tolmetin and Gastrointestinal Hemorrhage studies

Tolmetin: A non-steroidal anti-inflammatory agent (ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL) similar in mode of action to INDOMETHACIN.
tolmetin : A monocarboxylic acid that is (1-methylpyrrol-2-yl)acetic acid substituted at position 5 on the pyrrole ring by a 4-methylbenzoyl group. Used in the form of its sodium salt dihydrate as a nonselective nonsteroidal anti-inflammatory drug.

Gastrointestinal Hemorrhage: Bleeding in any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM.

Research Excerpts

Excerpt	Relevance	Reference
"The new antirheumatic agents, fenoprofen calcium, naproxen, and tolmetin sodium, are effective in the management of rheumatoid arthritis."	3.65	New antirheumatic agents: Fenoprofen calcium (Nalfon), naproxen (Naprosyn), and tolmetin sodium (Tolectin). ( Lewis, JR, 1977)
"Treatment with ketorolac is completed during hospitalization; therefore, compliance is ensured."	2.68	Ketorolac prophylaxis against heterotopic ossification after hip replacement. ( Pritchett, JW, 1995)
" In general, the adverse events associated with ketorolac are similar to other NSAIDs."	2.39	Side effects of NSAIDs and dosing recommendations for ketorolac. ( Camu, F; Lauwers, MH; Vanlersberghe, C, 1996)
"Ketorolac was 5 times more gastrotoxic than all other NSAIDs (RR, 5."	1.30	Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs. ( Agostinis, L; Cattaruzzi, C; García Rodríguez, LA; Troncon, MG, 1998)
" A dose-response relationship was evident between average daily ketorolac dose and both gastrointestinal bleeding and operative site bleeding (trend test P < ."	1.29	Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study. ( Berlin, JA; Carson, JL; Feldman, H; Hennessy, S; Kimmel, S; Kinman, JL; Spitz, PW; Strom, BL, 1996)
"Ketorolac proved safe for short-term intravenous use in children more than 1 year of age when patients with known contraindications to the use of non-steroidal antiinflammatory drugs were excluded."	1.29	Safety of intravenous ketorolac therapy in children and cost savings with a unit dosing system. ( Berde, CB; Houck, CS; McDermott, JS; Sethna, NF; Wilder, RT, 1996)

Research

Studies (23)

Authors

Clinical Trials (2)

Trial Overview

Trial Outcomes

Average Inpatient Hydromorphone Use

Timeframe	Studies, this research(%)	All Research%
pre-1990	4 (17.39)	18.7374
1990's	19 (82.61)	18.2507
2000's	0 (0.00)	29.6817
2010's	0 (0.00)	24.3611
2020's	0 (0.00)	2.80

Authors	Studies
Joubert, DW	1
Rimbau, V	1
Fernández, E	1
Torralba, A	1
Sabater, J	1
Pritchett, JW	1
Yarboro, TL	1
Wiedrick, JE	1
Friesen, EG	1
Garton, AM	1
Otten, NH	1
Marcos Sánchez, F	1
Aparicio Martínez, JC	1
Arranz Nieto, MJ	1
Pérez-Navarro, AD	1
Murray, RP	1
Watson, RC	1
Quigley, EM	1
Ruh, P	1
Steinberg, RB	1
Tessier, EG	1
McDonald, E	1
Marino, C	1
Schwartz, E	1
Strom, BL	1
Berlin, JA	1
Kinman, JL	1
Spitz, PW	1
Hennessy, S	1
Feldman, H	1
Kimmel, S	1
Carson, JL	1
Sacanella, E	1
Muñoz, F	1
Cardellach, F	1
Estruch, R	1
Miró, O	1
Urbano-Márquez, A	1
Houck, CS	1
Wilder, RT	1
McDermott, JS	1
Sethna, NF	1
Berde, CB	1
O'Hanlon, JJ	1
Beers, H	1
Huss, BK	1
Milligan, KR	1
Alcaraz, A	1
López-Herce, J	1
Seriñá, C	1
Bueso-Inchausti, A	1
Saez, MJ	1
Sancho, L	1
Camu, F	1
Lauwers, MH	1
Vanlersberghe, C	1
Lagerkranser, M	1
Belfrage, M	1
Flordal, PA	1
Persson, E	1
Dies, DF	1
Clarkston, WK	1
Schratz, CL	1
García Rodríguez, LA	1
Cattaruzzi, C	1
Troncon, MG	1
Agostinis, L	1
Lewis, JR	1
Pemberton, RE	1
Strand, LJ	1
O'Hara, DA	1
Horswell, JL	1

