Generic name: acular
Availability: Prescription only
Pregnancy & Lactation: Risk data available
Brand names: Ketorolac ophthalmic, Acular, Acular ls, Acuvail
What is Ketorolac (eent) (monograph)?
Introduction
Prototypical NSAIA; a pyrrolizine carboxylic acid derivative.
Uses for Ketorolac (EENT)
Conjunctivitis
Temporary relief of ocular itching due to seasonal allergic (hay fever, pollinosis) conjunctivitis.
Postoperative Ocular Inflammation
Management of postoperative inflammation associated with cataract extraction.
Postoperative Ocular Pain
Reduction of ocular pain and burning/stinging following corneal refractive surgery and photorefractive keratectomy (PRK).
Ketorolac tromethamine 0.5% preservative-free ophthalmic solution is used for the reduction of ocular pain and photophobia following incisional refractive surgery.
Cystoid Macular Edema
Treatment, with or without concomitant topical corticosteroid therapy, to prevent or relieve postoperative cystoid macular edema associated with cataract extraction† [off-label].
Has been used for the active treatment of chronic aphakic or pseudophakic cystoid macular edema† [off-label].
Inhibition of Intraoperative Miosis
Has been used prophylactically before ocular surgery to prevent or reduce intraoperative miosis† [off-label].
Related/similar drugs
diclofenac ophthalmic, dexamethasone ophthalmic, ketorolac ophthalmic, prednisolone ophthalmic, Pataday, olopatadine ophthalmic, LotemaxKetorolac (EENT) Dosage and Administration
Administration
Ophthalmic Administration
Apply topically to the eye as an ophthalmic solution.
Avoid contamination of the solution container.
Do not administer while wearing contact lenses.
Preservative-free solution is for single use only in one or both eyes; use immediately after opening and discard any unused portion immediately after administration.
Has been safely administered with other ophthalmic medications (e.g., antibiotics, β-blockers, carbonic anhydrase inhibitors, cycloplegics, mydriatics).
Dosage
Available as ketorolac tromethamine; dosage expressed in terms of the salt.
Pediatric Patients
Conjunctivitis
Ophthalmic
Children ≥3 years of age: 1 drop (250 mg) of a 0.5% solution in the affected eye(s) 4 times daily.
Postoperative Ocular Inflammation
Ophthalmic
Children ≥3 years of age: 1 drop (250 mcg) of a 0.5% solution in the eye(s) undergoing surgery 4 times daily beginning 24 hours after surgery and typically continuing for 2 weeks after surgery.
Postoperative Ocular Pain
Ophthalmic
Children ≥3 years of age undergoing ocular incisional refractive surgery: 1 drop (250 mcg) of a 0.5% preservative-free solution 4 times daily in the eye(s) that underwent surgery as needed for up to 3 days after surgery.
Children ≥3 years of age undergoing corneal refractive surgery: 1 drop (200 mcg) of a 0.4% solution 4 times daily in the eye(s) that underwent surgery as needed for up to 4 days after surgery.
Adults
Conjunctivitis
Ophthalmic
1 drop (250 mg) of a 0.5% solution in the affected eye(s) 4 times daily.
Postoperative Ocular Inflammation
Ophthalmic
1 drop (250 mcg) of a 0.5% solution in the eye(s) undergoing surgery 4 times daily beginning 24 hours after surgery and typically continuing for 2 weeks after surgery.
Postoperative Ocular Pain
Ophthalmic
Patients undergoing ocular incisional refractive surgery: 1 drop (250 mcg) of a 0.5% preservative-free solution 4 times daily in the eye(s) that underwent surgery as needed for up to 3 days after surgery.
Patients undergoing corneal refractive surgery: 1 drop (200 mcg) of a 0.4% solution 4 times daily in the eye(s) that underwent surgery as needed for up to 4 days after surgery.
Cystoid Macular Edema
Postoperative Cystoid Macular Edema† [off-label]
Ophthalmic1–2 drops (250–500 mcg) of a 0.5% solution in the eye(s) undergoing surgery every 6–8 hours beginning 24 hours prior to surgery and continuing for 3–4 weeks after surgery.
Chronic Aphakic or Pseudophakic Cystoid Macular Edema† [off-label]
Ophthalmic1–2 drops (250–500 mcg) of a 0.5% solution in the affected eye(s) 4 times daily for 2–3 months.
Warnings
Contraindications
Known hypersensitivity to ketorolac tromethamine or any ingredient in the formulation.
Warnings/Precautions
Warnings
Hematologic Effects
May inhibit platelet aggregation and prolong bleeding time.
May increase bleeding (e.g., hyphemas) of ocular tissues in patients undergoing ocular surgery.
