Ketorolac Tromethamine Injection - Pharmaceutical Information, Clinical Trials, Detailed Pharmacology, Toxicology
Россия
  • Россия
  • Украина

Ketorolac Tromethamine Injection - Scientific Information

Manufacture: Fresenius Kabi USA, LLC
Country: Canada
Condition: Anesthesia
Class: Nonsteroidal anti-inflammatory agents
Form: Liquid solution, Intramuscular (IM)
Ingredients: Ketorolac Tromethamine

Pharmaceutical Information

Structural formula:
Molecular formula: C15H13NO3 • C4H11NO3
Molecular weight: 376.40
Chemical name: (±)-5-Benzoyl-2,3-dihydro-1H-pyrrolizine-1- carboxylic acid, 2-amino-2-(hydroxymethyl)-1, 3-propanediol.
Physical Form: Ketorolac tromethamine is a white to off-white crystalline powder.
Solubility: It is freely soluble in water and methanol; slightly soluble in alcohol, in dehydrated alcohol, in tetrahydrofuran; and practically insoluble in acetone, in dichloromethane, in toluene, in ethylacetate, in dioxane, in hexane, in butyl alcohol and in acetonitrile.
pKa and pH: The pKa is 3.46 and the pH of a 1% (w/v) solution in carbon dioxide free, purified water is 5.7 - 6.7.
Melting Point: Melts at about 162 °C with decomposition.

Composition

Ketorolac Tromethamine Injection, USP 15 mg/mL, each mL contains: ketorolac tromethamine 15 mg, and as non-medicinal ingredients: alcohol USP 100 mg, citric acid 1 mg, sodium chloride 6.68 mg for isotonicity, and sodium hydroxide and/or hydrochloric acid for pH adjustment, in sterile water for injection.

Ketorolac Tromethamine Injection, USP 30 mg/mL, each mL contains: ketorolac tromethamine 30 mg, and as non-medicinal ingredients: alcohol USP 100 mg, citric acid 1 mg, sodium chloride 4.35 mg for isotonicity, and sodium hydroxide and/or hydrochloric acid for pH adjustment, in sterile water for injection.

Stability and Storage Recommendations

Store between 15 °C and 30 °C, protect from light, protect from freezing.

Availability of Dosage Forms

Ketorolac Tromethamine Injection, USP is available as follows:

C160101 15 mg/mL ketorolac tromethamine, 1 mL fill in a 2 mL single-dose vial with latex free stopper with a yellow coloured flip-off cap. Available in packages of 25 vials.
C160201 30 mg/mL ketorolac tromethamine, 1 mL fill in a 2 mL single-dose vial with latex free stopper with a mist gray coloured flip-off cap. Available in packages of 25 vials.
C160202 30 mg/mL ketorolac tromethamine, 2 mL fill in a 2 mL single-dose vial with latex free stopper with a purple coloured flip-off cap. Available in packages of 25 vials.

Pharmacology

Animal Pharmacology

Analgesic Properties

Ketorolac is a potent orally active analgesic agent in tests utilizing an underlying inflammatory state. In mice, given oral or subcutaneous doses ranging from 0.05 - 2.25 mg/kg, the compound was 250 - 350 times more potent than ASA in inhibiting phenylquinone-induced writhing. Using a similar test in rats which received 0.03 - 1.0 mg/kg p.o., ketorolac was 180 times as potent as aspirin in inhibiting the writhing response.

In rats having adjuvant-induced arthritis, ketorolac p.o. was 400 - 800 times more potent than aspirin and twice as potent as naproxen in alleviating pain. The compound also significantly increased the pain threshold in yeast-inflamed paws of rats which were compressed at a constant rate of pressure (Randall-Selitto Test), its potency being 3 to 10 times that of naproxen.

The fact that ketorolac does not increase the pain threshold of the non-inflamed paw and does not exhibit analgesic activity in the mouse hot plate test indicates that it is not a morphine like compound.

Anti-inflammatory Properties

Ketorolac displayed anti-inflammatory properties when tested in classical rat models to test intrinsic anti-inflammatory actions. The free acid form of the compound had approximately 36 times the anti-inflammatory potency of phenylbutazone, while the tromethamine salt was 118 times as active as phenylbutazone in inhibiting carrageenin-induced paw inflammation when administered orally. This difference in potency is due to the compound.

