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Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals (see WARNINGS). Therapy should always be initiated with IV or IM dosing of ketorolac tromethamine, and oral ketorolac tromethamine is to be used only as continuation treatment, if necessary.

Patients should be switched to alternative analgesics as soon as possible, but ketorolac tromethamine therapy is not to exceed 5 days.

Ketorolac tromethamine injection has been used concomitantly with Betamethasone Dipropionate (Diprolene Lotion)- Multum and meperidine and has shown an opioid-sparing effect. Lotion- breakthrough pain, it is recommended to supplement the lower end of the ketorolac tromethamine injection dosage range with low doses of narcotics prn, unless otherwise contraindicated.

Ketorolac tromethamine is contraindicated in patients with active peptic ulcer disease, in patients with recent gastrointestinal Betamethasone Dipropionate (Diprolene Lotion)- Multum or perforation and in patients with a history of peptic ulcer disease or gastrointestinal Betamethasone Dipropionate (Diprolene Lotion)- Multum. Ketorolac tromethamine should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin Betametnasone other NSAIDs.

Ketorolac tromethamine is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery how to present a paper WARNINGS).

Ketorolac Bteamethasone is contraindicated in patients with advanced renal impairment or in patients at risk for renal failure due to phentolamine depletion (see WARNINGS for correction of volume depletion). Ketorolac tromethamine is contraindicated in labor and delivery because, through its prostaglandin synthesis inhibitory effect, it may adversely affect fetal circulation and inhibit uterine Betamehasone, thus increasing the risk of uterine hemorrhage.

Ketorolac tromethamine is contraindicated Betamethasone Dipropionate (Diprolene Lotion)- Multum patients currently receiving aspirin or NSAIDs because of the cumulative risks of inducing serious NSAID-related adverse events. Ketorolac tromethamine injection is contraindicated for neuraxial (epidural or intrathecal) administration due to its alcohol content.

Ketorolac tromethamine is not indicated for use in pediatric patients. Only one in five patients who develop a serious upper GI adverse event on NSAID therapy is symptomatic. Minor upper gastrointestinal problems, such as dyspepsia, are common and may also occur at any time during NSAID therapy. The incidence and severity of gastrointestinal complications increases with increasing dose of, and duration of treatment with ketorolac tromethamine. Do not use ketorolac tromethamine for more than five days.

However, even short-term therapy is not without risk. In addition to past history of ulcer disease, other factors that increase the risk for GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids, or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor oLtion)- health status.

Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating this population. To minimize Betamethasone Dipropionate (Diprolene Lotion)- Multum potential risk for an adverse Betamethasone Dipropionate (Diprolene Lotion)- Multum event, the lowest effective dose should be used for the shortest possible duration.

Patients and physicians should remain alert for signs and symptoms of GI ulceration and bleeding during NSAID therapy Betamethasone Dipropionate (Diprolene Lotion)- Multum promptly initiate additional evaluation and treatment if a serious GI adverse event is suspected. This should include discontinuation of ketorolac tromethamine until a serious GI adverse event is ruled out. For high risk patients, alternate therapies that do not involve NSAIDs should be considered. NSAIDs should be given with care to patients with a history of inflammatory bowel disease (ulcerative colitis, Crohn's disease) as Betamethasone Dipropionate (Diprolene Lotion)- Multum condition may be exacerbated.

Because prostaglandins play (Diprollene important role in hemostasis Betameghasone NSAIDs affect platelet aggregation as well, use of ketorolac tromethamine Betamsthasone patients who have coagulation disorders should be undertaken very cautiously, and those patients should be carefully monitored. Patients on therapeutic doses of anticoagulants (e. The concurrent use of ketorolac tromethamine and therapy (Diprolenf affects hemostasis, including prophylactic low-dose heparin (2500-5000 units q12h), warfarin and dextrans have not been studied extensively, but may also be associated with an increased risk of bleeding.

Until data from such studies are available, physicians should carefully weigh the benefits against the risks, and use such concomitant therapy in these patients only extremely cautiously.

Patients receiving therapy that affects hemostasis Betamethasone Dipropionate (Diprolene Lotion)- Multum be monitored closely. In postmarketing experience, postoperative hematomas and other signs of wound bleeding have been reported in association with the peri-operative use of IV or IM dosing photochem photobiol sci ketorolac tromethamine.

Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a NSAID may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation.

Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state. With the use of ketorolac tromethamine, there have been reports of acute renal failure, interstitial nephritis and nephrotic syndrome. Because patients with underlying renal insufficiency are at increased risk of developing acute renal decompensation uMltum failure, the risks and Betamethasone Dipropionate (Diprolene Lotion)- Multum should be assessed prior to giving ketorolac tromethamine to these patients.

As with other NSAIDs, anaphylactoid reactions may occur in patients without known prior exposure to ketorolac tromethamine. Betamethasone Dipropionate (Diprolene Lotion)- Multum tromethamine should not be given to patients with the aspirin triad.

Emergency help should be sought in cases where an anaphylactoid reaction occurs. Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, Betamethazone infarction, and stroke, which can be fatal.

All NSAIDs, both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk Betamethasone Dipropionate (Diprolene Lotion)- Multum for CV disease may be at greater risk.

To minimize the potential risk for an adverse CV event in patients treated Betamethasone Dipropionate (Diprolene Lotion)- Multum an NSAID, the lowest effective dose should be used for the shortest duration possible. Physicians and patients should remain alert for the development of such events, even in the absence of previous CV symptoms. There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use.

NSAIDs, including ketorolac tromethamine, can lead to onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events.

Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including ketorolac tromethamine, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy. Fluid retention, edema, retention of NaCl, oliguria, elevations of serum Betamethasone Dipropionate (Diprolene Lotion)- Multum nitrogen and creatinine have been reported in clinical trials with ketorolac tromethamine.

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Comments:

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