Ketorolac + Olopatadine

Usage

Ketorolac + Olopatadine ophthalmic solution is prescribed for the short-term treatment of the signs and symptoms of seasonal allergic conjunctivitis (SAC). It is particularly useful when both the allergic/inflammatory components and the pain associated with this condition need to be addressed.

• Pharmacological classification: This is a combination product containing a non-steroidal anti-inflammatory drug (NSAID) and an antihistamine.

  • Ketorolac: NSAID (analgesic, anti-inflammatory)
  • Olopatadine: Antihistamine, mast cell stabilizer

• Mechanism of action:

  • Ketorolac: Inhibits cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing prostaglandin synthesis, which plays a key role in inflammation and pain.
  • Olopatadine: A relatively selective H1-receptor antagonist and inhibits the release of histamine from mast cells. Histamine is a key mediator in allergic reactions.

Alternate Names

There is no officially recognized alternate name for the combination product itself. The individual components may be referred to by their chemical names: Ketorolac tromethamine and Olopatadine hydrochloride. Several brand names exist, but they can vary regionally. Some examples include Kapiket-OL and Levokap in India, and other brands internationally.

How It Works

• Pharmacodynamics: The combination exerts a synergistic effect by targeting both the inflammatory and allergic pathways contributing to SAC symptoms.

  • Ketorolac’s anti-inflammatory and analgesic actions alleviate pain, redness, and swelling.
  • Olopatadine’s antihistaminic activity and mast cell stabilization reduce itching, tearing, and other allergic manifestations.

• Pharmacokinetics:

  • Absorption: Following topical ocular administration, both drugs achieve therapeutic concentrations in ocular tissues. Systemic absorption is minimal.
  • Metabolism: Limited information is available regarding the metabolism of the combination product when administered topically. Olopatadine is partially metabolized, while ketorolac undergoes more extensive hepatic metabolism.
  • Elimination: Primarily renal excretion for both drugs, with some hepatic contribution.

• Mode of action:

  • Ketorolac: Inhibits COX enzymes, which catalyze the formation of prostaglandins from arachidonic acid. This reduces the inflammatory and pain response.
  • Olopatadine: Antagonizes H1 receptors, preventing histamine from binding and triggering downstream allergic effects. It also stabilizes mast cells, preventing the release of histamine and other inflammatory mediators.

Dosage

Standard Dosage

Adults: One drop in each affected eye twice a day, approximately 6-8 hours apart.

Children (2 years and older): One drop in each affected eye twice a day, approximately 6-8 hours apart for 0.1% olopatadine and once a day for 0.2% olopatadine. Use in children under 2 years old must be determined by a physician.

Special Cases:

• Elderly Patients: No specific dosage adjustments are typically required. Monitor for potential systemic side effects, particularly if there is renal impairment.
• Patients with Renal Impairment: Exercise caution and adjust dosage as needed based on renal function.
• Patients with Hepatic Dysfunction: Exercise caution. Closely monitor hepatic function. Dosage adjustment might be necessary.
• Patients with Comorbid Conditions: Carefully assess individual cases, considering underlying medical conditions, potential drug interactions, and associated risks.

Clinical Use Cases

The combination is not typically used in the clinical settings you listed (intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations). Its primary indication is for seasonal allergic conjunctivitis.

Dosage Adjustments

Dosage adjustments may be necessary in patients with renal or hepatic impairment. Individualized assessment is required.

Side Effects

Common Side Effects

• Ocular: Burning or stinging, blurred vision, eye irritation, dry eyes, foreign body sensation
• Systemic: Headache, bad taste in the mouth

Rare but Serious Side Effects

• Ocular: Corneal complications, vision changes
• Systemic: Allergic reactions (rash, itching, swelling), breathing difficulties

Long-Term Effects

Prolonged use of topical NSAIDs can potentially increase the risk of corneal complications.

Contraindications

• Hypersensitivity to ketorolac, olopatadine, or any component of the formulation.
• Patients with active corneal ulcers or other corneal defects.
• History of asthma, nasal polyps, or angioedema triggered by aspirin or other NSAIDs.
• Patients with known bleeding tendencies or those taking anticoagulants.

Drug Interactions

• Other NSAIDs (increased risk of bleeding)
• Anticoagulants (increased risk of bleeding)
• High doses of aspirin (increased risk of bleeding)

Pregnancy and Breastfeeding

• Pregnancy: The safety of this combination during pregnancy has not been established. Use only if clearly needed and under close medical supervision.
• Breastfeeding: Ketorolac and olopatadine may be excreted in breast milk. Exercise caution when administering to breastfeeding mothers. Consider the potential risk to the infant.

Drug Profile Summary

• Mechanism of Action: Ketorolac (NSAID) inhibits COX enzymes, reducing prostaglandin synthesis. Olopatadine (antihistamine, mast cell stabilizer) blocks H1 receptors and prevents histamine release.
• Side Effects: Burning/stinging, blurred vision, dry eyes, headache, bad taste.
• Contraindications: Hypersensitivity, corneal problems, aspirin/NSAID sensitivity, bleeding disorders.
• Drug Interactions: Other NSAIDs, anticoagulants.
• Pregnancy & Breastfeeding: Use with caution.
• Dosage: One drop in each affected eye twice daily (6-8 hours apart). Adjust as needed.
• Monitoring Parameters: Ocular signs and symptoms, vision changes, systemic side effects (if any).

Popular Combinations

This is already a combination product. Its use as a standalone treatment is typically preferred in its indicated condition.

Precautions

• General Precautions: Assess for allergies, corneal integrity, renal/hepatic function.
• Specific Populations: See “Dosage - Special Cases.”
• Lifestyle Considerations: May cause transient blurred vision. Advise patients to avoid driving or operating machinery immediately after administration.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Ketorolac + Olopatadine?

A: One drop in each affected eye twice a day, 6-8 hours apart. Pediatric and special populations may require adjustments.

Q2: How long can Ketorolac + Olopatadine be used?

A: It’s intended for short-term use. Consult a physician for treatment duration beyond a typical course (e.g., up to 10 days).

Q3: Can contact lens wearers use this medication?

A: Remove contact lenses before instillation. Reinsert after 15 minutes.

Q4: Is it safe to use during pregnancy or breastfeeding?

A: Use cautiously and only if clearly needed. Consult a physician about potential risks.

Q5: What should I do if I experience severe side effects?

A: Discontinue use and seek immediate medical attention.

Q6: Can this medication be used for other types of eye allergies?

A: It’s primarily indicated for seasonal allergic conjunctivitis. Consult a physician for other allergic conditions.

Q7: How does the combination product compare to using Ketorolac or Olopatadine alone?

A: The combination offers synergistic benefits in addressing both the inflammatory and allergic components of SAC.

Q8: Can I use other eye drops along with Ketorolac + Olopatadine?

A: Consult your physician about using other ophthalmic medications concomitantly. It is recommended to wait at least 5 minutes between applications when using multiple eye drops.

Q9: Can this medicine be used in children?

A: It can be used in children 2 years and older. Dosage adjustments are based on the olopatadine concentration (0.1% or 0.2%). For children under 2, consult a physician.