Solution for intramuscular introduction: pale yellow color or colourless, transparent (on 1 ml in ampoules, on 5 or 10 ampoules in a cardboard pack or on 5, 10 ampoules in pallets, on 1 pallet in a cardboard pack);
Tablets, coated or film cover: biconvex, round, almost white or white color, on one of the parties – an engraving of "KVT" (on 10 pieces in blister strip packagings, on 1-3, 10 packagings in a cardboard pack).

For intramuscular introduction is a part of 1 ml of solution:

Active agent: a ketorolaka трометамин – 30 mg;
Auxiliary components: sodium chloride, эдетат dinatrium, ethanol, sodium hydroxide, water for injections.

Is a part of 1 tablet:

Active agent: a ketorolaka трометамин – 10 mg;
Auxiliary components: corn starch, microcrystallic cellulose, colloid silicon dioxide, magnesium stearate.

Structure of a film cover: a gidroksipropilmetiltsellyuloza, polyethyleneglycol 400 (a macrogoal 400), the purified talc, titanium dioxide, the purified water.

Indications to use

Ketones appoint at a pain syndrome of strong and average intensity of various genesis (including at oncological diseases, during the postoperative period).

Contraindications

Digestive tract erosive cankers (at an aggravation), hypocoagulation (including hemophilia), round ulcers;
Renal and/or liver failure (at creatinine of plasma it is higher than 50 mg/l);
Hemopoiesis disturbance, the hemorrhagic diathesis, hemorrhagic stroke (suspected or confirmed), simultaneous use with other non-steroidal anti-inflammatory drugs, high risk of a recurrence or developing of bleeding (including after carrying out operations);
Dehydration;
Quincke's disease;
Hypovolemia (regardless of the reason, it caused);
"Aspirinovy asthma";
Anesthesia before and during surgeries (high risk of development of bleedings);
Chronic pains;
Bronchospasm;
Age up to 16 years (efficiency and safety of use of Ketanov for this age group of patients are not established);
Pregnancy, childbirth and period of a lactation;
Hypersensitivity to components of drug or other non-steroidal anti-inflammatory drugs.

Ketanov it is necessary to apply with care in the presence of the following diseases / states:

Bronchial asthma;
Chronic heart failure;
Cholecystitis;
Cholestasia;
Arterial hypertension;
Functional disturbances of kidneys (at creatinine of plasma it is lower than 50 mg/l);
Active hepatitis;
System lupus erythematosus;
Sepsis;
Polyps of a mucous membrane of a nasopharynx and nose;
The age is more senior than 65 years.

Route of administration and dosage

Ketones in the form of tablets accept inside.

The single dose at a single dose makes 10 mg (1 tablet). If necessary it is possible to accept drug in the same dose to 4 times a day (as much as possible – 40 mg a day).

Intramusculary (deeply) Ketanov in the form of solution for injections it is necessary to enter in minimum effective doses which the doctor selects individually depending on intensity of pain and reaction to therapy. In case of need perhaps simultaneous use with the reduced doses of opioid analgetics.

At single intramuscular introduction single doses of Ketanov make:

Patients up to 65 years – 10-30 mg (is defined by weight of a pain syndrome);
Patients are more senior than 65 years or patients with functional disturbances of kidneys – 10-15 mg.

At repeated intramuscular introduction usually apply:

Patients up to 65 years – 10-30 mg, then each 4-6 hours on 10-30 mg;
Patients are more senior than 65 years or patients with functional disturbances of kidneys – each 4-6 hours on 10-15 mg.

The maximum daily doses at intramuscular introduction make:

Patients up to 65 years – 90 mg;
Patients are more senior than 65 years or patients with functional disturbances of kidneys – 60 mg.

The same total daily doses should not be exceeded upon transition from parenteral administration of Ketanov to administration of drug inside (in day of transition we will allow reception of 30 mg of drug inside).

Duration of use of Ketanov in any dosage form should not exceed 5 days.

Side effects

During Ketanov's use the following side effects which are shown with various frequency can develop: (more than 3% – are frequent; 1-3% – are less frequent; less than 1% – are rare):

