Ketorolac Questions

[smoothie567]

Hi everyone, I have some questions about ketorolac:

1) I know the maximum duration of treatment from IV to PO is 5 days. If a patient received 2 days of IV treatment in the hospital, was discharged from the hospital, and didn't pick up the oral ketorolac tablets at the retail pharmacy 3 days after the discharge, can he still take the 3 days worth of oral ketorolac at that point?

2) Is there a specific time frame you have to wait after a 5 days treatment to do another 5 days treatment?

I really appreciate any help. Thank you so much!

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[mustang sally]

1) I don't see why he couldn't take it, though I would wonder why he would need to if he didn't pick it up right away.

2) As far as I know, there is no defined time period to date.

 

[Ackj]

For #1, I haven't been able to find anything concrete. All of the dosing recommendations state "oral, as a continuation to parenteral" so if you're off of the IV for a few days, I don't really think that qualifies as the continuation.

I remember searching for info a while ago because we had someone who got IV ketorolac for migraines, and just wanted to have the tablets at home to avoid going in whenever they had an episode. Prescriber didn't know about the drug's 5 day limit either, so they went with a triptan instead.

 

[ACE_Dx]

Do you guys order/recommend a PPI if they are getting > 75 mg IV daily of ketorolac for prophylaxis?

 

[Carboxide]

Do you guys order/recommend a PPI if they are getting > 75 mg IV daily of ketorolac for prophylaxis?

No. I am not aware of evidence supporting that. If you have it, please share.

 

[MSSimpson12]

Well, if no one is able to find information on it directly we can make some decisions based on the pharmacokinetic profile.

Ketone place has about a 6 hour half-life, unless your patient is elderly which increases the time 50% or has significant renal damage which could extend the half-life upwards of 19 hours. If, to your knowledge, the patient is renally stable and we not elderly, conservatively ~30 hours to drug free. I believe the platelet inhibition is reversible with ketorolac as well. Renally and bleed wise he's probably in the clear.

If the patient is overall healthy 3 more days of ketorolac is not likely to be detrimental, but after waiting 3 days to fill he probably doesn't really need it. I'd be fine with it as long as he doesn't pass the 20 doses mark.