酮咯酸
Ketorolac
Ketorolac tromethamine
別名: Toradol · Acular · RS-37619-00-31-3 · Ketorolac trometamol
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| As an analgesic | 0.5 mg/kg IV three times daily or 0.3 mg/kg PO twice daily | IV, PO | TID (IV) or BID (PO) | < 3 days | 🌎 NA |
| As an analgesic | 0.3-0.5 mg/kg IV , IM q8-12h for one or two doses | IV, IM | q8-12h | 1-2 doses | 🌎 NA |
| Anterior uveitis and ulcerative keratitis | 1 drop per eye | topical | q6-24h | — | 🌍 EU |
- As an analgesic: Repeated doses have considerable potential for causing GI or renal toxicity. Treated dogs should receive misoprostol.
- Anterior uveitis and ulcerative keratitis: Frequency depends on the severity of inflammation.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| As an analgesic | 0.25 mg/kg IM q8-12h for one or two doses | IM | q8-12h | 1-2 doses | 🌎 NA |
| Anterior uveitis and ulcerative keratitis | 1 drop per eye | topical | q6-24h | — | 🌍 EU |
- Anterior uveitis and ulcerative keratitis: Frequency depends on the severity of inflammation.
小型哺乳類
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| As an analgesic (Mice) | 0.7-10 mg/kg PO once daily | PO | once daily | — | 🌎 NA |
| As an analgesic (Rats) | 3-5 mg/kg PO once to twice a day; 1 mg/kg IM once to twice a day | PO, IM | once to twice a day | — | 🌎 NA |
山羊
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| As an analgesic | 0.3-0.7 mg/kg IV , IM, SC, PO three times daily | IV, IM, SC, PO | three times daily | — | 🌎 NA |
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
酮咯酸 (Ketorolac) 是一種強效的非類固醇消炎止痛藥 (NSAID)，在獸醫學中主要用於短期的鎮痛治療。
- 臨床要點：雖然酮咯酸能提供極佳的止痛效果（在人類醫學中常與鴉片類藥物相提並論），但由於目前已有更安全的獸醫專用 NSAID，且其在犬貓身上引發胃腸道毒性（潰瘍與穿孔）及腎臟毒性的風險極高，因此其使用備受爭議且通常不建議。
- 若必須用於犬隻，多數臨床獸醫師會嚴格限制療程在3天以內，並強烈建議同時給予胃腸保護劑如米索前列醇 (misoprostol)（可合併或不合併使用硫糖鋁）。
作用機制
Ketorolac exerts its analgesic, anti-inflammatory, and antipyretic effects by non-selectively inhibiting cyclooxygenase (COX-1 and COX-2) enzymes.
Arachidonic Acid → COX-1/COX-2 Inhibition → Decreased synthesis of prostaglandins and thromboxanes.
By blocking prostaglandin production, it reduces inflammation and pain signaling. However, the profound inhibition of constitutive COX-1 also depletes protective prostaglandins in the gastric mucosa and kidneys, leading to its severe ulcerogenic and nephrotoxic side effect profile in small animals.
安全性與警告
禁忌症
- Active GI ulcers
- History of hypersensitivity to ketorolac
- Pre-existing hematologic, renal, or hepatic disease (relative contraindication)
- Known hypersensitivity to NSAIDs
- Use with extreme caution in patients with deep or progressive corneal ulcers
不良反應
- Gastrointestinal ulceration and erosion
- Gastrointestinal perforation
- Renal toxicity
- Hepatic toxicity
- Platelet inhibition (increased bleeding risk)
- Local ocular irritation
- Delayed corneal epithelial healing
- Increased intraocular pressure (IOP)
- Corneal 'melting' (keratomalacia) - reported in humans, theoretical risk in animals
注意事項
Use cautiously in patients with a history of GI ulcers, heart failure (may cause fluid retention), and in geriatric patients. Long-term use (>3 days) is not recommended in dogs due to a high tendency to cause gastric erosion and ulcers. Animals suffering from inflammation secondary to concomitant infection should receive appropriate antimicrobial therapy.