Ketorolac was weakly effective in inhibiting the development of ultraviolet-induced erythema when applied topically at a dose of 1 mg to guinea pigs. In the rat, however, topical application at dose levels of 0.01 and 0.1 mg/rat, was very effective in suppressing the heat induced local inflammatory reaction.

When administered to rats at a dose of 2 mg/kg/day p.o., for 6 days, ketorolac did not produce thymic involution. This indicates that the anti-inflammatory activity is not due to intrinsic corticosteroid activity in the molecule nor due to the stimulation of endogenous corticosteroid production. These findings were further confirmed by the dose-related anti-inflammatory activity in adrenalectomized rats.

Antipyretic Properties

When administered orally to yeast-infected rats in doses ranging from 0.1 - 2.7 mg/kg, ketorolac had 20 times the antipyretic potency of aspirin.

Prostaglandin Inhibition

There is substantial evidence in the literature to suggest that the anti-inflammatory, analgesic and antipyretic activities of non-steroidal anti-inflammatory drugs (NSAIDs) are due to their ability to inhibit prostaglandin biosynthesis.

Ketorolac, like other NSAIDs, inhibited the prostaglandin synthetase activity in bovine seminal vesicle microsomes, rabbit renal medullary microsomes, and human platelet microsomes, having substantially greater potency (1.0 to 5.3 times) than indomethacin.

Platelet Effects

In in vitro studies, ketorolac was 37 times as active as aspirin in inhibiting aggregation of human platelets induced by collagen and 28 times more potent than aspirin in inhibiting arachidonic acid-induced platelet aggregation. However, ketorolac did not inhibit the primary phase of adenosine diphosphate-induced aggregation nor the aggregation elicited by thromboxane A2.

Central Nervous System Effects

The acute intraperitoneal administration of ketorolac to mice had minimal behavioral effects at doses up to 300 mg/kg. Above this dose level, depression of normal behavior was seen.

No appreciable central nervous system (CNS) activity was produced by ketorolac. It did not possess anticonvulsant activity in mice in the maximal electroshock test nor did it inhibit pentylenetetrazol-induced seizures in mice or rats.

In mice, hexobarbital-induced sleep time was unaltered by ketorolac suggesting that the compound was not a CNS depressant.

The gross behavior and sleep patterns of cats dosed at up to 10 mg/kg, i.v., were unchanged.

Cardiovascular Effects

Sequential administration of 1, 3 and 10 mg/kg, i.v. of ketorolac to anesthetized cats, produced minimal cardiovascular or autonomic responses.

In anesthetized dogs, doses of 1 to 30 mg/kg, i.v. produced inconsistent and variable changes in the cardiac contractile force, heart rate and blood pressure. The cardiovascular responses to adrenaline, nor-adrenaline, tyramine, phenylephrine and bilateral carotid artery occlusion were inhibited by ketorolac, suggesting that the compound may possess mild alpha-adrenoceptor blocking activity.

Bronchial Effects

Ketorolac, when administered intravenously to guinea pigs in doses of 0.01 - 10 mg/kg failed to block histamine-or methacholine-induced bronchoconstriction. In the rat, the compound blocked methacholine-induced airway constriction (ED50 = 0.5 mg/kg).

Gastric Effects

Doses of ketorolac at 0.1 and 1.0 mg/kg p.o. in rats did not alter significantly either the gastric juice volume or the total mEq of hydrogen ions secreted in response to histamine stimulation. Moreover, in common with other NSAIDs, both the acid and the tromethamine salt of ketorolac had a similar propensity to cause gastrointestinal erosions in rats independent of the route of administration.

Pharmacokinetics

A series of studies were carried out in mice, rats, rabbits, monkeys and humans to characterize the pharmacokinetic profile of the free acid of ketorolac and ketorolac tromethamine. The salt form of the compound was later selected for development due to its more rapid and complete absorption.

