Phenylephrine and ketorolac are two different medications with distinct mechanisms of action and uses.

• Phenylephrine:
  • Class: Phenylephrine is a decongestant that belongs to the class of medications known as alpha-1 adrenergic agonists.
  • Mechanism of Action: It works by constricting blood vessels, particularly in the nasal passages. This constriction helps reduce nasal congestion associated with conditions like the common cold or allergies.
  • Uses: Phenylephrine is commonly used to relieve nasal discomfort caused by congestion.
• Ketorolac:
  • Class: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID).
  • Mechanism of Action: It works by inhibiting the production of prostaglandins, which are substances in the body that play a role in inflammation. By reducing prostaglandin levels, ketorolac can help alleviate pain and inflammation.
  • Uses: Ketorolac is often used for the short-term management of moderate to severe pain, such as that resulting from surgery, injury, or certain medical conditions. It is available in both oral and injectable forms.

Phenylephrine and Ketorolac (Omidria) is a combination of an alpha-adrenergic receptor agonist that dilates the pupil and an NSAID that relieves inflammation and pain. It is used during ocular surgeries for pain and for pupillary dilation.

Phenylephrine and ketorolac Use:

• Ophthalmic surgical irrigation:
  • In order to dilate the pupil and preserve pupillary size during cataract surgery or intraocular lens replacement, it is added to an ophthalmic irrigation solution. This prevents intraoperative miosis and lessens postoperative ocular discomfort.

Phenylephrine and Ketorolac (Omidria) Dose in Adults

Phenylephrine and Ketorolac (Omidria) Dose in surgical irrigation:

• The amount used depends on the needs of the surgery, and it's applied during the procedure to help with things like reducing congestion and managing pain and inflammation.

Phenylephrine and Ketorolac (Omidria) Dose in Children

Phenylephrine and Ketorolac (Omidria) Dose in surgical irrigation:

Babies, children, and teenagers having eye surgery, phenylephrine and ketorolac can be used in a diluted solution.

• The amount used depends on what's necessary for that specific surgery, and it's applied during the procedure for one patient at a time.

Phenylephrine and Ketorolac (Omidria) Pregnancy Category: C

• When you use these eye medications during surgery, the chance of them spreading throughout the whole body is pretty low.
• However, it's important to be cautious, especially during the last few months of pregnancy, as using similar drugs in that period has been linked to early closure of a blood vessel in the developing baby.
• To be safe, the manufacturer suggests not using this product late in pregnancy.

Use of phenylephrine or ketorolac during breastfeeding

• When you use these eye medications during surgery, they usually don't spread much throughout the body.
• If you're a breastfeeding mom and considering these medications, it's advised to think about the potential exposure of your baby to the medication.
• The decision to breastfeed or not should consider the balance between the benefits of breastfeeding for your baby, the risk of the baby being exposed to the medication, and how helpful the treatment is for you as a mom.

Dose in Kidney Disease:

• The instructions from the company that makes the medication don't say you need to change the dose if your kidneys aren't working perfectly.
• So, if you have any kidney issues, you might not need to adjust how much of the medicine you take based on what the manufacturer recommends.

Dose in Liver disease:

• The information from the company that makes the medication doesn't include any changes in the recommended dose for people with liver problems.
• This means that if you have issues with your liver, the usual dose as mentioned by the manufacturer should still be okay.

Common Side Effects of Phenylephrine and Ketorolac (Omidria):

• Ophthalmic:
  • Anterior chamber inflammation

Less Common Side Effects of Phenylephrine and ketorolac:

• Central nervous system:
  • Foreign body sensation of eye
• Ophthalmic:
  • Increased intraocular pressure
  • Posterior capsule opacification
  • Eye irritation

Contraindications to Phenylephrine and Ketorolac (Omidria):

• If your body is super sensitive or allergic to phenylephrine, ketorolac, or any part of the medicine mixture, you shouldn't use it.
• This means if you've had a bad reaction to these things before, it's not safe for you.

Warnings and precautions

Hypersensitivity

• If you've had issues with allergies to acetylsalicylic acid (aspirin), phenylacetic acid, or other similar anti-inflammatory drugs in the past, there's a chance you could also have a bad reaction to ketorolac.
• It's important to be careful if you have a history of being sensitive to these medications.
• In some cases, people who've had problems with aspirin or other anti-inflammatory drugs, or who have a history of asthma, may experience difficulty breathing or asthma getting worse after using ketorolac.

Hypertension:

• Using phenylephrine for eye irrigation can lead to small amounts of it getting into the bloodstream, and this might cause an increase in blood pressure.
• If you have hypertension (high blood pressure), it's something to be aware of.

Ocular light sensitivity:

• Using this medication might make your eyes more sensitive to light.
• So, if you notice that light bothers your eyes more than usual while using it, that's a possible side effect.

Phenylephrine and Ketorolac injection: Drug Interaction

Monitoring Parameters:

None mentioned. Monitor Blood pressure and signs and symptoms of sympathetic overdrive such as tachycardia.   

How to administer Phenylephrine and Ketorolac (Omidria)?

Ophthalmic Irrigation During Surgery: Simple Guidelines

• Dilution is a Must:
  • Before using for eye surgery, make sure to dilute the solution.
• Clarity Matters:
  • Do not use the solution if it looks cloudy or has particles in it.

Mechanism of action of Phenylephrine and Ketorolac (Omidria):

Ketorolac:

• Type: NSAID (Nonsteroidal Anti-Inflammatory Drug)
• Action:
  • Inhibits both COX-1 and COX-2 cyclooxygenase enzymes.
  • Decreases prostaglandin concentrations.
  • Reduces surgical pain.
  • Prevents surgically induced contraction of the pupil.

Phenylephrine:

• Type: Alpha-Adrenergic Receptor Agonist
• Action:
  • Causes dilation of the pupil.
  • Achieved by contracting the radial muscle of the iris.

These medications work differently but play important roles during surgical procedures. Ketorolac helps manage pain and prevents pupil contraction, while phenylephrine contributes to pupil dilation through its action on the iris muscles.

Absorption After Irrigation:

• Systemic Absorption:
  • Low to undetectable following irrigation.
• Plasma Concentrations:
  • Phenylephrine:
    • 1.2 to 1.4 ng/mL within 2 hours.
  • Ketorolac:
    • 1 to 4.2 ng/mL within 8 hours.

These findings indicate that after irrigation with a diluted phenylephrine/ketorolac solution, the absorption into the bloodstream is minimal. Plasma concentrations, or the amount of these substances in the blood, remain within specific ranges within a few hours after the irrigation process.Top of Form

International Brand Names of Phenylephrine and ketorolac:

• Omidria

Phenylephrine and ketorolac Brand Names in Pakistan:

Not available.