Generic Name

Ketorolac Tromethamine and Phenylephrine Hydrochloride

---

Classification

FDA Approved Indications

• Used during ocular surgery (especially cataract surgery) to reduce postoperative pain and intraoperative miosis

Mechanism of Action

Ketorolac inhibits cyclooxygenase (COX-1 and COX-2), reducing prostaglandin synthesis, thereby diminishing inflammation and pain. Phenylephrine stimulates alpha-adrenergic receptors, causing vasoconstriction and pupil dilation.

Dosage and Administration

Adult: Administer as directed by the ophthalmic surgeon, typically as an intraoperative irrigation or drop. Exact dosing varies by procedure.

Pediatric: Use in children only if specifically indicated, with dosing determined by the physician.

Geriatric: Use with caution; adjust dosage based on patient response.

Renal Impairment: Use cautiously; no specific dose adjustment available, monitor renal function.

Hepatic Impairment: Use cautiously; no specific dose adjustment specified.

Pharmacokinetics

Absorption: Ocular absorption occurs locally with minimal systemic absorption.

Distribution: Limited systemic distribution via topical application.

Metabolism: Ketorolac metabolized hepatically; Phenylephrine undergoes hepatic metabolism; systemic absorption can occur.

Excretion: Renal excretion of metabolites.

Half Life: Ketorolac: approximately 4-6 hours; Phenylephrine: around 2-3 hours.

Contraindications

• Known hypersensitivity to NSAIDs or phenylephrine.
• Active bleeding or known bleeding disorders.
• Patients with severe hypertension or cardiovascular disease.
• Use in patients with ocular infection or injury not related to surgery.

Precautions

• Use with caution in patients with renal impairment, bleeding disorders, or hypertension.
• Limit systemic absorption by careful application.

Adverse Reactions - Common

• Eye irritation or discomfort (Common)
• Postoperative ocular redness or swelling (Uncommon)

Adverse Reactions - Serious

• Anaphylaxis or allergic reactions (Rare)
• Increased intraocular pressure (Rare)
• Systemic cardiovascular effects such as hypertension, tachycardia (Rare)

Drug-Drug Interactions

• Other systemic NSAIDs or anticoagulants may increase bleeding risk.
• Systemic sympathomimetics may have additive effects

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report any eye pain, redness, or allergic symptoms.
• Follow postoperative instructions carefully.
• Avoid rubbing eyes or using unapproved eye products.

Special Considerations

Black Box Warnings:

• Risk of bleeding, gastrointestinal bleeding (systemic NSAID effects)

Genetic Factors: None specified for this combination.

Lab Test Interference: Possible interference with coagulation tests, monitor as appropriate.

Overdose Management

Signs/Symptoms: Systemic absorption may cause vasoconstriction, hypertension, or bleeding.

Treatment: Supportive care; manage symptoms; activated charcoal if ingestion occurs oral, though topical use minimizes systemic risk.

Storage and Handling

Storage: Store at room temperature, protected from light.

Stability: Stable under recommended storage conditions.