Objective: To improve quality-of-life and health care delivery to patients receiving ureteral stents.
Specific Aims: Evaluate the feasibility, practicality, and qualitative outcomes of utilizing intra-nasal ketorolac in patients with indwelling ureteral stents (Phase I), followed by a randomized trial comparing two non-steroidal anti-inflammatory drugs, intra-nasal Ketorolac versus oral Diclofenac.
Hypotheses: Due to its favorable pharmacokinetics in relieving acute pain, investigators expect improved pain scores and a lower rate of unplanned clinical encounters in patients receiving intra-nasal ketorolac compared to those taking oral diclofenac following ureteroscopic surgery for urolithiasis.
Study Rationale: Following ureteroscopic management of urolithiasis, patient with indwelling ureter stents have higher levels of discomfort compared to those without a ureter stent. Prior studies showed that intramuscular Ketorolac at time of ureter stent removal decreased the incidence of unplanned clinical encounters. Furthermore, onset of analgesic effect by intra-nasal ketorolac is faster than its oral form, and similar its intramuscular and intravenous counterparts.

Start Date01 Jan 2025

Sponsor / Collaborator

The University of Texas Southwestern Medical Center

[+1]

NCT06081101 / Not yet recruitingEarly Phase 1IIT

Ultrasound Guided Sacroiliac Joint Injections With Ketorolac Versus Corticosteroid: A Prospective Non-inferiority Study

This study will contribute to the current literature that have compared joint injections with steroid versus ketorolac providing evidence for the use of ketorolac for SI joint pain. Currently steroid is the clinical standard for joint injections, however with repetitive use, steroid injections can damage the joint. Ketorolac is an alternative anti-inflammatory medication that does not cause the same joint damage and at a cheaper cost than steroid. The investigators hypothesize that ultrasound guided SI joint injections utilizing ketorolac provide the same pain relief as corticosteroid SI joint injections measured at 2, 6 and 12 weeks post injection. This would allow more frequent injections to control pain at a decreased cost to the healthcare system.

Start Date01 Jan 2025

Sponsor / Collaborator

McMaster University

CTRI/2024/11/077278 / Not yet recruitingPhase 3IIT

The efficacy of sublingual ketorolac with tramadol in post operative pain relief in cesarean cases a double blinded randomized controlled trial - NIL

Start Date15 Dec 2024

Sponsor / Collaborator

Vinayaka Missions University

100 Clinical Results associated with Ketorolac

100 Translational Medicine associated with Ketorolac

100 Patents (Medical) associated with Ketorolac

3,317

Literatures (Medical) associated with Ketorolac

15 Dec 2024·Spine

Addition of Ketorolac to Local Anesthesia for Wound Infiltration in Multilevel Posterior Lumbar Spinal Fusion

Article

Author: Sudbanthad, Pawin ; Weerakul, Santi ; Mahatthanatrakul, Akaworn ; Laoruengthana, Artit ; Chaibhuddanugul, Nattharut ; Varakornpipat, Panapol

Study Design.:

Randomized double-blind controlled trial.

Objective.:

The purpose of this study was to determine the efficacy of pain control and opioid consumption after administration of ketorolac directly to paraspinal muscle after spinal fusion.

Summary of Background Data.:

Ketorolac is added to multimodal analgesia regimens to improve pain control, reduce opioid consumption following orthopaedics and spine surgery. However, evidence of the efficacy of adding ketorolac to local anesthesia for intrawound infiltration after spine surgery is still limited.

Materials and Methods.:

The patients who underwent multilevel lumbar decompression and posterolateral fusion were recruited and randomized to the control group which received 0.5% bupivacaine hydrochloride injected into paraspinal muscles before wound closure, and the ketorolac group which received 30 mg ketorolac in addition to 0.5% bupivacaine hydrochloride. Postoperative numerical rating scale (NRS) for back pain, leg pain, morphine consumption, and adverse events were recorded.