Ketorolac tromethamine was rapidly (Tmax ranged from 0.25 - 1.5hr) and completely absorbed after oral and i.m. doses in animals (>87%) and humans (>99%). The pharmacokinetics of ketorolac in man following single or multiple intramuscular doses are linear. Steady state plasma levels are achieved after dosing every 6 hours for one day. No changes in clearance occurred with chronic dosing. The plasma half life of ketorolac ranged from 2.1 hours in rabbits to 6.6 hours in rhesus monkeys and 7.7 hours in mice. In humans, the plasma half life averaged 6.0 hours. The volume of distribution of ketorolac was estimated following intravenous dosing and ranged from 0.09 L/kg in mice to 0.38 L/kg in rats; in humans it averaged 0.15 L/kg. Total plasma clearance ranged from 0.44 mL/min/kg in mice to 2.44 mL/min/kg in rats and averaged 0.35 mL/min/kg in humans.

Ketorolac was highly protein bound in human (99.2%), monkey (98.3%) and rabbit (98.2%) plasma; moderately bound in rat plasma (92.1%); and poorly bound in mouse plasma (72.0%). Binding was concentration independent in all species studied.

The tissue distribution of ketorolac-associated radioactivity was studied in male mice. The highest levels were found in the kidney which was the only organ which exceeded plasma levels at all time points (by about 50%). The lowest levels were present in the brain. However, all tissues eliminated ketorolac-associated radioactivity rapidly with a tissue half life of < 3.6 hours.

Distribution studies in pregnant rabbits and rats showed that ketorolac-associated radioactivity distributed into the fetus in low but measurable levels - less than 15% in rabbits and 6% in rats based upon fetal to maternal plasma or blood concentration ratios. Ketorolac-associated radioactivity was also passed into the milk of lactating animals. In rats, radioactivity concentrations in milk exceeded plasma concentrations at all time points by as much as four fold. However, in rabbits, milk concentrations were only about 12% of plasma concentrations.

Metabolism

In vitro and in vivo studies demonstrated that ketorolac does not induce or inhibit its own metabolism or the metabolism of other drugs such as aniline, ethylmorphine and hexobarbital, upon multiple dosing.

A moderate first pass metabolism (about 20%) was observed in humans, while rabbits exhibited more extensive first pass metabolism (about 50%) following oral doses.

The metabolism and excretion patterns of ketorolac and its metabolites were similar following p.o., i.v. and i.m. dosing in the species studied. Ketorolac accounted for most of the radioactivity circulating in the plasma ranging from 79% in rabbits to 99% in mice and averaged 96% in humans. Conjugates of ketorolac were not detected in plasma in appreciable amounts in any species. However, the p-hydroxy metabolite (which is essentially inactive when compared to ketorolac) was detected in the plasma of rats, rabbits and humans. Ketorolac and its metabolites were excreted predominantly in the urine of all species, ranging from 69% in rats to essentially 100% in the cynomolgus monkey and averaged 92% in humans. The most comparable species with respect to man metabolically was the mouse.

Toxicology

Acute Toxicity Studies

Animal Strain Sex Route LD 50 (mg/kg)
Mouse HLA- SW/ICR F Oral approx. 400
Mouse HLA- SW/ICR M/F Oral+ 529 (281 - 1540)*
Rat COX-SD F Oral 112 (68 - 191)*
Rat COX-SD M/F Oral+ 100 - 400
Mouse HLA- SW/ICR F i.p. >400
Mouse HLA- SW/ICR M/F i.p.+ 473 (315 - 771)*
Rat COX-SD F i.p. 158 (101 - 248)*
Rat COX-SD M/F i.p.+ 100 - 400

Note:    * 95% confidence interval

            + studies with ketorolac tromethamine; all others with ketorolac free acid. All doses were administered in solution form.

Administration of the free acid of ketorolac at a dose of 200 mg/kg, p.o. in 1 male and 1 female cynomolgus monkey caused both monkeys to vomit after dosing. Other changes seen in the female included diarrhea and anorexia starting 5 days after dosing. The male monkey gained weight while the female had weight loss. Both animals had decreased hemoglobin and hematocrit and survived the 2 week post dose period.

