Remopain Mechanism of Action

Pharmacology: Pharmacodynamics: Ketorolac trometamol is a non-steroidal anti-inflammatory drug (NSAID). It acts on cyclooxygenase route, inhibits prostaglandin synthesis and may be considered a strong analgesic, both peripherally and centrally, besides having anti-inflammatory and antipyretic effects. Ketorolac reduce the mild to severe pain at emergency cases, musculoskeletal pain, post minor or major operative, renal cholic & pain in cancer at adult or children. Ketorolac has analgesic efficacy equivalent to morphine or pethidine. Initial analgesic effects of ketorolac may be slower, but the duration longer than opioid. Combination therapy of ketorolac and opioid may reduce 25-50% of opioid needs. And for some patients, this case is accompanied by decreasing side effects which is induced by opioid, faster normalization of gastrointestinal tract function and shorter hospital stay.
Pharmacokinetics: Bioavailability has been reported to range from 80-100% following oral administration. T_max occurs within 30-60 minutes after oral or parenteral administration. Food decreases the absorption rate, but not the extent of oral absorption. 99% of the ketorolac in plasma is protein-bound, volume distribution (Vd) <0.3 L/kg. Ketorolac is metabolized in the liver, and excreted renally. The metabolites do not have significant analgesic activity. The elimination terminal half-life of ketorolac (t¹/₂β) is ± 5 hours.
In geriatric patients, absorption of ketorolac and plasma protein binding is not affected substantially, but the plasma clearance is decreased (CL) (t¹/₂β= 6-7 hours). In patients with renal impairment the plasma clearance is decreased, it prolongs t¹/₂β (9-10 hours).
Patients with alcoholic cirrhosis show a little increase of t¹/₂β and T_max.