Results.:

A total of 47 patients were randomized (24 in the ketorolac group and 23 in the control group). The mean age was 60.9±6.9 years old. The mean NRS for back pain at 6 hours after surgery was 5.8±3.0 points for the control group and 3.3±2.1 points for the ketorolac group (P<0.01). The ketorolac group consumed lesser morphine than the control group by 9.1 mg in the first 24 hours, 13.8 mg at 48 hours, 14.3 mg at 72 hours, and 13.9 mg at 96 hours after the surgery (P<0.05). Postoperative complications were not different between the two groups.

Conclusions.:

The addition of ketorolac to bupivacaine for wound infiltration after posterior lumbar spine decompression and fusion reduces early postoperative pain and total morphine consumption as compared with bupivacaine alone.

03 Dec 2024·JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

Peptic Ulcer Disease

Review

Author: Vakil, Nimish

Importance:

In the US, peptic ulcer disease affects 1% of the population and approximately 54 000 patients are admitted to the hospital annually for bleeding peptic ulcers.

Observations:

Approximately 10% of patients presenting with upper abdominal pain in a primary care setting have a peptic ulcer as the cause of their symptoms. The principal causes of peptic ulcer disease are Helicobacter pylori infection, which affects approximately 42% of patients with peptic ulcer disease, and aspirin or nonsteroidal anti-inflammatory drug (NSAID) use, which are etiologic factors in approximately 36% of people with peptic ulcer disease. Complications of peptic ulcer include bleeding (73% of patients), perforation (9% of patients), and pyloric obstruction (3% of patients). Annually, 10 000 people die of peptic ulcer disease in the US. Endoscopy definitively diagnoses peptic ulcer disease. Acid blockers, such as omeprazole, can heal peptic ulcers in approximately 80% to 100% of patients within 4 weeks, but gastric ulcers larger than 2 cm may require 8 weeks of treatment. Eradication of H pylori decreases peptic ulcer recurrence rates from approximately 50% to 60% to 0% to 2%. Discontinuing NSAIDs heals 95% of ulcers identified on endoscopy and reduces recurrence from 40% to 9%. When discontinuing an NSAID is not desirable, changing the NSAID (eg, from ketorolac to ibuprofen), adding a proton pump inhibitor such as omeprazole or lansoprazole, and eradicating H pylori with treatment such as bismuth, metronidazole, and tetracycline combined with omeprazole can reduce recurrence rates.

Conclusions and Relevance:

Peptic ulcer disease is associated with increased hospitalization rates and mortality. Acid blocking with proton pump inhibitors, such as omeprazole or lansoprazole, is the primary treatment. Recurrence of ulcers can be prevented by eradicating H pylori if present and discontinuing aspirin or NSAIDs if applicable.

01 Dec 2024·Pharmacology Research & Perspectives

Evidence‐based safety profile of oral ketorolac in adults: Systematic review and meta‐analysis

Review

Author: Masuoka‐Ito, David ; Esparza‐Villalpando, Vicente ; Ortiz‐Barroso, Gladys

Abstract:

The primary objective of the present review was to report the safety profile of oral ketorolac in adults using the systematic review and meta‐analysis methodology based on clinical trials. The present study is a PRISMA‐based systematic review and risk ratio (RR) meta‐analysis of the adverse events reported in clinical trials that used oral ketorolac; the review includes 50 clinical trials. The RR for the comparison of a single intake of oral ketorolac versus placebo, including all types of adverse events, was RR = 2.59, IC95% (1.5102; 4.4360) with p = 0.02, the RR for the comparison of a multiple intakes of oral ketorolac versus placebo for all types of adverse events was RR = 1.39, IC95% (0.95; 2.05) with p = 0.093, the RR for the comparison of a single intake of oral ketorolac versus active drugs for all types of adverse events was RR = 0.61, IC95% (0.49; 0.77) with p < 0.0001, the RR for the comparison of multiple intakes of oral ketorolac versus active drugs for all types of adverse events was RR = 0.78, IC95%(0.65; 0.93) with p = 0.006. Multiple intakes of 5, 10, or 20 mg of oral ketorolac, in treatment over 1–10 days, do not increase the risk of adverse events compared to placebo and show a tendency to reduce the risk of adverse events compared to active drugs. When a single intake of ketorolac (5, 10, 20, or 30 mg) is compared to a placebo, the risk increases only for trivial and mild adverse events.

