Ketorolac Accord (Ketorolac Trometamol)

Ketorolac Accord, an NSAID analgesic, is used for conditions involving acute pain and postoperative inflammation.

• Moderate to severe acute pain: provides rapid analgesia for non‑cancer pain lasting up to five days.
• Post‑operative pain: reduces pain and inflammation following surgical procedures.
• Acute musculoskeletal pain: alleviates pain and swelling associated with injuries or strain.

• Ketorolac Trometamol exerts its effect by non‑selectively inhibiting cyclooxygenase‑1 (COX‑1) and cyclooxygenase‑2 (COX‑2) enzymes, which blocks the conversion of arachidonic acid to prostaglandins. The reduction in prostaglandin synthesis diminishes peripheral sensitisation of nociceptors, leading to analgesic, anti‑inflammatory and antipyretic actions. By decreasing prostaglandin‑mediated vasodilation, the drug can also affect renal blood flow and platelet aggregation, contributing to its safety profile.

Ketorolac Accord may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea: mild gastrointestinal upset.
• Headache: transient headache.
• Dizziness: light‑headed sensation.
• Injection site pain: discomfort at the site of administration.
• Elevated blood pressure: modest increase in systolic/diastolic pressure.
• Edema: mild peripheral swelling.

Serious or Rare Side Effects

• Gastrointestinal bleeding: ulceration or hemorrhage in the stomach or intestines, requiring medical attention.
• Renal impairment: reduced kidney function or acute kidney injury, potentially serious.
• Severe hypersensitivity: anaphylaxis or skin reactions such as Stevens‑Johnson syndrome.
• Cardiovascular thrombotic events: increased risk of myocardial infarction or stroke.
• Liver enzyme elevation: significant rise in ALT/AST indicating hepatic stress.

When using Ketorolac Accord, clinicians should observe several precautionary measures to minimise risk.

• Assess renal function: avoid use in patients with severe renal impairment.
• Evaluate bleeding risk: contraindicated in active gastrointestinal ulceration or coagulopathy.
• Monitor blood pressure: use cautiously in hypertensive patients.
• Limit duration: restrict therapy to the shortest possible period, generally not exceeding five days.
• Avoid concurrent NSAIDs: increase risk of adverse events when combined with other NSAIDs or aspirin.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Ketorolac Accord can interact with several medicines, affecting efficacy or safety.

Major Interactions (Avoid)

• Anticoagulants (e.g., warfarin): heightened risk of serious bleeding.
• Selective COX‑2 inhibitors: additive renal and cardiovascular toxicity.
• ACE inhibitors or ARBs: may reduce renal perfusion leading to kidney injury.

Moderate Interactions (Monitor Closely)

• Diuretics: may exacerbate renal function decline.
• Lithium: NSAIDs can increase lithium serum levels.
• Methotrexate: reduced clearance may cause toxicity.
• SSRIs or SNRIs: increased bleeding tendency.