What is Tolar LX?
Tolar LX is a nonsteroidal anti-inflammatory drug (NSAID). Tolar LX works by reducing hormones that cause inflammation and pain in the body.
Tolar LX is used short-term (5 days or less) to treat moderate to severe pain.
Tolar LX may also be used for purposes not listed in this medication guide.
Tolar LX indications
Carefully consider the potential benefits and risks of Tolar LX Tromethamine and other treatment options before deciding to use Tolar LX. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
Acute Pain in Adult Patients
Tolar LX Tromethamine is indicated for the short-term (≤5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting. Therapy should always be initiated with IV or IM dosing of Tolar LX Tromethamine, and oral Tolar LX Tromethamine is to be used only as continuation treatment, if necessary.
The total combined duration of use of Tolar LX Tromethamine injection and oral Tolar LX Tromethamine is not to exceed 5 days of use because of the potential of increasing the frequency and severity of adverse reactions associated with the recommended doses. Patients should be switched to alternative analgesics as soon as possible, but Tolar LX Tromethamine therapy is not to exceed 5 days.
Tolar LX Tromethamine injection has been used concomitantly with morphine and meperidine and has shown an opioid-sparing effect. For breakthrough pain, it is recommended to supplement the lower end of the Tolar LX Tromethamine injection dosage range with low doses of narcotics prn, unless otherwise contraindicated. Tolar LX Tromethamine injection and narcotics should not be administered in the same syringe.
How should I use Tolar LX?
Use Tolar LX spray as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Tolar LX spray comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Tolar LX spray refilled.
- Do not take Tolar LX spray by mouth. Use in your nose only.
- Before you use each bottle for the first time, you must prime it. Remove the clear plastic cover and the blue plastic safety clip. Hold the bottle at arm's length away from you. Using your index and middle fingers on the top of the bottle and your thumb on the bottom of the bottle, press down evenly and release the pump 5 times. The bottle is now ready to use.
- To use this nose spray, gently blow your nose. Sit up straight or stand and tilt your head forward slightly. Place the tip of the spray container into the nose. Be sure to point the container away from the center of your nose. Breathe gently through the nostril and squeeze the spray container. If your dose requires 2 sprays, repeat the process for your other nostril. Replace the clear plastic cover after each use.
- Do NOT use Tolar LX spray for more than 5 days. Tolar LX spray is not for the treatment of mild to moderate or chronic pain (eg, headache).
- Avoid contact with the eyes. If you get Tolar LX spray in your eyes, rinse it out with water. If eye irritation persists for more than 1 hour, contact your doctor.
- Each bottle contains 1 day's supply of Tolar LX spray. Discard each bottle within 24 hours of opening it, even if it still contains some unused medicine.
- If you miss a dose of Tolar LX spray and you are taking it regularly, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Tolar LX spray.
Uses of Tolar LX in details
Use: Labeled Indications
Pain, moderate to moderately severe: Short-term (up to 5 days) management of moderate to moderately severe pain in adults that requires analgesia at the opioid level.
Off Label Uses
Migraine
Data from a prospective, randomized, double-blind, double-dummy, placebo and active comparator, crossover, non-inferiority trial suggests that intranasal Tolar LX may be beneficial for acute abortive treatment of migraine in patients with a history of episodic migraines for at least 1 year.
Tolar LX description
A synthetic opioid that is used as the hydrochloride. It is an opioid analgesic that is primarily a mu-opioid agonist. It has actions and uses similar to those of morphine. It also has a depressant action on the cough center and may be given to control intractable cough associated with terminal lung cancer. Tolar LX is also used as part of the treatment of dependence on opioid drugs, although prolonged use of methadone itself may result in dependence. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1082-3)
Tolar LX dosage
Carefully consider the potential benefits and risks of Tolar LX tromethamine tablets and other treatment options before deciding to use Tolar LX tromethamine tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals. In adults, the combined duration of use of IV or IM dosing of Tolar LX tromethamine and Tolar LX tromethamine tablets is not to exceed 5 days. In adults, the use of Tolar LX tromethamine tablets is only indicated as continuation therapy to IV or IM dosing of Tolar LX tromethamine.
Transition from IV or IM dosing of Tolar LX tromethamine (single- or multiple-dose) to multiple-dose Tolar LX tromethamine tablets:
Patients age 17 to 64: 20 mg PO once followed by 10 mg q4 to 6 hours prn not > 40 mg/day
Patients age ≥ 65, renally impaired, and/or weight < 50 kg (110 lbs): 10 mg PO once followed by 10 mg q4 to 6 hours prn not > 40 mg/day
Note:
Oral formulation should not be given as an initial dose.
Use minimum effective dose for the individual patient.
Do not shorten dosing interval of 4 to 6 hours.
Total duration of treatment in adult patients: the combined duration of use of IV or IM dosing of Tolar LX tromethamine and Tolar LX tromethamine tablets is not to exceed 5 days.
The following table summarizes Tolar LX tromethamine tablet dosing instructions in terms of age group:
| Patient Population | Tolar LX Tromethamine Tablets (following IV or IM dosing of Tolar LX tromethamine) |
| Age < 17 years | Oral not approved |
| Adult Age 17 to 64 years | 20 mg once, then 10 mg q4 to 6 hours prn not > 40 mg/day |
| Adult Age ≥ 65 years, renally impaired, and/or weight < 50 kg | 10 mg once, then 10 mg q4 to 6 hours prn not > 40 mg/day |
Tolar LX interactions
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What other drugs will affect Tolar LX?
Tolar LX slightly reduces the plasma protein-binding of warfarin. In vitro studies indicate that at therapeutic concentration of salicylate, the binding of Tolar LX reduces from approximately 99.2-97.5%; representing a potential 2-fold increase in unbound plasma Tolar LX levels. Tolar LX has been reported to reduce the diuretic response to furosemide in normovolemic individuals by approximately 20%.
Concomitant administration of Tolar LX and probenecid results in decreased clearance of Tolar LX and significant increase in Tolar LX plasma levels (approximately 3-fold increase), and there is an increase of approximately 2-fold in terminal half-life.
Increase in plasma lithium concentration due to inhibition of renal lithium clearance has been reported with some NSAIDs. There have been some reports of increased lithium plasma levels with Tolar LX also.
There have been reports of a possible interaction of Tolar LX and nondepolarizing muscle relaxants, which lead to apnea. Concomitant use of Tolar LX and angiotensin-converting enzyme inhibitors may increase the risk of renal impairment, particularly in volume-depleted patients.
Very few cases of seizure have been reported with concomitant use of Tolar LX and antiepileptic drugs (phenytoin, carbamazepine). There have been reports of hallucinations when Tolar LX is concomitantly used with psychoactive drugs (fluoxetine, thiothixene, alprazolam).
Laboratory Tests: Tolar LX inhibits platelet aggregation and may prolong bleeding time.
Food: Food reduces the rate but not the extent of absorption.
Tolar LX side effects
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What are the possible side effects of Tolar LX?
Applies to Tolar LX ophthalmic: ophthalmic solution
In addition to its needed effects, some unwanted effects may be caused by Tolar LX ophthalmic. In the event that any of these side effects do occur, they may require medical attention.
Major Side Effects
You should check with your doctor immediately if any of these side effects occur when taking Tolar LX ophthalmic:
More common:
- Itching, redness, tearing, or other sign of eye irritation not present before use of this medicine or becoming worse during use
- redness of the clear part of the eye
- sensitivity to light
- swelling of the eye
- tearing
- throbbing pain
- Blurred vision or other change in vision
- eye irritation or redness
Minor Side Effects
Some of the side effects that can occur with Tolar LX ophthalmic may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:
More common:
- Stinging or burning of the eye when medicine is applied
- Dry eyes
- headache
Tolar LX contraindications
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What is the most important information I should know about Tolar LX?
Tolar LX Tromethamine is contraindicated in patients with previously demonstrated hypersensitivity to Tolar LX Tromethamine.
Tolar LX Tromethamine is contraindicated in patients with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or perforation and in patients with a history of peptic ulcer disease or gastrointestinal bleeding.
Tolar LX Tromethamine should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients.
Tolar LX Tromethamine is contraindicated as prophylactic analgesic before any major surgery.
Tolar LX Tromethamine is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
Tolar LX Tromethamine is contraindicated in patients with advanced renal impairment or in patients at risk for renal failure due to volume depletion.
Tolar LX Tromethamine is contraindicated in labor and delivery because, through its prostaglandin synthesis inhibitory effect, it may adversely affect fetal circulation and inhibit uterine musculature, thus increasing the risk of uterine hemorrhage.
Tolar LX Tromethamine inhibits platelet function and is, therefore, contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis and those at high risk of bleeding.
Tolar LX Tromethamine is contraindicated in patients currently receiving aspirin or NSAIDs because of the cumulative risks of inducing serious NSAID-related adverse events.
The concomitant use of Tolar LX Tromethamine and probenecid is contraindicated.
The concomitant use of Tolar LX Tromethamine and pentoxifylline is contraindicated.
Tolar LX Tromethamine injection is contraindicated for neuraxial (epidural or intrathecal) administration due to its alcohol content.