藥物相互作用
Increased risk for nephrotoxicity
Hallucinations reported in some human patients taking with ketorolac
Increased risk for nephrotoxicity
Increased risk for bleeding possible
Increased likelihood of GI adverse effects (blood loss)
May increase risk for GI ulceration
Concomitant administration with NSAIDs may significantly increase the risks for GI adverse effects
May increase risk for nephrotoxicity
May increase NSAID levels
Hallucinations reported in some human patients taking with ketorolac
Ketorolac may reduce the saluretic and diuretic effects of furosemide
Serious toxicity has occurred when NSAIDs have been used concomitantly; use together with extreme caution
Ketorolac may potentiate effects
May cause a significant increase in serum levels and half-life of ketorolac
May lead to increased corneal penetration of the NSAID
Concurrent use is a identified risk factor for precipitating severe corneal problems (e.g., corneal melting)
監測
- Analgesic and anti-inflammatory efficacy
- Gastrointestinal signs (appetite, vomiting, diarrhea, occult blood in feces)
- Renal function parameters (BUN, creatinine, urinalysis) with repeated use
- Intraocular pressure (IOP), especially in predisposed breeds
- Corneal healing via fluorescein staining
- Signs of corneal melting or worsening ulceration
藥物動力學
半衰期
吸收
Rapidly absorbed after oral administration; in dogs peak levels occur in about 50 minutes and oral bioavailability is about 50-75%.
分佈
Distributed marginally through the body. Highly bound to plasma proteins (99%). Volume of distribution in dogs is about 0.33-0.42 L/kg. Crosses the placenta but does not appear to cross the blood-brain barrier.
代謝
Primarily metabolized via glucuronidation and hydroxylation.
排除
Both unchanged drug and metabolites are excreted mainly in the urine. Patients with diminished renal function will have longer elimination times.
過量
Ketorolac has a narrow margin of safety in small animals.
- Cats: Have developed renal toxicity at doses as low as 0.7 mg/kg.
- Mice: The oral LD50 is 200 mg/kg.
- Clinical Signs: GI effects, including severe GI ulceration and bleeding, are highly likely in overdoses in small animals. Metabolic acidosis has been reported in humans.
- Treatment: Consider GI emptying for large, recent overdoses. Patients must be closely monitored for GI bleeding and renal impairment. Treat aggressively with GI protectants (sucralfate) and consider giving misoprostol early.
可用產品
劑型
- Tablets
- Injection
- Ophthalmic drops: 0.5% solution
人用標示
- Ketorolac Tromethamine Tablets: 10 mg
- Ketorolac Tromethamine Injection: 15 mg/mL & 30 mg/mL in 1 mL, 2 mL single-dose vials, & 10 mL multiple-dose vials
- Acular 0.5% eye drops (5 ml bottle)
各地核准狀態
Human authorized product (Acular) used off-label under the cascade.
Human authorized product (Acular) used off-label under the cascade.
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store tablets and injection at room temperature and protect from light. Protect tablets from excessive humidity. The injection is stable for at least 48 hours in commonly used IV solutions. It is recommended not to mix the injection with other drugs in the same syringe.
飼主須知
重要安全警告：酮咯酸是一種非常強效的止痛藥，但如果未完全按照指示使用，可能會對寵物造成嚴重的胃潰瘍和腎臟損傷。
- 嚴格遵守劑量：絕對不可超過獸醫師處方的天數（通常最多限制在1至3天內）。不可增加給藥頻率。
- 注意副作用：如果您發現寵物有任何腸胃不適的跡象，包括食慾不振、嘔吐、腹瀉、排出黑色/柏油狀糞便或糞便帶血，請立即停藥並通知您的獸醫師。
- 行為改變：如果您的寵物變得異常抑鬱、嗜睡或虛弱，請聯繫獸醫師。
- 不可混用藥物：除非獸醫師特別指示，否則絕對不可將酮咯酸與其他止痛藥（如阿斯匹靈、Rimadyl、Metacam 或類固醇）同時使用。
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