Ketorolac tromethamine (0.4% w/v) is a potent, non-narcotic, non-steroidal anti-inflammatory drug (NSAID) formulated for ophthalmic use. It is a racemic mixture of [-]S- and [+]R-enantiomers, with the S-form being pharmacologically active. It provides rapid and effective relief from ocular inflammation and pain by inhibiting prostaglandin synthesis. In the Indian context, it is a widely prescribed first-line agent for post-operative ocular inflammation following cataract surgery and other ophthalmic procedures.
Adult: For post-operative inflammation: One drop (0.4% w/v) to the affected eye(s) four times daily beginning 24 hours after surgery and continuing through the first 2 weeks of the post-operative period. For allergic conjunctivitis: One drop four times daily as needed.
Note: 1. Wash hands before use. 2. Tilt head back. 3. Gently pull lower eyelid down to form a pouch. 4. Hold dropper above eye and instill one drop. 5. Close eyes gently for 1-2 minutes. Apply gentle pressure to the inner corner of the eye (nasolacrimal occlusion) for 1 minute to reduce systemic absorption. 6. Do not touch dropper tip to any surface to avoid contamination. 7. Wait at least 5 minutes before instilling any other eye drops.
Ketorolac is a non-selective, reversible inhibitor of both cyclooxygenase (COX-1 and COX-2) enzymes. This inhibition prevents the conversion of arachidonic acid to prostaglandin precursors (prostaglandin G2 and H2), thereby reducing the synthesis of prostaglandins (PGs), thromboxane A2, and prostacyclin. In the eye, prostaglandins are key mediators of inflammation, pain, and miosis. By blocking their production, ketorolac reduces ocular inflammation, pain, and helps maintain mydriasis during surgery.
Pregnancy: Pregnancy Category C (US FDA). Animal studies show fetal abnormalities. Adequate and well-controlled studies in pregnant women are lacking. Should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Avoid use, especially during the third trimester (risk of premature closure of ductus arteriosus).
Driving: May cause transient blurred vision immediately after instillation. Patients should not drive or use machinery until vision clears.
| Oral Anticoagulants (Warfarin, Acenocoumarol) | Potential increased risk of ocular and systemic bleeding due to additive antiplatelet effect. | Major |
| Other Systemic NSAIDs (e.g., Ibuprofen, Diclofenac, Aspirin) | Additive risk of gastrointestinal ulceration/bleeding and renal toxicity. | Major |
| Corticosteroids (Oral or Topical Ophthalmic) | Increased risk of corneal perforation, especially in dry eye or autoimmune conditions. Also additive increased IOP risk with steroids. | Major |
| ACE Inhibitors/Angiotensin II Receptor Blockers (ARBs) | May diminish antihypertensive effect and worsen renal function. | Moderate |
| Diuretics (Furosemide, Thiazides) | Risk of reduced diuretic and antihypertensive efficacy; potential for nephrotoxicity. | Moderate |
| Methotrexate | May decrease methotrexate clearance, increasing toxicity risk. | Major |
| Lithium | May increase lithium plasma levels and risk of toxicity. | Major |
| Cyclosporine | Increased risk of nephrotoxicity. | Major |
| Topical Ophthalmic Cholinergic Agents (e.g., Pilocarpine) | Theoretical interference with miosis. Clinical significance is low. | Minor |