Ketorolac Tromethamine (Page 8 of 9)

Postmarketing Surveillance Study

A large postmarketing observational, nonrandomized study, involving approximately 10,000 patients receiving ketorolac tromethamine ^IV/IM , demonstrated that the risk of clinically serious gastrointestinal (GI) bleeding was dose-dependent (see Tables 3A and 3B). This was particularly true in elderly patients who received an average daily dose greater than 60 mg/day of ketorolac tromethamine ^IV/IM (see Table 3A).

Table 3: Incidence of Clinically Serious GI Bleeding as Related to Age, Total Daily Dose, and History of GI Perforation, Ulcer, Bleeding (PUB) After up to 5 Days of Treatment With Ketorolac Tromethamine ^IV/IM

A. Adult Patients Without History of PUB
Age of Patients	Total Daily Dose of Ketorolac Tromethamine IV/IM
	≤ 60 mg	> 60 to 90 mg	> 90 to 120 mg	> 120 mg
< 65 years of age	0.4%	0.4%	0.9%	4.6%
≥ 65 years of age	1.2%	2.8%	2.2%	7.7%
B. Adult Patients With History of PUB
Age of Patients	Total Daily Dose of Ketorolac Tromethamine IV/IM
	≤ 60 mg	> 60 to 90 mg	> 90 to 120 mg	> 120 mg
< 65 years of age	2.1%	4.6%	7.8%	15.4%
≥ 65 years of age	4.7%	3.7%	2.8%	25%

To report SUSPECTED ADVERSE REACTIONS, contact Teva at 1-888-838-2872 or FDA at 1-800-FDA-1088 or http://www.fda.gov/medwatch.

OVERDOSAGE

Symptoms and Signs

Symptoms following acute NSAID overdoses are usually limited to lethargy, drowsiness, nausea, vomiting, and epigastric pain, which are generally reversible with supportive care. Gastrointestinal bleeding can occur. Hypertension, acute renal failure, respiratory depression and coma may occur, but are rare. Anaphylactoid reactions have been reported with therapeutic ingestion of NSAIDs, and may occur following an overdose.

Treatment

Patients should be managed by symptomatic and supportive care following a NSAIDs overdose. There are no specific antidotes. Emesis and/or activated charcoal (60 g to 100 g in adults, 1 g/kg to 2 g/kg in children) and/or osmotic cathartic may be indicated in patients seen within 4 hours of ingestion with symptoms or following a large oral overdose (5 to 10 times the usual dose). Forced diuresis, alkalization of urine, hemodialysis or hemoperfusion may not be useful due to high protein binding.

Single overdoses of ketorolac tromethamine have been variously associated with abdominal pain, nausea, vomiting, hyperventilation, peptic ulcers and/or erosive gastritis and renal dysfunction which have resolved after discontinuation of dosing.

DOSAGE AND ADMINISTRATION

Carefully consider the potential benefits and risks of ketorolac tromethamine tablets and other treatment options before deciding to use ketorolac tromethamine tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals. In adults, the combined duration of use of IV or IM dosing of ketorolac tromethamine and ketorolac tromethamine tablets is not to exceed 5 days. In adults, the use of ketorolac tromethamine tablets is only indicated as continuation therapy to IV or IM dosing of ketorolac tromethamine.

Transition from IV or IM dosing of ketorolac tromethamine (single- or multiple-dose) to multiple-dose ketorolac tromethamine tablets:

Patients age 17 to 64: 20 mg PO once followed by 10 mg q4 to 6 hours prn not > 40 mg/day

Patients age ≥ 65, renally impaired, and/or weight < 50 kg (110 lbs): 10 mg PO once followed by 10 mg q4 to 6 hours prn not > 40 mg/day

Note:

Oral formulation should not be given as an initial dose.

Use minimum effective dose for the individual patient.

Do not shorten dosing interval of 4 to 6 hours.

Total duration of treatment in adult patients: the combined duration of use of IV or IM dosing of ketorolac tromethamine and ketorolac tromethamine tablets is not to exceed 5 days.

The following table summarizes ketorolac tromethamine tablet dosing instructions in terms of age group:

Table 4: Summary of Dosing Instructions

Patient Population	Ketorolac Tromethamine Tablets (following IV or IM dosing of ketorolac tromethamine)
Age < 17 years	Oral not approved
Adult Age 17 to 64 years	20 mg once, then 10 mg q4 to 6 hours prn not > 40 mg/day
Adult Age ≥ 65 years, renally impaired, and/or weight < 50 kg	10 mg once, then 10 mg q4 to 6 hours prn not > 40 mg/day

HOW SUPPLIED

Ketorolac tromethamine tablets, USP are available as follows:

10 mg: White, round, convex, unscored, film-coated tablets, debossed “93” on one side and “314” on the other side. They are available in

NDC: 70518-0048-00

NDC: 70518-0048-01

NDC: 70518-0048-02

NDC: 70518-0048-03

NDC: 70518-0048-04

PACKAGING: 25 in 1 BOTTLE PLASTIC

PACKAGING: 1 in 1 BOTTLE PLASTIC

PACKAGING: 100 in 1 BOTTLE

PACKAGING: 8 in 1 BOTTLE PLASTIC

PACKAGING: 20 in 1 BOTTLE PLASTIC

Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].

Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as required).

PROTECT FROM LIGHT AND EXCESSIVE HUMIDITY.

KEEP THIS AND ALL MEDICATIONS OUT OF THE REACH OF CHILDREN.

Repackaged and Distributed By:

Remedy Repack, Inc.

625 Kolter Dr. Suite #4 Indiana, PA 1-724-465-8762