News (Medical) associated with Ketorolac

05 Nov 2024

·www.prnewswire.com

New Study Compares Caldolor® (ibuprofen injection) to ketorolac

– Real World Study Compared Over 150,000 Adult & Pediatric Patients – – Caldolor Associated with Fewer Adverse Drug Reactions – – Caldolor also Improved Healthcare Utilization – NASHVILLE, Tenn., Nov. 5, 2024 /PRNewswire/ -- Specialty pharmaceutical company Cumberland Pharmaceuticals (Nasdaq: CPIX) today announced the publication of new real-world outcomes research demonstrating the safety and healthcare resource advantages of its Caldolor (ibuprofen) injection over ketorolac in both adult and pediatric populations. The study, published in Frontiers of Pain Research, provides compelling evidence that Caldolor is associated with a significantly reduced incidence of adverse drug reactions (ADRs) and improved healthcare utilizations when compared to ketorolac. This extensive, retrospective, payer database analysis evaluated the records of over 17 million patients who had received either ketorolac or Caldolor. Ultimately, 31,046 Caldolor and 124,184 ketorolac adult patients were selected and compared for ADRs and subsequent healthcare resource utilization, which includes inpatient, outpatient and emergency department visits as well as all procedures and prescriptions during the follow up time of 29 days. An additional 5,579 pediatric patients were identified in each arm and compared in a separate claims analysis. Key findings reveal that, in adults, Caldolor was associated with a 45% reduction in renal dysfunction (p<0.001) and a 78% decrease in hematuria rates (p<0.001) when compared to ketorolac. Notably, patients also experienced fewer gastrointestinal complications as well as reduced headaches, nausea and abdominal pain. Among pediatric patients, the results showed Caldolor was associated with a 51-65% lower rate of ADRs, including headache and nausea, with 95% confidence intervals supporting clinical significance. Caldolor also demonstrated a positive impact on healthcare resource utilization (HCRU) when compared to ketorolac, with decreased emergency room and outpatient visits, as well as a shortened hospital length of stay for both adults and children. "These findings underscore Caldolor's potential to improve patient care by reducing their treatment complications, while also delivering potential savings for healthcare systems through decreased hospital readmissions and shortened treatment times," said A.J. Kazimi, CEO of Cumberland Pharmaceuticals. About Caldolor® (ibuprofen) Injection Caldolor is indicated in adults and pediatric patients for the management of mild to moderate pain and management of moderate to severe pain as an adjunct to opioid analgesics, as well as the reduction of fever. It was the first FDA-approved intravenous therapy for fever. Caldolor is contraindicated in patients with known hypersensitivity to ibuprofen or other NSAIDs, patients with a history of asthma or other allergic type reactions after taking aspirin or other NSAIDs. Caldolor is contraindicated for use during the peri-operative period in the setting of coronary artery bypass graft (CABG) surgery. For full prescribing and safety information, including boxed warning, visit . About Cumberland Pharmaceuticals Cumberland Pharmaceuticals Inc. is the largest biopharmaceutical company founded and headquartered in Tennessee and is focused on providing unique products that improve the quality of patient care. The company develops, acquires, and commercializes products for the hospital acute care, gastroenterology and oncology market segments. The company's portfolio of FDA-approved brands includes: Acetadote® (acetylcysteine) injection, for the treatment of acetaminophen poisoning; Caldolor® (ibuprofen) injection, for the treatment of pain and fever; Kristalose® (lactulose) oral, a prescription laxative, for the treatment of constipation; Sancuso® (granisetron) transdermal, for the prevention of nausea and vomiting in patients receiving certain types of chemotherapy treatment; Vaprisol® (conivaptan) injection, to raise serum sodium levels in hospitalized patients with euvolemic and hypervolemic hyponatremia; and Vibativ® (telavancin) injection, for the treatment of certain serious bacterial infections including hospital-acquired and ventilator-associated bacterial pneumonia, as well as complicated skin and skin structure infections. The company also has a series of Phase II clinical programs underway evaluating its ifetroban product candidate in patients with cardiomyopathy associated with Duchenne Muscular Dystrophy, Systemic Sclerosis and Idiopathic Pulmonary Fibrosis. For more information on Cumberland's approved products, including full prescribing information, please visit links to the individual product websites, which can be found on the company's website . Forward-Looking Statements This press release contains forward-looking statements, which are subject to certain risks and reflect Cumberland's current views on future events based on what it believes are reasonable assumptions. No assurance can be given that these events will occur. As with any business, all phases of Cumberland's operations are subject to factors outside of its control, and any one or combination of these factors could materially affect Cumberland's results of operations. These factors include market conditions, competition, an inability of manufacturers to produce Cumberland's products on a timely basis or failure of manufacturers to comply with regulations applicable to pharmaceutical manufacturers, maintaining an effective sales and marketing infrastructure, natural disasters, public health epidemics, and other events beyond our control, as more fully discussed in the Company's most recent Form 10-K and subsequent 10-Qs as filed with the SEC. There can be no assurance that results anticipated by the Company will be realized or that they will have the expected effects. Readers are cautioned not to place undue reliance on forward-looking statements, which speak only as of the date hereof. The Company does not undertake any obligation to publicly revise these statements to reflect events after the date hereof. SOURCE Cumberland Pharmaceuticals Inc. 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Clinical ResultDrug ApprovalPhase 2

29 Nov 2023

·www.sciencedaily.com

Certain migraine medications may be more effective than Ibuprofen

For many people with migraine, it can be difficult to find a treatment that is effective and reliable, and information on how medications compare to one another is lacking. A new study draws data from nearly 300,000 people using a smartphone app to help people make decisions about their medications. The study found that certain migraine medications like triptans, ergots and anti-emetics may be two to five times more effective than ibuprofen for treating migraine attacks, according to new research. For many people with migraine, it can be difficult to find a treatment that is effective and reliable, and information on how medications compare to one another is lacking. A new study draws data from nearly 300,000 people using a smartphone app to help people make decisions about their medications. The study found that certain migraine medications like triptans, ergots and anti-emetics may be two to five times more effective than ibuprofen for treating migraine attacks, according to new research published in the November 29, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. Migraine attacks are characterized by intense throbbing head pain, sensitivity to light and sound, nausea or vomiting. Previous research has shown migraine can also be associated with cognitive issues. All of these symptoms may impact a person's quality of life and productivity. "There are many treatment options available to those with migraine. However, there is a lack of head-to-head comparisons of the effectiveness of these treatment options," said study author Chia-Chun Chiang, MD, of the Mayo Clinic in Rochester, Minnesota, and member of the American Academy of Neurology. "These results confirm that triptans should be considered earlier for treating migraine, rather than reserving their use for severe attacks." For the study, researchers included over 3 million migraine attacks from nearly 300,000 users that were self-reported by people using a smartphone app during a six-year period. The app allows users to monitor the frequency of migraine attacks, triggers, symptoms and medication effectiveness. For those migraine attacks, participants entered 4.7 million treatment attempts with various medications into the app. They recorded in the app whether a medication was helpful or not. Researchers then used that information to calculate the effectiveness of each drug compared to ibuprofen. Researchers looked at a total of 25 medications among seven drug classes. Different dosages of medication and formulas of each medication were combined in this analysis. The study found that the top three classes of medications more effective than ibuprofen were triptans, ergots and anti-emetics. Triptans were five times more effective than ibuprofen, ergots were three times more effective and anti-emetics were two and a half times more effective. When looking at individual medications, the top three were eletriptan which was six times more effective than ibuprofen, zolmitriptan which was five and a half times more effective and sumatriptan which was five times more effective. Researchers found that when using eletriptan, participants found it helpful 78% of the time. Zolmitriptan was helpful 74% of the time and sumatriptan was helpful 72% of the time. Ibuprofen was helpful 42% of the time. Researchers also looked at other groups of medication such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs other than ibuprofen were 94% more effective than ibuprofen. Participants found ketorolac helpful 62% of the time, indomethacin was helpful 57% of the time, and diclofenac was helpful 56% of the time. However, acetaminophen was helpful 37% of the time and found to be 17% less effective than ibuprofen when used for treating migraines. Additionally, a common combination of medications used to treat migraine, aspirin, acetaminophen and caffeine was also evaluated and found to be 69% more effective than ibuprofen. "For people whose acute migraine medication is not working for them, our hope is that this study shows that there are many alternatives that work for migraine, and we encourage people to talk with their doctors about how to treat this painful and debilitating condition," said Chiang. A limitation of the study was evaluations of medications could be influenced by a user's expectations of the medication or the dosage they took. Another limitation was that newer migraine medications, gepants and ditans, were not included in the study due to the low amount of data when the study was conducted and lack of availability in many countries. The study was supported by the Kanagawa University of Human Services.

