STERILE OPHTHALMIC SOLUTION

Ketorolac tromethamine is a member of the pyrrolo-pyrrole group of nonsteroidal anti-inflammatory drugs (NSAIDs) for ophthalmic use. Its chemical name is (±)-5-benzoyl-2, 3-dihydro-1H-pyrrolizine-1-carboxylic acid compound with 2-amino-2-(hydroxytmethyl)-1,3-propanediol (1:1) and it has the following structure:

Ketorolac Tromethamine Opthalmic Solution is supplied as a sterile isotonic aqueous 0.4% solution, with a pH of 7.3 to 7.5. Ketorolac Tromethamine Ophthalmic Solution is a racemic mixture of R-(+) and S-(-)- ketorolac tromethamine. Ketorolac tromethamine may exist in three crystal forms. All forms are equally soluble in water. The pKa of ketorolac is 3.5. This white to off-white crystalline substance discolors on prolonged exposure to light. The molecular weight of ketorolac tromethamine is 376.41. The osmolality of Ketorolac Tromethamine  Ophthalmic Solution is 290 mOsmol/kg.

Each mL of Ketorolac Tromethamine Ophthalmic Solution contains: Active: Ketorolac tromethamine 0.4%. Preservative: Benzalkonium chloride 0.006%. Inactives: Edetate disodium dihydrate 0.015%; octoxynol 40; sodium chloride; hydrochloric acid and/or sodium hydroxide to adjust the pH; and water for injection.

Ketarolac tromethamine is a nonsteroidal anti-inflammatory drug which, when administered systemically, has demonstrated analgesic, anti-inflammatory, and anti-pyretic activity. The mechanism of its action is thought to be due to its ability to inhibit prostaglandin biosynthesis. Ketorolac tromethamine given systemically does not cause pupil constriction.

One drop (0.05 mL) of 0.5% ketorolac tromethamine ophthalmic solution was instilled into one eye and one drop of vehicle into the other eye TID in 26 normal subjects. Only 5 of 26 subjects had a detectable amount of ketorolac in their plasma (range 10.7 to 22.5 ng/mL) at Day 10 during topical ocular treatment. When ketorolac tromethamine 10 mg is administered systemically every 6 hours, peak plasma levels at steady state are around 960 ng/mL.

In two double-masked, multi-centered, parallel-group studies, 313 patients who had undergone photorefractive keratectomy received ketorolac tromethamine ophthalmic solution 0.4% or its vehicle QID for up to 4 days. Significant differences favored ketorolac tromethamine ophthalmic solution for the reduction of ocular pain and burning/stinging following photorefractive keratectomy surgery.

Results from clinical studies indicate that ketorolac tromethamine has no significant effect upon intraocular pressure.

The safety and effectivess of ketorolac tromethamine ophthalmic solution in post-cataract surgery patients has not been established.

Ketorolac tromethamine  ophthalmic solution is indicated for the reduction of ocular pain and burning/stinging following corneal refraction surgery.

Ketorolac tromethamine  ophthalmic solution is contraindicated in patients with previously demonstrated hypersensitivity to any of the ingredients in the formulation.

There is the potential for cross-sensitivity to acetylsalicylic acid, phenylacetic acid derivatives, and other nonsteroidal anti-inflammatory agents. Therefore, caution should be used when treating individuals who have previously exhibited sensitivities to these drugs.

With some nonsteroidal anti-inflammatory drugs, there exists the potential for increased bleeding time due to interference with thrombocyte aggregation. There have been reports that ocularly applied nonsteroidal anti-inflammatory drugs may cause increased bleeding of ocular tissues (including hyphemas) in conjunction with ocular surgery.

The most frequently reported adverse reactions for ketorolac tromethamine ophthalmic solution occurring in approximately 1 to 5% of he overall study population were conjunctival hyperemia, corneal infiltrates, headache, ocular edema and ocular pain.

The most frequent adverse events reported with the use of ketorolac tromethamine ophthalmic solutions have been transient stinging and burning on instillation. The events were reported by 20% - 40% of patients participating in these other clinical trials.

Other adverse events occurring approximately 1 to 10% of the time during treatment with ketorolac tromethamine ophthalmic solutions included allergic reactions, corneal edema, iritis, ocular inflammation, ocular irritation, superficial ocular infections, and superficial keratitis.

The recommended dose of ketorolac tromethamine ophthalmic solution is one drop four times a day in the operated eye as needed for pain and burning/stinging, for up to 4 days following corneal refractive surgery.

Ketorolac tromethamine ophthalmic solution has been safely administered in conjunction with other ophthalmic medications such as antibiotics, beta blockers, carbonic anhydrase inhibitors, cycloplegics, and mydriatics.

Ketorolac Tromethamine Ophthalmic Solution 0.4% is supplied sterile, ina white opaque LDPE plastic bottle with a white opaque dropper and a grey opaque plastic cap as follows:

5 mL in 11 mL bottle - NDC 21695-985-05

Store at 20° - 25°C (68° - 77°F) [See USP Controlled Room Temperature]. Protect from light.