Drugs List

Therapeutic Indications

Uses

Topical prophylaxis and treatment of inflammation after ocular surgery

Contraindications

Corneal epithelial breakdown
Breastfeeding
Pregnancy

Precautions and Warnings

Children under 18 years
Haemorrhagic diathesis
Soft contact lenses
Coagulopathy
Corneal damage
Corneal disorder
Diabetes mellitus
Dry eyes
Ocular infection
Rheumatoid arthritis

May mask symptoms or signs of infections
Advise patient blurred vision may affect ability to drive/operate machinery
Contains benzalkonium chloride. Not to be used with soft contact lenses
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Monitor for, and discontinue in, corneal epithelial breakdown
Monitor patients for development of keratitis
May prolong bleeding time
Advise patient to avoid touching the eye/other surfaces with container tip
If soft contact lenses worn,insert them 15 minutes after using eye drops

This medication should be used with caution in patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (for example, dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time, as they may be at increased risk for corneal adverse events which may become sight threatening.

Pregnancy and Lactation

Pregnancy

Ketorolac trometamol is contraindicated during pregnancy.

The manufacturer does not recommend ketorolac trometamol during pregnancy. Available studies have shown teratogenic effects including cardiac defects, orofacial clefts and spontaneous abortions following the use of ketorolac trometamol during pregnancy. Some studies suggested there was most risk of teratogenic effects in the 1st and 3rd trimesters (Briggs 2015).

Lactation

Ketorolac trometamol is contraindicated during breastfeeding.

The manufacturer states ketorolac trometamol eye drops should not be used during breastfeeding. Whilst available data shows ketorolac trometamol is present in breast milk, the amount was considered insignificant (Briggs 2015). Studies on lactation whilst using ketorolac trometamol are limited but there is no evidence of negative impact on ability to breastfeed (Lactmed 2022).

Side Effects

Blurred vision
Blurred vision (transient)
Conjunctival hyperaemia
Corneal erosion
Corneal infiltrates
Corneal perforation
Corneal thinning
Corneal ulcer
Dryness of eyes
Epiphora
Epithelial damage
Eye pain
Eyelid oedema
Headache
Hypersensitivity reactions
Impaired vision
Ocular burning
Ocular irritation
Ocular oedema
Ocular pruritus
Rash
Stinging
Superficial punctate keratitis
Urticaria

Presentation

Eye drops containing ketorolac trometamol (preservative containing).

Drugs List

Therapeutic Indications

Uses

Topical prophylaxis and treatment of inflammation after ocular surgery

Dosage

Adults

Contraindications

Corneal epithelial breakdown
Breastfeeding
Pregnancy

Precautions and Warnings

Children under 18 years
Haemorrhagic diathesis
Soft contact lenses
Coagulopathy
Corneal damage
Corneal disorder
Diabetes mellitus
Dry eyes
Ocular infection
Rheumatoid arthritis

May mask symptoms or signs of infections
Advise patient blurred vision may affect ability to drive/operate machinery
Contains benzalkonium chloride. Not to be used with soft contact lenses
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Monitor for, and discontinue in, corneal epithelial breakdown
Monitor patients for development of keratitis
May prolong bleeding time
Advise patient to avoid touching the eye/other surfaces with container tip
If soft contact lenses worn,insert them 15 minutes after using eye drops

This medication should be used with caution in patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (for example, dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time, as they may be at increased risk for corneal adverse events which may become sight threatening.

Pregnancy and Lactation

Pregnancy

Ketorolac trometamol is contraindicated during pregnancy.

The manufacturer does not recommend ketorolac trometamol during pregnancy. Available studies have shown teratogenic effects including cardiac defects, orofacial clefts and spontaneous abortions following the use of ketorolac trometamol during pregnancy. Some studies suggested there was most risk of teratogenic effects in the 1st and 3rd trimesters (Briggs 2015).

Lactation

Ketorolac trometamol is contraindicated during breastfeeding.

The manufacturer states ketorolac trometamol eye drops should not be used during breastfeeding. Whilst available data shows ketorolac trometamol is present in breast milk, the amount was considered insignificant (Briggs 2015). Studies on lactation whilst using ketorolac trometamol are limited but there is no evidence of negative impact on ability to breastfeed (Lactmed 2022).

Side Effects

Blurred vision
Blurred vision (transient)
Conjunctival hyperaemia
Corneal erosion
Corneal infiltrates
Corneal perforation
Corneal thinning
Corneal ulcer
Dryness of eyes
Epiphora
Epithelial damage
Eye pain
Eyelid oedema
Headache
Hypersensitivity reactions
Impaired vision
Ocular burning
Ocular irritation
Ocular oedema
Ocular pruritus
Rash
Stinging
Superficial punctate keratitis
Urticaria

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: July 2022

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Acular, AbbVie Ltd, revised April 2022.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 22 July 2022

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Ketorolac Last revised: April 2022
Last accessed: July 2022