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Ketorolac

Classification: A

Drug products: Ketorolac EG, Lixidol, Toradol, Tora-dol, Toradol®

ATC code: M01AB15

Substances: ketorolac, ketorolac trometamol

Summary

No difference in effect of ketorolac in men and women could be found in an experimental pain model.
 
The present evidence concerning differences between men and women is limited and do not motivate differentiation in dosing or treatment.

Additional information

Pharmacokinetics and dosing

No studies with a clinically relevant sex analysis regarding the pharmacokinetics or dosing of ketorolac have been found.

Effects

The analgesic efficacy of ketorolac (10 mg p.o.) was evaluated in an experimental pain method using cold pressor test (25 men, 25 women). No difference between men and women in ketorolac response was found [1].

Adverse effects

A case-control study (136 men, 130 women) found an association between NSAID exposure and liver injury in women but not in men (6.49 vs. 1.06). This may be due to differences in pharmacokinetics or levels of circulating hormones and/or more poly-pharmacy in women [2] or to a generally higher risk of drug-induced liver injury in women [3]. If this is an adverse effect for NSAIDs in general or only associated with certain NSAIDs is unclear. If ketorolac was included is not specified.

A meta-analysis evaluated NSAID use and the risk of Parkinson’s disease. Pooled risk ratio of Parkinson’s disease were similar in men and women using NSAID (men 0.79; women 0.72) [4]. If this is an effect for NSAIDs in general or only associated with certain NSAIDs is unclear. If ketorolac was included is not specified.

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Updated: 2019-02-26

Date of litterature search: 2015-01-26

References

  1. Compton P, Charuvastra VC, Ling W. Effect of oral ketorolac and gender on human cold pressor pain tolerance. Clin Exp Pharmacol Physiol. 2003;30:759-63. PubMed
  2. Lacroix I, Lapeyre-Mestre M, Bagheri H, Pathak A, Montastruc JL, Club de Reflexion des cabinets de Groupe de Gastro-Enterologie (CREGG) et al. Nonsteroidal anti-inflammatory drug-induced liver injury: a case-control study in primary care. Fundam Clin Pharmacol. 2004;18:201-6. PubMed
  3. Leise MD, Poterucha JJ, Talwalkar JA. Drug-induced liver injury. Mayo Clin Proc. 2014;89:95-106. PubMed
  4. Samii A, Etminan M, Wiens MO, Jafari S. NSAID use and the risk of Parkinson's disease: systematic review and meta-analysis of observational studies. Drugs Aging. 2009;26:769-79. PubMed
  5. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-05.] länk

Authors: Linnéa Karlsson Lind, Desirée Loikas

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson