Who can administer
May be administered by registered competent doctor or nurse/midwife
Important information
- Note: The maximum dose for intravenous use is 50mg tds for two days ONLY. The oral formulation has a maximum dose of 25mg tds.
- Maximum dose in mild forms of hepatic or renal impairment (which is likely to include most older persons) is 50mg in 24 hours. See dosage information for further details before prescribing
Available preparations
Keral 50mg per 2ml ampoule
Reconstitution
Already in solution
Draw up using a 5 micron filter needle
Infusion fluids
Sodium chloride 0.9% or Glucose 5%
Methods of intravenous administration
Intermittent intravenous injection (preferred method)
- Add 50mg to 100ml infusion fluid and administer over 10 to 30 minutes
- Protect infusion solution from natural daylight
- A 50ml infusion may be used if required (eg fluid restriction) but the residual volume in the infusion line must be flushed through at the same rate to avoid significant underdosing
Bolus intravenous injection
- (If necessary), can be administered undiluted over at least 15 seconds
Dose in adults
Usual dose
- Give 50mg every eight to twelve hours (if necessary, can be given at six hour intervals)
- Maximum daily dose 150mg (maximum 50mg daily for most elderly patients, see renal impairment below)
- Maximum duration of treatment two days (IV-->PO switch thereafter)
Renal impairment
- Maximum daily dose 50mg if creatinine clearance 60-89ml/min
- SHOULD NOT be used if creatinine clearance <60ml/min
Hepatic impairment
- Mild to moderate hepatic impairment (Child-Pugh score 5-9)- maximum daily dose is 50mg
- Cannot be used in severe hepatic impairment (Child-Pugh score 10 to 15)
Further information
- Contains 200mg alcohol per 2ml ampoule
- Can also be given by intramuscular injection
Storage
- Store below 25C
- Protect from light - keep ampoules in box until required
- The prepared infusion must be protected from natural daylight
References
SPC Jan 2022
Therapeutic classification
Non Steroidal Anti-inflammatory agent