31.5mg every 6-8 hours (1 spray of 15.75mg each nostril) 126mg max daily dose
if >64, renally impaired, <110lbs then 15.75mg every 6-8 hours 63mg max daily dose
- Lacks side effects of opioids and no risk of abuse
- Only non-opioid alternative for treatment of moderate to severe pain
Common side effects
- Nasal discomfort
- Nasal stinging
- Increased lacrimation
- Throat irritation
Cautions
- Can not use with other ketorolac formulations, not over 5 days of usage
- No allergy to aspirin, NSAID, ketorolac, EDTA
- Anti-epileptic drugs (phenytoin, carbamazepine) may cuase seizure
- Cyclosporine
- Lithium BIG NO-NO
- Methotrexate BIG NO-NO
- Psychoactive drugs cause hallucinations Prozac, Navane, Niravam
- Caution with serious liver disease
- Only use with caution in first 30 weeks pregnancy NO-NO after 30
- All NSAIDs can cause serious skin reactions, discontinue immediately if skin reaction
GI Risk
- Contraindicated in those with peptic ulcers
- Recent GI bleed or perf
- History of either of the above
- Increase risk GI bleeding if on warfarin (anti-coagulants), or SSRI
- Those taking other NSAIDs
Bleeding Risk
- CV bleeding or high risk CV incident
- Hemorrhagic diathesis
- High risk for bleeding for any reason
- Those taking Aspirin
Renal Risk
- Contraindicated in those with advanced renal impairment
- Those taking ACE inhibitors/angiotensin II receptor antagonists