ketorolac trometamol + phenylephrine hydrochloride: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
ketorolac trometamol + phenylephrine hydrochloride: clinical details
Prescribing considerations
- Restricted to adults undergoing intraocular lens replacement surgery in a controlled surgical setting.
- Address hyperthyroidism and unstable cardiovascular disease before surgery.
- Use caution with poorly controlled hypertension, pre-existing cardiovascular disease, asthma or previous aspirin/NSAID sensitivity.
- Safety and efficacy have not been evaluated in patients with previous uveitis, iris trauma or alpha-adrenergic antagonist use.
- Safety and efficacy are not established in people younger than 18 years.
Contraindications and cautions
- Hypersensitivity to ketorolac, phenylephrine or an excipient.
- Narrow-angle glaucoma.
Monitoring
- Assess relevant allergy, asthma, cardiovascular, blood-pressure, thyroid and glaucoma history preoperatively.
- Monitor haemodynamic status where cardiovascular risk or prolonged surgery makes phenylephrine effects clinically relevant.
- Assess postoperative pain, inflammation, corneal oedema, visual disturbance and intraocular pressure when clinically indicated.
Clinical pharmacology
Phenylephrine produces mydriasis through iris alpha-1 receptor activation. Ketorolac inhibits COX-1 and COX-2, reducing prostaglandin-mediated pain, inflammation and surgically induced miosis. Systemic exposure after intraocular irrigation is minimal and transient.
Formulation and product differences
- Concentrate for intraocular irrigation requiring dilution before use.
- Single-use vial for addition to a compatible surgical irrigation solution.
- Not interchangeable with topical ketorolac or phenylephrine eye drops and not intended for undiluted, intravitreal or systemic administration.
ketorolac trometamol + phenylephrine hydrochloride interactions
Formal interaction studies have not been performed, although systemic exposure during correct surgical use is expected to be minimal and brief.
Opioids
Their pupil-constricting effect may alter how well pupil dilation is maintained.
Non-sedating antihistamines
Their pupil-dilating effect may alter the overall degree of dilation.
Atropine
Combined effects with phenylephrine may increase blood pressure and cause a fast heart rate.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.