In another study, the identical dose of ketorolac tromethamine salt caused vomiting in the female. No other clinical signs were recorded for this animal. The male monkey appeared normal throughout the study duration.

Sensitization

The sensitization potential of a 0.1% solution of ketorolac tromethamine was evaluated in male guinea pigs. Ketorolac tromethamine did not cause sensitization when tested in the guinea pig model.

Vein Irritation

An intravenous formulation containing ketorolac tromethamine at a concentration of 10 mg/mL was injected into the marginal ear vein of the left ear of each of 6 rabbits (New Zealand albino). The right ear served as a sham control. No evidence of vein irritation was seen following gross or microscopic pathological examinations.

An intravenous formulation containing 10% ethanol and ketorolac tromethamine at a concentration of 10 or 30 mg/mL was injected into the marginal ear vein of the left ears of 6 rabbits (New Zealand albino). The right ear received vehicle only. There was no evidence of drug-related irritation in-life. Minimal irritation was noted microscopically in some animals that received the vehicle or drug formulations.

Subchronic Toxicity Studies

Oral

Ketorolac was administered to groups of male and female mice at doses of 0 (vehicle control), 0.25, 1.0, 4.0 or 16.0 mg/kg/day for a period of 4 weeks.

No drug related change was seen in the mice receiving 0.25 mg/kg/day. In mice receiving the higher doses, dose related changes included decreased activity, pallor, unthrifty appearance, wasting and rough coat. Treatment related deaths occurred in the high dose (16 mg/kg/day) group only (4/6 males and 5/6 females). Food intakes of the female mice in groups receiving 1.0 or 4.0 mg/kg/day were significantly lower than control values. In treated male groups, food intakes were comparable to control values throughout the study.

Hematologic parameters measured revealed decreased hemoglobin and hematocrit levels for groups receiving 4.0 or 16.0 mg/kg/day and elevated total leukocyte and neutrophil counts in the high dose group animals. No biologically meaningful changes were found in any of the plasma chemistry parameters or urinalysis. Gastrointestinal inflammation, erosions and/or ulcers were present in the high dose animals only. No drug related pathological change was present in mice from other dose groups.

Daily oral administration of ketorolac to monkeys at doses of 0.0 (vehicle control), 0.5, 2, 8 or 32 mg/kg/day for 4 weeks resulted in clinical signs of toxicity, and hematologic and pathologic effects at all dose levels. Clinically, a few isolated instances of dark colored urine, vomiting and dark colored feces (fecal blood) were seen in all dose groups but not in controls. There was a slight decrease in hemoglobin and hematocrit levels mainly in the high dose group animals. Other parameters, such as body weight, ophthalmoscopy, clinical chemistry and urinalysis, were all comparable to control values. Gastric erosions were observed in some animals at all dose levels, while gastric ulceration and hemorrhage were seen in some animals receiving 8 or 32 mg/kg/day. Chronic colitis was seen in 3 out of 4 monkeys treated with the highest dose.

Intravenous

Intravenous administration of ketorolac tromethamine to rabbits and monkeys at doses of 0 (vehicle), 0.5, 1.25 or 2.5 mg/kg/day for 2 weeks was well tolerated with no clinically significant treatment related effects.

Intramuscular

Rabbits were administered ketorolac tromethamine intramuscularly at daily doses of 0 (saline control), 10 or 15 mg for 29 consecutive days. Each group comprising 3 males and 3 females received a dose volume of 0.5 mL/animal.

There were no treatment related clinical changes during the study. Minimal to slight hematologic changes occurred in some treated animals. Gross and/or microscopic examinations of the injection sites revealed focal hemorrhage, muscle fiber degeneration and mixed leukocyte infiltration in all groups.

Five groups, each comprised of 3 male and 3 female cynomolgus monkeys, were administered intramuscular injections of saline, vehicle or 4.5, 9.0 or 13.5 mg/kg/day of ketorolac tromethamine for 3 months. Injections were given thrice daily with dose volumes of 0.15, 0.15, 0.05, 0.10 or 0.15 mL/kg/dose for saline, vehicle, low, mid and high dose groups, respectively. The sites injected on the first day and last 7 days of injections were noted for histological examination.

