Dolomite

Dolamine, which contains the active ingredient 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 potent NSAIDs, capable of providing 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 types, including pain after surgery, trauma, osteoarthritis, rheumatoid arthritis and other conditions.
2. Postoperative pain relief: The drug can be effective in relieving pain after various operations.
3. Menstrual pain: Dolomin can be used to relieve pain associated with menstruation.
4. Toothache: The drug can help reduce toothache.
5. Other pain conditions: Ketorolac can also be used to relieve pain in acute and chronic diseases of various nature.

Release form

1. Oral tablets: This is the most common form of ketorolac for outpatient use. The tablets are easy to use and provide fairly rapid action, suitable for managing acute pain symptoms.
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, which leads to a decrease in inflammation, pain and fever.

2. Analgesic effect:

   • Ketorolac has a potent 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 pain impulses in the nervous system.

3. Anti-inflammatory effect:

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

4. Antipyretic effect:

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

Pharmacokinetics

1. Absorption: Ketorolac is usually well absorbed after oral and intravenous administration. After taking the tablets, the maximum concentration in the blood plasma is achieved after 1-2 hours.
2. Distribution: It has a medium volume of distribution, which means it can spread rapidly throughout tissues and organs. The drug penetrates well through the blood-brain barrier.
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 compared to the drug itself.
5. Elimination: Ketorolac is excreted mainly by the kidneys in the form of metabolites and slightly unchanged. Its half-life is approximately 5-6 hours in young healthy patients and may be prolonged in older patients or those with impaired renal function.
6. Effect on other drugs: Ketorolac may interact with other drugs, in particular with anticoagulants, antihypertensives, diuretics and some antibiotics. This interaction may result in 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 use (tablets):

• Adults: The starting dose is usually 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 necessary due to increased risk of side effects.
• Tablets should be taken with water, and may 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 daily for intramuscular administration or 60 mg daily 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 initiated at the lowest effective dose and for the shortest period necessary to control symptoms.
• When switching from intravenous or intramuscular administration to oral administration, the total amount of ketorolac previously administered should be taken into account to avoid overdose.

Use Dolomina during pregnancy

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

1. Effect on pregnancy and childbirth: Ketorolac has the ability to reduce pain after surgery, including after 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 changes during pregnancy. Studies have shown that the clearance of ketorolac increases during pregnancy, which may require dosage adjustments (Allegaert et al., 2012).
3. Risk to Neonates: There is a risk of ketorolac affecting platelet function in newborns if taken during working life, which may result in clotting problems in the child (Greer et al., 1988).

The use of ketorolac during pregnancy should be limited and carried out only under strict medical supervision, especially due to the possibility of negative effects on the fetus and the maternal body. Always consult your 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). It is necessary to wait at least 14 days between stopping the MAOI and starting duloxetine treatment, as this may lead to a serious or even fatal interaction known as serotonin syndrome.
3. Severe liver diseases. Duloxetine is metabolized in the liver and its use in patients with severe hepatic impairment may result in increased toxicity.
4. Severe kidney disease. In the presence of severe renal failure, the use of duloxetine may be dangerous, since this condition affects the elimination of the drug from the body.

Duloxetine should be used with caution in patients with:

• Bipolar disorder. Duloxetine may cause manic episodes in people with this condition.
• Angle-closure 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 an increase in blood pressure.

Side effects Dolomina

1. Damage to the gastric mucosa: Dolomin can lead to the development of gastric ulcers and bleeding from the gastrointestinal tract. Therefore, people with gastric ulcers, exacerbation of gastritis or a predisposition to gastrointestinal bleeding are not recommended to use ketorolac.
2. Increased blood pressure: Dolomin may cause increased blood pressure, especially in people with hypertension.
3. Poor wound healing: Prolonged use of ketorolac may slow down the healing process of wounds and tissue damage.
4. Increased risk of blood clots: Like other NSAIDs, ketorolac may increase the risk of blood clots (blood clots), which increases the chance of developing cardiovascular complications.
5. Kidney Damage: Dolomin may cause problems with kidney function, especially in people with pre-existing kidney problems.
6. Allergic reactions: Rarely, some people may experience allergic reactions to ketorolac, including skin rash, itching, facial swelling, 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 ulcerative bleeding in the gastrointestinal tract, which can lead to serious complications, including perforation (hole) of the stomach or intestinal wall.
3. Kidney Failure: Ketorolac may cause kidney failure in individuals with pre-existing kidney problems or in those who suffer from dehydration due to prolonged vomiting or diarrhea, which may result from an overdose.
4. Cardiovascular complications: Excessive use of ketorolac may increase the risk of cardiovascular complications, including myocardial infarction and stroke, especially in people with pre-existing cardiovascular disease or risk factors.
5. Other complications: An overdose of ketorolac can also lead to other unwanted effects, including nausea, vomiting, dizziness, seizures, drowsiness, hypertension and even coma.

Interactions with other drugs

1. NSAIDs: Ketorolac belongs to the class of NSAIDs (non-steroidal anti-inflammatory drugs). Concomitant use with other NSAIDs may increase the risk of side effects such as stomach ulcers, bleeding and kidney damage.
2. Anticoagulants: Ketorolac may increase 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 (for example, alcohol, hypnotics) may increase 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 that affect liver or kidney function may increase its toxic effects.
5. Drugs that enhance the antihypertensive effect: Concomitant use of ketorolac with antihypertensive drugs may 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 together with anticoagulants, antiplatelet agents or glucocorticosteroids.

Storage conditions

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