Zeropain 60mg/2ml Injection

✔️ Indications

1. Acute pain management (short-term use only, typically 5 days or less).
2. Post-surgical pain (excluding prophylactic use before surgery).
3. Conditions requiring a non-opioid alternative for moderate to severe pain.

✔️ Side Effects

Common:

• Gastrointestinal: Nausea, vomiting, GI bleeding, melena, peptic ulcers, pancreatitis.
• Neurological: Anxiety, headache, drowsiness.
• Cardiovascular: Bradycardia, hypertension, palpitation, chest pain.
• Other: Infertility in females, pulmonary edema.

Rare but Severe:

• Anaphylactic reactions.
• Hepatotoxicity or renal toxicity.

✔️ Ketorolac Tromethamine Injection: Detailed Dosage and Administration

• Ketorolac injection is used for the management of moderately severe acute pain requiring opioid-level analgesia, often in a postoperative setting.
• Administered as IV or IM for short-term use (≤5 days) due to potential side effects.

✔️ Single-Dose Treatment

IM Dosing (Adults):

1. Adults <65 years:
   • Dose: 60 mg IM as a single dose.
2. Adults ≥65 years, renally impaired, or weighing <50 kg:
   • Dose: 30 mg IM as a single dose.

IV Dosing (Adults):

1. Adults <65 years:
   • Dose: 30 mg IV as a single dose.
2. Adults ≥65 years, renally impaired, or weighing <50 kg:
   • Dose: 15 mg IV as a single dose.

✔️ IV or IM Dosing (Children 2–16 years):

1. IM Dosing:
   • Dose: 1 mg/kg IM, up to a maximum of 30 mg.
2. IV Dosing:
   • Dose: 0.5 mg/kg IV, up to a maximum of 15 mg.

✔️ Multiple-Dose Treatment Adults <65 years:

• Dose: 30 mg every 6 hours (IV or IM).
• Maximum daily dose: 120 mg.

✔️ Adults ≥65 years, renally impaired, or weighing <50 kg:

• Dose: 15 mg every 6 hours (IV or IM).
• Maximum daily dose: 60 mg.

✔️ Conversion from Parenteral to Oral Therapy

1. Oral Ketorolac tablets can replace injections when feasible.
2. Maximum total daily dose (oral + parenteral):
   • Adults <65 years: 120 mg on the day of transition.
   • Adults ≥65 years or renally impaired: 60 mg on the day of transition.
3. Subsequent oral dosing:
   • Max daily dose: 40 mg orally.
4. Duration of combined treatment (parenteral + oral):
   • Should not exceed 5 days.

✔️ Administration Guidelines

1. IV Bolus:
   • Administer over no less than 15 seconds.
2. IM Injection:
   • Inject slowly and deeply into the muscle.

✔️ Onset, Peak Effect, and Duration

• Onset: Begins within 30 minutes after IV or IM administration.
• Peak Effect: Achieved in 1–2 hours.
• Duration: Last for 4–6 hours.

✔️ Important Warnings

1. Do not increase the dose or frequency for breakthrough pain.
2. Ensure total treatment duration (IV, IM, and oral combined) does not exceed 5 days to minimize risks of adverse effects.
3. Monitor patients for potential GI bleeding, renal impairment, and hypersensitivity reactions.

✔️ Mechanism of Action:

Ketorolac inhibits the COX enzyme system, which reduces prostaglandin production. This results in pain relief and reduced inflammation, although anti-inflammatory effects are less pronounced.

✔️ Drug Interactions

1. Other NSAIDs/Aspirin: Increases risk of side effects (e.g., GI bleeding).
2. Anticoagulants: Enhances bleeding risk.
3. ACE Inhibitors/Beta Blockers: May reduce anti-hypertensive effects or impair kidney function.
4. Methotrexate: Increases risk of toxicity.

✔️ Contraindications

• Hypersensitivity to Ketorolac or any NSAID.
• Active or suspected peptic ulcers or gastrointestinal bleeding.
• Patients with asthma, renal impairment, or liver dysfunction.
• Pregnancy (especially third trimester) and lactation.
• Not to be used as a prophylactic analgesic before surgery.

✔️ Pregnancy & Lactation

• FDA Pregnancy Category C: Avoid during pregnancy unless benefits outweigh risks. Contraindicated in the third trimester due to risk of premature ductus arteriosus closure.
• Avoid during lactation, as Ketorolac passes into breast milk.

✔️ Precautions & Warnings

1. Elderly patients (>65 years): Increased risk of GI and renal side effects; requires caution.
2. Liver & Kidney Dysfunction: Monitor liver enzymes and renal function.
3. Asthma: Risk of NSAID-exacerbated respiratory issues.
4. Ophthalmic Use: Discontinue immediately if corneal epithelial breakdown occurs; avoid wearing contact lenses during treatment.

✔️ Storage

• Store in a dry, cool place (<30°C), away from light and moisture.
• Keep out of reach of children.