Active ingredient matches for Tolar LX:
| Unit description / dosage (Manufacturer) | Price, USD |
| TOLAR LX EYE DROP 1 packet / 5 ML eye drop each (Pharmtak Ophtalmics India Pvt Ltd) | $ 0.60 |
| Tolar LX 0.5% w/v Eye Drop (Pharmtak Ophtalmics India Pvt Ltd) | $ 0.60 |
List of Tolar LX substitutes (brand and generic names): | |
| TOLAR MX | |
| TOLAR MX EYE DROP 1 packet / 5 ML eye drop each (Pharmtak Ophtalmics India Pvt Ltd) | $ 0.84 |
| Toloran (Mexico) | |
| Injectable; Injection; Ketorolac Tromethamine 30 mg / ml (Rayere) | |
| Tablet; Oral; Ketorolac Tromethamine 10 mg (Rayere) | |
| Tablets; Oral; Ketorolac Tromethamine 10 mg (Rayere) | |
| Topadol (Israel) | |
| Injectable; Injection; Ketorolac Tromethamine 3% (Teva) | |
| Tablet; Oral; Ketorolac Tromethamine 10 mg (Teva) | |
| Tablets; Oral; Ketorolac Tromethamine 10 mg (Teva) | |
| Tora-dol (Italy, South Africa, Switzerland) | |
| Injectable; Injection; Ketorolac Tromethamine 10 mg / ml (Recordati) | |
| Tablet, Film-Coated; Oral; Ketorolac Tromethamine 10 mg (Recordati) | |
| Tablets, Film-Coated; Oral; Ketorolac Tromethamine 10 mg (Recordati) | |
| Tora-dol 10mg (Switzerland) | |
| Tora-dol 30 mg/ml (Switzerland) | |
| Toradol I.M. | |
| Injectable; Injection; Ketorolac Tromethamine 10 mg / ml | |
| Injectable; Injection; Ketorolac Tromethamine 30 mg / ml | |
| Toradol IM | |
| Toradol Im solution 10 mg (Atnahs Pharma Uk Limited (Canada)) | |
| Toradol IV / IM | |
| Toradol Tablets | |
| Toragesic (Brazil) | |
| Toralac (Peru) | |
| Toralgin (Paraguay) | |
| Toramine (Indonesia) | |
| Toramine 10 mg x 1 mL x 5's (Otto) | $ 9.30 |
| Toramine 30 mg x 1 mL x 5's (Otto) | $ 14.26 |
| Torasic (Indonesia) | |
| Torasic 10 mg x 2 x 10's (Kalbe Farma) | $ 11.59 |
| Torasic 10 mg/1 mL x 1 x 6's (Kalbe Farma) | $ 14.58 |
| Torasic 30 mg/1 mL x 1 x 6's (Kalbe Farma) | $ 21.61 |
| Torasyn (Greece) | |
| Torax (Bangladesh) | |
| Torkol (Mexico) | |
| Injectable; Injection; Ketorolac Tromethamine 30 mg / ml (Sandoz) | |
| Tablet; Oral; Ketorolac Tromethamine 10 mg (Sandoz) | |
| Tablets; Oral; Ketorolac Tromethamine 10 mg (Sandoz) | |
| Toroaid (Bangladesh) | |
| Torolac (Bangladesh, India) | |
| Torolac 10mg TAB / 10 (Lupin Laboratories Ltd.) | $ 0.22 |
| Torolac 30mg INJ / 1ml (Lupin Laboratories Ltd.) | $ 0.10 |
| 10 mg x 10's (Lupin Laboratories Ltd.) | $ 0.22 |
| 30 mg x 1ml (Lupin Laboratories Ltd.) | $ 0.10 |
| Drops; Ophthalmic; Ketorolac Tromethamine 0.5% (Lupin Laboratories Ltd.) | |
| Injectable; Injection; Ketorolac Tromethamine 30 mg / ml (Lupin Laboratories Ltd.) | |
| Tablets; Oral; Ketorolac Tromethamine 10 mg (Lupin Laboratories Ltd.) | |
| Torolac 10 mg Tablet (Lupin Laboratories Ltd.) | $ 0.02 |
| Torolac Eye 5 ml Drop (Lupin Laboratories Ltd.) | $ 0.42 |
| Torolac 30 mg Injection (Lupin Laboratories Ltd.) | $ 0.10 |
| TOROLAC 0.5% EYE DROPS 1 packet / 5 ML eye drop each (Lupin Laboratories Ltd.) | $ 0.51 |
See 935 substitutes for Tolar LX | |
References
- PubChem. "ketorolac". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "ketorolac". http://www.drugbank.ca/drugs/DB00465 (accessed September 17, 2018).
- MeSH. "Cyclooxygenase Inhibitors". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