There were no clinical signs of drug related systemic toxicity. However, the incidence and severity of lacerations and ulcers of the extremities (limbs and tail) were increased in the drug treated groups compared to the controls. These lesions were probably the result of bite wounds and the analgesic effect of the drug may have reduced the normal avoidance behavior in response to painful stimuli.

No drug related changes in body weight gain, eye morphology or clinical pathologic results were observed except for slight increases in blood urea nitrogen (BUN) in high and mid dose females.

Local irritation at the injection site was noted in animals from all treatment groups. In conclusion, doses of 4.5, 9.0, and 13.5 mg/kg of ketorolac tromethamine given to monkeys by three times daily intramuscular injections for 3 months caused essentially no drug related systemic toxicity.

Chronic Toxicity Studies

Mice (30 males and 30 females per group) were given either a placebo diet or drug diet mixtures equivalent to an estimated daily dose of 0 (placebo), 3.3, 10 or 30 mg ketorolac tromethamine/kg/day for 6 months.

Treatment related clinical changes were seen in animals in the mid and high dose groups and these included pallor, rough coat, unthrifty appearance, wasting, abdominal enlargement, decreased activity, labored respiration and decreased body temperature. In general, trends of slightly lower body weight and lesser feed intake were observed in treated males and females relative to controls. No drug related ocular lesions were observed in animals.

Prior to termination of the study, 3 of 6 low dose, 9 of 60 mid dose and 52 of 60 high dose animals either died or had to be sacrificed because of poor clinical condition. The cause of debilitation or death of most of the mid and high dose animals was related to erosions and ulcerations in the stomach and large and/or small intestines. Many of these animals were anemic. At all dose levels, renal inflammatory lesions, especially in females were found. An apparent interruption of ovarian cyclic activity was noted histologically. Prostaglandin synthetase inhibitors have been reported to block ovulation by central activity.

Cynomolgus monkeys (4 males and 4 females/group) were administered ketorolac tromethamine orally, twice daily for a period of 6 months at doses of 0 (vehicle control), 0.75, 2.95 or 11.75 mg/kg/day.

There were no treatment related clinical changes or changes in laboratory tests with the exception of slightly elevated urea nitrogen levels in the ketorolac treated animals. The principal gross pathologic finding was pallor of the renal papilla and cortex in both males and females that received the test compound. The gross changes correlated microscopically with minimal to mild increases in interstitial matrix in the renal papilla of the mid and high dose animals only. No specific microscopic change was present in renal cortex which correlated with cortical pallor.

Two groups each with 5 male and 5 female cynomolgus monkeys were administered once daily 0.75 or 2.62 mg/kg of ketorolac tromethamine for 12 months. Two additional groups each with 8 males and 8 females received vehicle only or 9 mg/kg of ketorolac tromethamine for 12 months. All groups received 1.5 mL/kg/day of formulation administered into the stomach by nasal catheter. Three males and three female monkeys from the high dose and vehicle treated groups had a recovery period from dosing of months and then were given clinical laboratory analysis and a complete necropsy at the end of the 12 month dosing period.

Two females (one control and one mid-dose diagnosed with gastroenteropathy and enteropathy respectively) were sacrificed in a moribund condition at week 11 while one female diagnosed with pneumonia was sacrificed at study week 31. Causes of death were varied and not considered related to the test compound.

There were no drug related differences in the clinical condition of the surviving animals. The males showed a dose related decrease in RBC count, hemoglobin, hematocrit, mean corpuscular hemoglobin and hemoglobin concentration. The females were not affected to the same extent as the males but did show marginal decreases in some parameters at some time intervals (mainly in the highest dose group). Normalization of these tests occurred in animals after a 2 month drug free recovery period. The males had a significant increase in BUN, the magnitude of which increased with the dose and time of exposure to the drug. The females had no change in BUN, but the high dose group had a significant increase in serum creatinine at the 9 and 12 month intervals.

Oral administration of 9 mg/kg of ketorolac tromethamine for 12 months caused minimal renal microscopic pathologic changes which included increased intertubular matrix in the papilla and intratubular mineralization in the cortical, medullary and papillary tubules. Those animals given a 2 month period of recovery from dosing showed absences of morphologic damage.

