drug (NSAID)
Indications
Ketorolac Tromethamine ophthalmic solution is primarily indicated for the treatment of ocular inflammation and pain:
- Postoperative Inflammation: Treatment of inflammation following cataract surgery.
- Ocular Pain: Reduction of ocular pain and burning/stinging following corneal refractive surgery.
- Seasonal Allergic Conjunctivitis: Relief of ocular itching associated with seasonal allergic conjunctivitis.
- Cystoid Macular Edema (CME): Used off-label for the prevention and treatment of CME after cataract extraction.
Dosage & Administration
Strict adherence to the prescribed frequency is necessary to manage inflammation effectively.
- Post-Cataract Surgery: One drop applied to the affected eye(s) 4 times daily, starting 24 hours after surgery and continuing for 2 weeks.
- Refractive Surgery Pain: One drop applied to the affected eye(s) 4 times daily for up to 4 days.
- Allergic Conjunctivitis: One drop 4 times daily for the relief of itching.
- Administration: Wash hands before use. Tilt the head back, pull the lower eyelid down, and instill the drop. Do not touch the dropper tip to the eye or any surface to prevent contamination.
- Contact Lenses: Usually, lenses should be removed before instillation and may be reinserted after 15 minutes, unless the eye is inflamed/red.
Description & Pharmacokinetics
Ketorolac Tromethamine is a member of the pyrrolo-pyrrole group of non-steroidal anti-inflammatory drugs.
Mechanism of Action: It acts by **inhibiting the cyclooxygenase (COX) enzyme system**, which is responsible for the biosynthesis of prostaglandins. In the eye, prostaglandins serve as mediators of certain types of intraocular inflammation. By inhibiting prostaglandin synthesis, Ketorolac reduces miosis (pupil constriction), vasodilation, increased vascular permeability, and the pain response associated with ocular trauma or surgery.
Pharmacokinetics:
Mechanism of Action: It acts by **inhibiting the cyclooxygenase (COX) enzyme system**, which is responsible for the biosynthesis of prostaglandins. In the eye, prostaglandins serve as mediators of certain types of intraocular inflammation. By inhibiting prostaglandin synthesis, Ketorolac reduces miosis (pupil constriction), vasodilation, increased vascular permeability, and the pain response associated with ocular trauma or surgery.
Pharmacokinetics:
- Absorption: Systemic absorption is minimal following ocular administration.
- Distribution: Primarily acts locally within the ocular tissues (cornea, iris, and ciliary body).
- Onset: Rapid local effect on pain and itching.
- Excretion: Any small amount absorbed systemically is excreted primarily via the urine.
Side Effects
- Common: Transient stinging, burning, and blurred vision immediately after instillation.
- Ocular: Ocular irritation, corneal edema, and allergic reactions (itching, redness).
- Corneal Risks: Prolonged use may result in corneal epithelial breakdown, corneal thinning, or corneal ulceration (keratopathy).
- Systemic (Rare): Headache or hypersensitivity reactions.
Extra Important Information: Usage Insights
- Delayed Healing: Like all topical NSAIDs, Ketorolac may slow or delay the healing process of the cornea.
- Cross-Sensitivity: Use with caution in individuals who have previously shown sensitivities to Aspirin or other NSAIDs.
- Steroid Synergy: Often used in conjunction with topical corticosteroids to provide a synergistic effect on inflammation while reducing steroid-related side effects.
- Bleeding Risk: May increase the risk of ocular tissue bleeding (including hyphemas) in patients with known bleeding tendencies or those on anticoagulants.
Pregnancy & Lactation
- Pregnancy: Category C. Use only if clearly needed. Like other NSAIDs, it should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus.
- Lactation: Caution should be exercised when administered to nursing women, though systemic levels are expected to be extremely low.
Storage
Store at room temperature (15°C to 25°C). Protect from light. Keep the bottle tightly closed when not in use.
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