Use with caution in patients with underlying bleeding tendencies or in those receiving drugs known to prolong bleeding time.
Sensitivity Reactions
Cross-sensitivity
Possible cross-sensitivity with aspirin, phenylacetic acid derivatives, and other NSAIAs. Use with caution in patients with history of hypersensitivity to these drugs.
General Precautions
Wound Healing Complications
Possible slow or delayed wound healing; may be potentiated with concomitant adminsitration of topical NSAIAs or topical corticosteroids. (See Specific Drugs under Interactions.)
Ocular Effects
Use may result in keratitis. In susceptible patients, continued use may result in epithelial breakdown, corneal thinning, erosion, ulceration, or perforation, which may be sight-threatening.
If manifestations of corneal epithelial breakdown occur, discontinue immediately and closely monitor corneal health.
Increased risk of sight-threatening, adverse corneal effects in patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (e.g., dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time; use with caution in such patients.
Use >24 hours prior to surgery or >14 days postoperatively may precipitate or exacerbate adverse corneal effects.
Specific Populations
Pregnancy
Category C. Avoid use in the third trimester because of possible premature closure of the ductus arteriosus.
Lactation
Distributed into milk after systemic administration. Caution if used in nursing women.
Pediatric Use
Safety and efficacy not established in children <3 years of age.
Geriatric Use
No substantial differences in safety and efficacy relative to younger adults.
Common Adverse Effects
Ocular stinging and burning.
How should I use Ketorolac (eent) (monograph)
Administration
Ophthalmic Administration
Apply topically to the eye as an ophthalmic solution.
Avoid contamination of the solution container.
Do not administer while wearing contact lenses.
Preservative-free solution is for single use only in one or both eyes; use immediately after opening and discard any unused portion immediately after administration.
Has been safely administered with other ophthalmic medications (e.g., antibiotics, β-blockers, carbonic anhydrase inhibitors, cycloplegics, mydriatics).
Dosage
Available as ketorolac tromethamine; dosage expressed in terms of the salt.
Pediatric Patients
Conjunctivitis
Ophthalmic
Children ≥3 years of age: 1 drop (250 mg) of a 0.5% solution in the affected eye(s) 4 times daily.
Postoperative Ocular Inflammation
Ophthalmic
Children ≥3 years of age: 1 drop (250 mcg) of a 0.5% solution in the eye(s) undergoing surgery 4 times daily beginning 24 hours after surgery and typically continuing for 2 weeks after surgery.
Postoperative Ocular Pain
Ophthalmic
Children ≥3 years of age undergoing ocular incisional refractive surgery: 1 drop (250 mcg) of a 0.5% preservative-free solution 4 times daily in the eye(s) that underwent surgery as needed for up to 3 days after surgery.
Children ≥3 years of age undergoing corneal refractive surgery: 1 drop (200 mcg) of a 0.4% solution 4 times daily in the eye(s) that underwent surgery as needed for up to 4 days after surgery.
Adults
Conjunctivitis
Ophthalmic
1 drop (250 mg) of a 0.5% solution in the affected eye(s) 4 times daily.
Postoperative Ocular Inflammation
Ophthalmic
1 drop (250 mcg) of a 0.5% solution in the eye(s) undergoing surgery 4 times daily beginning 24 hours after surgery and typically continuing for 2 weeks after surgery.
Postoperative Ocular Pain
Ophthalmic
Patients undergoing ocular incisional refractive surgery: 1 drop (250 mcg) of a 0.5% preservative-free solution 4 times daily in the eye(s) that underwent surgery as needed for up to 3 days after surgery.
Patients undergoing corneal refractive surgery: 1 drop (200 mcg) of a 0.4% solution 4 times daily in the eye(s) that underwent surgery as needed for up to 4 days after surgery.
Cystoid Macular Edema
Postoperative Cystoid Macular Edema† [off-label]
Ophthalmic1–2 drops (250–500 mcg) of a 0.5% solution in the eye(s) undergoing surgery every 6–8 hours beginning 24 hours prior to surgery and continuing for 3–4 weeks after surgery.
Chronic Aphakic or Pseudophakic Cystoid Macular Edema† [off-label]
Ophthalmic1–2 drops (250–500 mcg) of a 0.5% solution in the affected eye(s) 4 times daily for 2–3 months.
What other drugs will affect Ketorolac (eent) (monograph)?
No formal drug interaction studies to date.
Specific Drugs
Drug |
Interaction |
Comments |
---|---|---|
Corticosteroids, ophthalmic |
Possible additive effects on delaying wound healing Additive ocular anti-inflammatory activity |
Concomitant use may increase the potential for wound healing complications Potential for additive effects used to therapeutic advantage |