Dolomin

Dolomine, which contains the active substance ketorolac, is a non-steroidal anti-inflammatory drug (NSAID) widely used for the short-term management of moderate to severe pain that typically requires opioid-level analgesics. Ketorolac is effective in situations of post-operative pain, trauma, dental pain, and to reduce inflammation and pain in a variety of conditions.

Ketorolac works by blocking the production of certain chemicals in the body that cause inflammation and pain. This makes it one of the more powerful NSAIDs that can provide significant pain relief.

Ketorolac is used primarily to relieve short-term acute pain that may be severe enough to require an alternative to opioid analgesics, especially in the postoperative period.

Indications Dolomina

1. Moderate to severe pain syndromes: Dolomin is often used to relieve pain of various origins, including pain after surgery, injury, osteoarthritis, rheumatoid arthritis and other conditions.
2. Postoperative pain relief: The drug can be effective in relieving pain after various types of surgery.
3. Menstrual pain: Dolomin can be used to relieve pain associated with menstruation.
4. Toothache: The drug may help in reducing toothache.
5. Other pain conditions: Ketorolac can also be used to relieve pain in acute and chronic diseases of various origins.

Release form

1. Oral tablets: This is the most common form of ketorolac for outpatient use. Tablets are convenient to use and provide a fairly rapid onset of action, making them suitable for acute pain management.
2. Injection solution: Ketorolac in injection form is used for faster and more effective pain relief, often used in hospital settings, especially in the postoperative period or when immediate relief of severe pain is needed.

Pharmacodynamics

1. Cyclooxygenase (COX) inhibition:

   • Ketorolac inhibits the action of the enzyme cyclooxygenase (COX). This enzyme is involved in the synthesis of prostaglandins from arachidonic acid.
   • Prostaglandins play a key role in the inflammatory process, causing vasodilation, increased vascular permeability and sensitivity to pain.
   • By inhibiting COX, ketorolac reduces the production of prostaglandins, resulting in reduced inflammation, pain and fever.

2. Analgesic effect:

   • Ketorolac has a powerful analgesic effect. It can reduce or eliminate pain of various origins: postoperative pain, migraine, toothache, muscle pain and other types of pain.
   • This analgesic effect is due to the suppression of inflammation and the prevention of the transmission of pain impulses in the nervous system.

3. Anti-inflammatory action:

   • As an NSAID, ketorolac also has an anti-inflammatory effect, although it may be less pronounced than other members of this class of drugs, such as ibuprofen or diclofenac.

4. Antipyretic action:

   • Ketorolac has the ability to reduce body temperature in individuals with fever.

Pharmacokinetics

1. Absorption: Ketorolac is generally well absorbed after oral and intravenous administration. After tablet administration, peak plasma concentrations are reached within 1-2 hours.
2. Distribution: It has a medium volume of distribution, which means it can spread quickly throughout tissues and organs. The drug penetrates the blood-brain barrier well.
3. Plasma protein binding: Ketorolac binds to plasma proteins in small amounts (about 99%).
4. Metabolism: It is metabolized in the liver to form several metabolites. One of them, transformed ketorolac, has less pharmacological activity than the drug itself.
5. Elimination: Ketorolac is eliminated primarily by the kidneys as metabolites and some unchanged drug. Its half-life is approximately 5-6 hours in young healthy patients and may be prolonged in elderly patients or those with renal impairment.
6. Effect on other drugs: Ketorolac may interact with other drugs, in particular with anticoagulants, antihypertensive agents, diuretics and some antibiotics. This interaction may lead to increased effects or adverse reactions.
7. Pharmacokinetics in different population groups: The half-life of ketorolac may be increased in elderly patients, in patients with poor renal function or in those who are postoperative.

Dosing and administration

Oral administration (tablets):

• Adults: The usual starting dose is 10 mg every 4 to 6 hours as needed to control pain. Do not exceed the maximum daily dose of 40 mg.
• Elderly patients: Dose reduction may be required due to increased risk of side effects.
• The tablets should be taken with water, and can be taken with food or milk to reduce stomach irritation.

Injections:

• Adults: Initial dose may be given intramuscularly or intravenously at a dose of 10 mg, followed by 10-30 mg every 4-6 hours as needed. The maximum dose should not exceed 120 mg per day for intramuscular administration or 60 mg per day for intravenous administration.
• Elderly patients, patients with low body weight or impaired renal function: The initial dose should be reduced.

General instructions:

• The duration of use of ketorolac should generally not exceed 5 days due to the increased risk of gastrointestinal and other side effects.
• Treatment should always be started at the lowest effective dose and for the shortest duration necessary to control symptoms.
• When switching from intravenous or intramuscular administration to oral administration, the total amount of ketorolac previously administered must be taken into account to avoid overdose.

Use Dolomina during pregnancy

Using Ketorolac (Dolomin) during pregnancy is associated with certain risks and should be done with caution. Here are some key points from the available research:

1. Effects on pregnancy and childbirth: Ketorolac has the ability to reduce pain after surgery, including cesarean section. However, its use may affect uterine contractions and lead to bleeding due to its anti-inflammatory properties (Kulo et al., 2017).
2. Pharmacokinetics: The pharmacokinetics of ketorolac are altered during pregnancy. Studies have shown that ketorolac clearance increases during pregnancy, which may require dosage adjustment (Allegaert et al., 2012).
3. Risk to newborns: There is a risk of ketorolac affecting platelet function in newborns if taken during labor, which may lead to bleeding problems in the baby (Greer et al., 1988).