Trial	Phase	Enrollment	Study Type	Start Date	Status
Opioid-Free Versus Transitional Anesthetic With Opioids From Tonsillectomy[NCT04528173]	Phase 4	550 participants (Anticipated)	Interventional	2020-07-22	Recruiting
A Randomized Control Trial Study of the Efficacy of Celecoxib Versus Ketorolac for Perioperative Pain Control[NCT03331315]	Phase 2	170 participants (Actual)	Interventional	2013-09-01	Completed
[information is prepared from clinicaltrials.gov, extracted Sep-2024]

Average inpatient hydromorphone use measured in milligrams (NCT03331315)
Timeframe: 48 hrs following surgery

Average Inpatient Ondansetron Use

Intervention	Milligrams (Mean)
Ketorolac	0.7
Celecoxib	0.8

Average inpatient ondansetron use measured in milligrams (NCT03331315)
Timeframe: 48 hrs following surgery

Average Inpatient Postoperative Pain Score

Intervention	Milligrams (Mean)
Ketorolac	1.5
Celecoxib	1.3

Pain measured using the Visual Analog Scale, no pain (0-0.4 cm), mild pain(0.5-4.4 cm), moderate pain (4.5-7.4 cm), and severe pain (7.5-10.0 cm). Subscale scoring was not used in analysis but provided as reference for patient and nursing staff. (NCT03331315)
Timeframe: 48 hrs following surgery

Days of Oral Narcotic Use After Discharge

Intervention	units on a scale (Mean)
Ketorolac	2.7
Celecoxib	2.4

Measured using postoperative questionnaire (NCT03331315)
Timeframe: 2 weeks after discharge

Number of Oral Narcotic Pills Used After Discharge

Intervention	Days (Mean)
Ketorolac	5.7
Celecoxib	3.8

Number of oral narcotic pills used after discharge until 2 week postoperative visit. (NCT03331315)
Timeframe: 2 weeks after discharge

Number of Participants With Perioperative Complications

Intervention	Pills (Mean)
Ketorolac	8.1
Celecoxib	6.0

Perioperative Complications measured intraoperatively and postoperatively by type (NCT03331315)
Timeframe: During and after surgery

Return to Activities of Daily Living

Intervention	Patients (Number)
Ketorolac	5
Celecoxib	6

Average number of days required for complete return to independent activities of daily living (NCT03331315)
Timeframe: 2 weeks after discharge

Total Hospital Stay

Intervention	Days (Mean)
Ketorolac	2.4
Celecoxib	2.2

Total hospital stay from time fo admission to time of discharge measured in hours (NCT03331315)
Timeframe: Following surgery

Article	Year
Ketorolac prophylaxis against heterotopic ossification after hip replacement. Clinical orthopaedics and related research, 1995, Issue:314 Topics: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female	1995
A comparison of the effect of intramuscular diclofenac, ketorolac or piroxicam on post-operative pain following laparoscopy. European journal of anaesthesiology, 1996, Volume: 13, Issue:4 Topics: Adult; Analgesia; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Bronchial Disea	1996
A review of upper-gastrointestinal effects of the newer nonsteroidal antiinflammatory agents. Digestive diseases and sciences, 1979, Volume: 24, Issue:1 Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Rheumatoid; Aspirin; Clinical Trials as	1979