These findings suggest that only mild, reversible kidney changes occurred with high doses of ketorolac tromethamine after one year of treatment. This conclusion is supported by the minimal histopathologic effects observed and by the absence of effects after the recovery period.

Carcinogenicity

The carcinogenic potential of ketorolac tromethamine was assessed in an 18 month feeding study. Fifty Swiss-Webster albino mice were randomly assigned to receive 0.5, 1.0 or 2.0 mg/kg/day of ketorolac tromethamine in their diet. A control group of 100 animals of each sex received the same diet without ketorolac. The duration of the study was 78 weeks. However, males in the highest dose group received control diet for the last 3 weeks of the study due to the high mortality rate in that group relative to controls. Female survival was not affected. All animals received a complete necropsy.

The average body weight of the high dose males was generally lower than that of the controls during the second half of the study. No such effect was evident in males in the lower dose groups or in females. Since the average food intake was similar for all dose groups throughout the study, the difference in body weight was not the result of reduced food intake.

Histopathologic examinations revealed no treatment related increase in the incidence of any type of tumor. Enteritis, gastroenteropathy and peritonitis were seen primarily in the high dose group and were considered expected sequelae to high doses of an NSAID.

In conclusion, there was no evidence for a carcinogenic effect of ketorolac tromethamine in the mouse.

A 24 month feeding study was conducted in rats to assess the carcinogenic potential of ketorolac tromethamine. Fifty Sprague-Dawley rats of either sex were administered in their diet either 0.8, 2.0 or 5.0 mg ketorolac/kg body weight. A control group of 100 animals received the same diet without the drug.

No treatment related changes were noted in clinical condition except for a reddish discoloration of the urine which occurred more frequently in treated males than in controls. The survival times were significantly lower than controls in high dose males and mid and high dose females.

The body weights of the high dose group females were approximately 10% lower than the controls during the last 6 months of the study although no differences in food intakes were noted among the various groups. The high dose males had decreased erythroid parameters, elevated platelet count and a higher incidence of blood in the urine specimens. High dose males and females had elevated BUN and increased neutrophil and decreased lymphocyte counts. Mid and high dose females had a lower urinary specific gravity compared to control females.

There was no evidence for a carcinogenic effect of ketorolac tromethamine in rats.

Mutagenicity

In vitro mutagenic studies were performed with ketorolac, ketorolac tromethamine and tromethamine using 5 strains of bacteria and one of yeast.

Tests were carried out with and without mammalian microsomal activation. None of the compounds tested were mutagenic in any of these test systems. Ketorolac tromethamine was also negative in the in vivo mouse micronucleus test.

Fertility and Reproduction

Female Rat

A two generation study was conducted to evaluate the effects of ketorolac tromethamine on fertility and reproduction in female rats. Groups, each composed of 40 female rats, were administered drug-diet mixtures to achieve doses of 0 (placebo control), 1, 4 or 16 mg/kg/day. The P1 female rats were treated from 14 days before mating until gestation day 13 or until the F1 pups were weaned at 21 days postpartum. The reproductive performance of F2 pups was also evaluated.

No treatment-related effects were seen on the reproductive status at gestation day 13. Some treated females died during the study and the deaths were attributed to gastroenteropathy, nephropathy, or dystocia.

The length of gestation was significantly increased in the high-dose (P1 females) group (median 25 days) when compared to the controls (median 22 days). A slight increase in the length of gestation (median 22.5 days) was noted in the mid-dose group when compared to the controls. Decreased live litter sizes and survival indices were noted in the high-dose group when compared to controls. No pups from the high dose group survived to day 4 of postnatal life. Decreased survival indices (up to day 7) were noted in the mid-dose group when compared to controls. The maternal care and lactation data were comparable among the control, low and mid-dose groups. The clinical condition and body weights of surviving F1 pups were comparable among all groups. The postnatal behavioral and developmental evaluation of F1 pups indicated no treatment-related effects. The reproductive performance of the F1 pups and the neonatal survival of their offspring (F2 pups) were comparable among the groups.