The use of ketorolac during pregnancy should be limited and carried out only under strict medical supervision, especially because of the potential for adverse effects on the fetus and mother's body. Always consult a doctor before using this or any other medication during pregnancy.

Contraindications

1. Individual hypersensitivity to duloxetine or any other component of the drug.
2. Concomitant use with monoamine oxidase inhibitors (MAOIs): A minimum of 14 days should be observed between stopping the MAOI and starting treatment with duloxetine, as this may result in a serious or even fatal interaction known as serotonin syndrome.
3. Severe liver disease. Duloxetine is metabolized in the liver and its use in patients with severe liver dysfunction may result in increased toxicity.
4. Severe kidney disease. If you have severe kidney failure, using duloxetine can be dangerous because this condition affects how the drug is eliminated from the body.

Duloxetine should be used with caution in patients with:

• Bipolar disorder. Duloxetine can cause a manic reversal in people with this disorder.
• Closed-angle glaucoma. The drug may cause an increase in intraocular pressure.
• Bleeding or bleeding disorders. Duloxetine may increase the risk of bleeding.
• High blood pressure. Duloxetine may cause high blood pressure.

Side effects Dolomina

1. Damage to the gastric mucosa: Dolomin may cause gastric ulcers and gastrointestinal bleeding. Therefore, people with gastric ulcers, exacerbation of gastritis or a predisposition to gastrointestinal bleeding are not recommended to use ketorolac.
2. Increased blood pressure: Dolomine may cause an increase in blood pressure, especially in people with hypertension.
3. Poor wound healing: Long-term use of ketorolac may slow down the healing of wounds and tissue damage.
4. Increased risk of blood clots: Like other NSAIDs, ketorolac may increase the risk of blood clots (thrombosis), which increases the chance of developing cardiovascular complications.
5. Kidney Damage: Dolomine may cause kidney damage, especially in people with existing kidney problems.
6. Allergic reactions: Rarely, some people may have allergic reactions to ketorolac, which may include skin rash, itching, swelling of the face, or difficulty breathing.
7. Systemic side effects: Like other NSAIDs, ketorolac may cause headaches, dizziness, drowsiness, nausea, vomiting, and diarrhea.

Overdose

1. Bleeding: Overdose of ketorolac may increase the risk of bleeding, especially in the gastrointestinal tract. This is due to its ability to suppress platelet function and inhibit prostaglandin synthesis.
2. Stomach and intestinal ulcers: Excessive use of ketorolac may cause the development of ulcers and ulcer bleeding in the gastrointestinal tract, which may lead to serious complications, including perforation (hole) in the wall of the stomach or intestine.
3. Kidney failure: Ketorolac may cause kidney failure in individuals with pre-existing kidney problems or in those who are dehydrated due to prolonged vomiting or diarrhea, which may result from overdose.
4. Cardiovascular complications: Excessive use of ketorolac may increase the risk of cardiovascular complications, including heart attack and stroke, especially in people with existing cardiovascular disease or risk factors.
5. Other complications: Overdose of ketorolac can also lead to other adverse effects, including nausea, vomiting, dizziness, seizures, drowsiness, hypertension, and even coma.

Interactions with other drugs

1. NSAIDs: Ketorolac belongs to a class of drugs called NSAIDs (non-steroidal anti-inflammatory drugs). Using it with other NSAIDs may increase the risk of side effects such as stomach ulcers, bleeding, and kidney damage.
2. Anticoagulants: Ketorolac may enhance the effects of anticoagulants such as warfarin, which may lead to an increased risk of bleeding.
3. Analgesics and drugs affecting the central nervous system: Concomitant use of ketorolac with other analgesics or drugs affecting the central nervous system (eg, alcohol, hypnotics) may enhance their sedative effect.
4. Drugs affecting the liver or kidneys: Ketorolac is metabolized in the liver and excreted through the kidneys. Concomitant use with other drugs affecting liver or kidney function may increase its toxic effects.
5. Drugs that enhance the antihypertensive effect: The combined use of ketorolac with antihypertensive drugs can enhance their antihypertensive effect and lead to a decrease in blood pressure.
6. Drugs that increase the risk of bleeding: Ketorolac increases the risk of bleeding, especially when used in combination with anticoagulants, antiplatelet agents or glucocorticosteroids.

Storage conditions

1. Temperature: Store Dolomin at a temperature of 15 to 30 degrees Celsius. Avoid overheating or freezing the drug.
2. Humidity: Keep the product in a dry place, protected from moisture.
3. Light: Avoid direct sunlight. Store Dolomin in its original packaging to prevent negative effects of light on the quality of the product.
4. Child safety: Keep the medicine out of reach of children to avoid accidental consumption.
5. Storage conditions for a specific formulation: If Dolomin is presented as an injection solution, additional attention to storage conditions such as temperature requirements or special precautions may be required.