Central nervous system: often – a headache, drowsiness, dizziness; seldom – aseptic meningitis (a severe headache, fever, spasms, muscle tension of a back and/or neck), a depression, a hyperactivity (concern, changeability of mood), hallucinations, psychosis;
Alimentary system: often (in particular at patients 65 years with instructions in the anamnesis on digestive tract erosive cankers are more senior) – diarrhea, a gastralgia; less often – a meteorism, stomatitis, a lock, feeling of overflow of a stomach, vomiting; seldom – nausea, digestive tract erosive cankers (it is possible with bleeding and/or perforation: abdominal pains, spasms or burning in the area epigastriums, a melena, nausea, vomiting as "a coffee thick", heartburn), cholestatic jaundice, a hepatomegalia, hepatitis, acute pancreatitis;
Respiratory system: seldom – rhinitis, диспноэ or a bronchospasm, throat hypostasis (breath difficulty, an asthma);
Urinary system: seldom – an acute renal failure, pains in a waist with or without azotemia and/or a hamaturia, a hemolitic uraemic syndrome (a purpura, a renal failure, hemolitic anemia, thrombocytopenia), nephrite, a frequent urination, increase or reduction of volume of urine, hypostases of renal genesis;
Cardiovascular system: less often – increase in arterial pressure; seldom – a syncope, a fluid lungs;
Bodies of a hemopoiesis: seldom – an eosinophilia, anemia, a leukopenia;
Sense bodys: seldom – a ring in ears, decrease in hearing, a vision disorder (including an illegibility of visual perception);
System of a hemostasis: seldom – rectal, postoperative, nasal bleeding;
Integuments: less often – a purpura, skin rash (including makulopapulezny rash); seldom – exfoliative dermatitis (the fever which is followed by a fever or without it, reddening, a Lyell's disease, Stephens-Johnson's syndrome, a small tortoiseshell, a peeling or consolidation of skin, morbidity and/or swelling of palatine tonsils);
Allergic reactions: seldom – anaphylactoid reactions (skin rash, face skin discoloration, a small tortoiseshell, a skin itch, a tachypnea or диспноэ, swell a century, periorbital hypostasis, goose breathing, the complicated breath, an asthma, weight in a thorax) or an anaphylaxis;
Local reactions: less often – pain or burning in a solution injection site;
Others: often – hypostases a foot, shins, anklebones, fingers, the person, increase in body weight; less often – the increased perspiration; seldom – fever, a paraglossa.

Special instructions

Ketanov's influence on aggregation of thrombocytes stops in 24-48 hours.

If necessary perhaps simultaneous use with narcotic analgetics.

The hypovolemia increases probability of emergence of side effects from kidneys.

Ketanov's use for premedication, carrying out the supporting anesthesia and anesthesia in obstetrics is not recommended.

It is longer not necessary to apply 5 days along with paracetamol. At blood coagulation disturbances Ketanov appoint only at constant control of number of thrombocytes (especially important in the post-operational period in need of carrying out careful control of a hemostasis).

During therapy it is recommended to avoid performance of potentially dangerous types of the works (control of motor transport, work with mechanisms) requiring high attention and bystry reactions that is connected with high probability of development of disturbances of the central nervous system (dizziness, drowsiness, a headache).

Medicinal interaction

At simultaneous use of Ketanov with some medicines there can be undesirable effects:

Paracetamol: increase in nephrotoxicity;
Glucocorticosteroids, calcium drugs, ethanol, acetylsalicylic acid or other non-steroidal anti-inflammatory drugs, corticotropin: formation of ulcers of digestive tract and developing of gastrointestinal bleedings;
Probenetsid: reduction of plasma clearance and volume of distribution of a ketorolak, increase in its concentration in a blood plasma and an elimination half-life;
Methotrexate: increase nefro-and hepatotoxics (perhaps simultaneous use only with low doses of a methotrexate and under control of its concentration in a blood plasma);
Lithium, methotrexate: reduction of their clearance and strengthening of toxicity;
Peroral hypoglycemic drugs, insulin: increase in hypoglycemic action (dose adjustment is necessary);
Indirect anticoagulants, heparin, trombolitik, antiagregant, цефоперазон, цефотетан, пентоксифиллин: increase in risk of development of bleeding;
The drugs blocking canalicular secretion: decrease in clearance of a ketorolak and increase in its concentration in a blood plasma;
Opioid analgetics: strengthening of their action (perhaps essential decrease in the applied doses);
Diuretic and hypotensive medicines: decrease in their effects;
Nifedipine, verapamil: increase in their concentration in a blood plasma;
Sodium Valproatum: disturbance of aggregation of thrombocytes;
Nephrotoxic medicines (including medicines with the content of gold): increase in risk of development of nephrotoxicity.

Because of loss of a deposit Ketanov's solution cannot be mixed in one syringe with morphine sulfate, Hydroxyzinum and promethazine.

Ketones pharmaceutical it is incompatible with drugs of lithium and solution of a tramadol, we will combine with Plazmalit solution, normal saline solution, Ringer's solution and Ringera-laktata, 5% dextrose solution, and also with infusion solutions, with the maintenance of Aminophyllinum, heparin of sodium salt, a hydrochloride of lidocaine, a hydrochloride of a dopamine, insulin of the person of short action.