In conclusion, dietary administration of ketorolac tromethamine to female rats prior to and during mating, gestation, parturition and lactation resulted in increased mortality among F0 dams and reduced F1 litter size at 16 mg/kg/day and prolonged gestation period and reduced neonatal survival at 4 and 16 mg/kg/day.

Male Rat

Four groups each with 25 male rats were dosed once daily by gavage with 0, 3.0, 6.0 or 9.0 mg/kg of ketorolac tromethamine. Males were dosed for 104 days prior to cohabitation with undosed females and continued to be dosed through the 14 day mating period. Mating units consisted of one dosed male and two untreated females. Approximately half of the females with evidence of mating were sacrificed at midgestation while the other half were allowed to litter and raise their pups until 21 days postpartum.

No drug-related changes in the clinical condition of the males were observed. Body weight and food intake were not affected by drug treatment. There were no drug related differences in the number of males leaving evidence of mating, the pre-coital interval, or in the number impregnating females.

The females mated with high-dose males and sacrificed at midgestation had a significant preimplantation loss resulting in smaller litter sizes. However, there was no increase in the number of resorptions (post implantation loss) and no decreases in litter size of dams littering at term. Therefore, the reduced number of implantations in the high dose females was not considered to be a drug effect.

There were no differences between drug groups and the control group in regard to body weight, length of gestation, gestation index, lactation index, number of pups born alive and survival indices. Thus, administration of ketorolac tromethamine by gavage to male rats prior to and during the mating period resulted in no effects on male reproductive performance and no drug related effects in their offspring.

Perinatal and Postnatal Reproduction Study

Four groups, each of 25 female rats with evidence of mating were administered 0, 1.8, 4.8, or 9.0 mg/kg/day of ketorolac tromethamine once daily by gavage from day 15 of pregnancy until 21 days postpartum or until all of their pups died. Females that did not litter were treated until approximately 25 days following the last day of mating and then sacrificed for pregnancy determination. Pups found dead within the first four days after parturition received an external examination and a skeletal examination if possible.

Ketorolac tromethamine at a dose of 9.0 mg/kg/day increased the length of gestation, the number of dams found dead or killed for cause as a result of dystocia, the number of pups found dead at first observation and, the number of pups dying within the first seven days postpartum. The weight of male and female pups was also decreased at days 4 and 7 postpartum compared to the control group.

Ketorolac tromethamine at a dose of 4.8 mg/kg/day did not alter the length of gestation of dams littering normally but did increase the incidence of dams found dead or sacrificed for cause as a result of dystocia. The maternal effects observed at the two highest dose levels were expected for a drug of this class.

Ketorolac tromethamine at a dose of 1.8 mg/kg/day caused no alterations in the length of gestation, nature of parturition, pup survival or any other aspect of reproductive performance.

Teratology

Studies were conducted in rats and rabbits. Female rats (25 per group) were administered ketorolac tromethamine at doses of 0 (vehicle control), 0.1, 0.6 or 3.6 mg/kg/day by gavage, once daily from day 6 through day 15 of gestation.

At these doses no maternal toxicity or fetal anatomical abnormalities related to the administration of ketorolac tromethamine were observed.

In a second study, female rats which were administered ketorolac tromethamine 10 mg/kg orally by gavage once daily showed pallor, rough coat and lower body weight gains than the control dams. One dam died on gestation day 15; duodenal ulceration and peritonitis considered to be treatment related were seen. No embryotoxicity or embryolethality were observed. External and skeletal or visceral examinations of fetuses did not reveal any teratogenic changes attributable to the test compound.

Administration of ketorolac tromethamine, to female rabbits during organogenesis (day 6 through day 18 of gestation) by gavage, once daily at doses of 0.1, 0.6 or 3.6 mg/kg/day was not teratogenic.

There were no treatment related clinical changes during the course of the study. One mid dose animal died on gestation day 18 of undetermined cause. All other animals survived to the end of the study. A slight body weight loss was noted in the high dose animals and there was a slight dose related reduction in food consumption during days 6 through 11 of gestation.

There were no statistically significant or biologically meaningful differences in the number of litters with malformations in any of the treated groups when compared to the control group. Developmental and genetic variations in fetuses were comparable for all groups.