Drug/Small Molecule:
ketorolac

2D structure

Overview

Generic Names: Ketoralac; Ketorolac Tromethamine; Ketorolaco [Spanish]; Ketorolacum [Latin]
Trade Names: Acular; Acular LS; Acular Preservative Free; Toradol
PharmGKB Accession Id: PA450150

Description

A pyrrolizine carboxylic acid derivative structurally related to indomethacin. It is an NSAID and is used principally for its analgesic activity. (From Martindale The Extra Pharmacopoeia, 31st ed) (source: Drug Bank)

Indication

For the short-term (~5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting. (source: Drug Bank)

ATC Therapeutic Categories

  • M01AB:Acetic acid derivatives and related substances
  • S01BC:Antiinflammatory agents, non-steroids

Pharmacology, Interactions, and Contraindications

Mechanism Of Action

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) chemically related to indomethacin and tolmetin. Ketorolac tromethamine is a racemic mixture of []S and [+]R-enantiomeric forms, with the S-form having analgesic activity. Its antiinflammatory effects are believed to be due to inhibition of both cylooxygenase-1 (COX-1) and cylooxygenase-2 (COX-2) which leads to the inhibition of prostaglandin synthesis leading to decreased formation of precursors of prostaglandins and thromboxanes from arachidonic acid. The resultant reduction in prostaglandin synthesis and activity may be at least partially responsible for many of the adverse, as well as the therapeutic, effects of these medications. Analgesia is probably produced via a peripheral action in which blockade of pain impulse generation results from decreased prostaglandin activity. However, inhibition of the synthesis or actions of other substances that sensitize pain receptors to mechanical or chemical stimulation may also contribute to the analgesic effect. In terms of the ophthalmic applications of ketorolac - ocular administration of ketorolac reduces prostaglandin E2 levels in aqueous humor, secondary to inhibition of prostaglandin biosynthesis. (source: Drug Bank)

Pharmacology

Ketorolac, an antiinflammatory agent with analgesic and antipyretic properties, is used to treat osteoarthritis and control acute pain. It is a peripherally acting analgesic. The biological activity of ketorolac tromethamine is associated with the S-form. Ketorolac tromethamine possesses no sedative or anxiolytic properties. (source: Drug Bank)

Food Interactions

Take with food to reduce GI irritation (source: Drug Bank)

Absorption, Distribution, Metabolism, Elimination & Toxicity

Biotransformation

Primarily hepatic. Less than 50% of a dose is metabolized. The major metabolites are a glucuronide conjugate, which may also be formed in the kidney, and p-hydroxy ketorolac. Neither metabolite has significant analgesic activity. (source: Drug Bank)

Protein Binding

99% (source: Drug Bank)

Absorption

Rapidly and completely absorbed after oral administration (source: Drug Bank)

Toxicity

LD<sub>50</sub> = 189 mg/kg (rat, oral). (source: Drug Bank)

Isomeric SMILES Code:

c1ccc(cc1)C(=O)c2ccc3n2CCC3C(=O)O (source: Drug Bank)

The following genes are in curated knowledge about this drug.

  Gene Relationship Evidence
Phenotype data available No genotype data Literature annotations available Not annotated
PDE4D
  •   
  • PD
  •   
  • FA
  •   
Publications

A list of non-curated publications that mention this drug along with other genes is available.

Drug Targets

Gene Description
PTGS1 Uncurated Annotation (source: Drug Bank)
PTGS2 Uncurated Annotation (source: Drug Bank)

PharmGKB Curated Pathways

A list of non-curated publications that mention this drug along with other drugs is available.

Drug Interactions

Drug Description
acenocoumarol Uncurated Annotation The NSAID increases the anticoagulant effect (source: Drug Bank)
alendronate Uncurated Annotation Increased risk of gasrtic toxicity (source: Drug Bank)
aspirin Uncurated Annotation ASA increases toxicity of ketorolac (source: Drug Bank)
dicumarol Uncurated Annotation The NSAID increases the anticoagulant effect (source: Drug Bank)
lithium Uncurated Annotation The NSAID increases serum levels of lithium (source: Drug Bank)
methotrexate Uncurated Annotation The NSAID increases the effect and toxicity of methotrexate (source: Drug Bank)
probenecid Uncurated Annotation Probenecid increases toxicity of ketorolac (source: Drug Bank)
warfarin Uncurated Annotation The NSAID increases the anticoagulant effect (source: Drug Bank)

Curated Information

The following diseases are in curated knowledge about this drug.

  Disease Relationship Evidence
No phenotype data No genotype data Literature annotations available Not annotated
Pain
  •   
  • PD
  •   
  • FA
  •   
Publications

Non-Curated Information

A list of non-curated publications that mention this drug along with other diseases is available.

LinkOuts

Web Resource:
Wikipedia
DrugBank:
DB00465
KEGG Compound ID:
C07062
PubChem Compound ID:
3826
PubChem Substance ID:
9274

Common Searches

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Non-Curated Publications

A list of non-curated publications that mention this drug is available.

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