Article	Year
Zomepirac overdose and review of literature on acute toxicity of nonsteroidal antiinflammatory agents. Drug intelligence & clinical pharmacy, 1982, Volume: 16, Issue:4 Topics: Adult; Anti-Inflammatory Agents; Arrhythmias, Cardiac; Bicarbonates; Charcoal; Gastrointestinal Hemo	1982
Comparative study of the gastrointestinal tolerability of tolmetin and 4'-acetamidophenyl-2-(5'-p-toluyl-1'-methylpyrrole) acetate (AU-8001). Arzneimittel-Forschung, 1983, Volume: 33, Issue:6 Topics: Animals; Feces; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Hemoglobins; Kinetics; Male;	1983
Intramuscular Toradol, gastrointestinal bleeding, and peptic ulcer perforation: a case report. Journal of the National Medical Association, 1995, Volume: 87, Issue:3 Topics: Adult; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Drug Combinations; Fema	1995
Upper gastrointestinal bleeding associated with oral ketorolac therapy. The Annals of pharmacotherapy, 1994, Volume: 28, Issue:9 Topics: Administration, Oral; Adult; Anti-Inflammatory Agents, Non-Steroidal; Drug Administration Schedule;	1994
[Upper digestive hemorrhage after oral administration of ketorolac]. Anales de medicina interna (Madrid, Spain : 1984), 1994, Volume: 11, Issue:10 Topics: Administration, Oral; Aged; Anti-Inflammatory Agents, Non-Steroidal; Gastrointestinal Hemorrhage; Hu	1994
Acute renal failure and gastrointestinal bleed associated with postoperative toradol and vancomycin. Orthopedics, 1993, Volume: 16, Issue:12 Topics: Acute Kidney Injury; Adult; Anti-Inflammatory Agents, Non-Steroidal; Drug Combinations; Gastrointest	1993
Ketorolac-associated upper gastrointestinal hemorrhage. The American journal of gastroenterology, 1994, Volume: 89, Issue:2 Topics: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Female; Gastrointestinal Hemorrhag	1994
Gastrointestinal bleeding after administration of ketorolac. Anesthesiology, 1993, Volume: 79, Issue:5 Topics: Aged; Aged, 80 and over; Analgesics; Female; Gastrointestinal Hemorrhage; Humans; Injections, Intram	1993
Toradol and the risk of gastrointestinal complications in the elderly. Journal of the American Geriatrics Society, 1993, Volume: 41, Issue:1 Topics: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Drug Combinations; Female; Gastroi	1993
Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study. JAMA, 1996, Feb-07, Volume: 275, Issue:5 Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies;	1996
Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study. JAMA, 1996, Feb-07, Volume: 275, Issue:5 Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies;	1996
Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study. JAMA, 1996, Feb-07, Volume: 275, Issue:5 Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies;	1996
Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study. JAMA, 1996, Feb-07, Volume: 275, Issue:5 Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies;	1996
Massive haemorrhage due to colitis secondary to nonsteroidal anti-inflammatory drugs. Postgraduate medical journal, 1996, Volume: 72, Issue:843 Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Aortic Aneurysm, Abdominal; Colitis; Gastrointestinal	1996
Safety of intravenous ketorolac therapy in children and cost savings with a unit dosing system. The Journal of pediatrics, 1996, Volume: 129, Issue:2 Topics: Adolescent; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Child; Child, Prescho	1996
Gastrointestinal bleeding following ketorolac administration in a pediatric patient. Journal of pediatric gastroenterology and nutrition, 1996, Volume: 23, Issue:4 Topics: Analgesics, Non-Narcotic; Aneurysm, False; Aortic Coarctation; Female; Gastrointestinal Hemorrhage;	1996
[Reduce the dosage of ketorolac! Following EEC recommendations reduces the risk of hemorrhage with a marginal reduction of the analgesic effect]. Lakartidningen, 1996, Dec-04, Volume: 93, Issue:49 Topics: Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Clinical Trials as Topic; Europea	1996
No harm was done. The American journal of gastroenterology, 1997, Volume: 92, Issue:3 Topics: Adjuvants, Anesthesia; Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Cons	1997
Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs. Archives of internal medicine, 1998, Jan-12, Volume: 158, Issue:1 Topics: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Antihypertensive Agents; Ca	1998
New antirheumatic agents: Fenoprofen calcium (Nalfon), naproxen (Naprosyn), and tolmetin sodium (Tolectin). JAMA, 1977, Mar-21, Volume: 237, Issue:12 Topics: Anti-Inflammatory Agents; Arthritis, Rheumatoid; Aspirin; Fenoprofen; Gastrointestinal Hemorrhage; H	1977
Bleeding diathesis after perioperative ketorolac. Anesthesia and analgesia, 1992, Volume: 74, Issue:1 Topics: Anti-Inflammatory Agents, Non-Steroidal; Gastrointestinal Hemorrhage; Humans; Ketorolac; Postoperati	1992
Bleeding diathesis after perioperative ketorolac. Anesthesia and analgesia, 1992, Volume: 74, Issue:1 Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Gastrointestinal Hemorrhage; Humans; Ketorolac; Male;	1992

tolmetin and Gastrointestinal Hemorrhage