Clinical Result

10 Jul 2023

·www.drugs.com

EMS Crews May Not Always Follow Guidelines When Dosing Kids: Study

MONDAY, July 10, 2023 -- Less than half of all children treated by emergency medical services receive the right amount of medication during out-of-hospital emergencies, a new study found. In some cases, these incorrect doses can have serious consequences. “If you don't give the appropriate dose of the anti-seizure medication for a patient with an ongoing seizure, the seizure will not stop,” said study co-author Dr. Sriram Ramgopal , an attending physician in emergency medicine at Ann & Robert H. Lurie Children's Hospital of Chicago. “The longer a patient is seizing, the higher risk they are of having complications from that seizure," he said. They might aspirate into their lungs and get pneumonia from that, or they might have respiratory depression. And of course, if a child is having a seizure and you give too much of a medication, since they're also sedatives, they can suppress the child's breathing.” Specifically, the study -- published July 10 in the journal Pediatrics -- found that in the nearly 1 million pediatric encounters examined, just 42.6% administrations of 10 commonly used medications followed national guidelines. Seizure and sedating medications like morphine were among some of those most often given in incorrect amounts -- with most deviations representing an underdose. Those with the lowest adherence to guidelines were diazepam (19.4%) and lorazepam (21.2%). Appropriate dosing was most common with the anti-inflammatory methylprednisone (75.1%); intramuscular epinephrine (67.9%), which is often given to treat anaphylaxis; and the pain reliever ketorolac (56.4%). Dr. Jennifer Anders is a pediatric emergency medicine specialist at Johns Hopkins Children’s Center in Baltimore. While she was aware that incorrect dosing outside the hospital was a problem, she didn’t realize just how grave the situation was until she read the study. “What I found really stunning about this work that they did was … just how pervasive and extensive the problem is,” Anders said. “Even knowing that this was a problem, it really knocked my socks off.” Researcher Ramgopal stressed that blame for these inaccuracies should not be put on EMS workers themselves. “I think when we wrote the paper, we were very clear that while we think dosing errors are a part of it, I don't think that's all of it,” he said. “The paramedics who are doing this have a complex job in front of them. Rather than assigning blame to anybody, I think the important thing is: What can we do to improve systems, to minimize the risk of errors?” For children, most medications are dosed out based on weight. While there are techniques for doing so, guessing someone’s weight with relative accuracy can be difficult. Plus, when EMS workers face the stress of treating a child in crisis all while riding in the back of a truck, doing math to determine how much medication is needed can prove quite challenging. “It is not uncommon to have people do an error by 10 times the dose if they've misplaced a decimal point when they're doing that math,” Anders said. To make matters more complicated, there is no national standard among paramedics for pediatric drug doses. “The protocols that EMS is following vary from region to region, so those protocols might call for different doses of medications,” Ramgopal said. He said more centralized EMS practices could help close the gap on incorrect dosing. Several states rely guidelines put forth by the National Association of State EMS Officials, but many have their own guidelines, or, in some places, no official practices at all. The EMS for Children Program is also working to give all U.S. emergency departments the necessary resources and guidelines to care for children. Ramgopal also mentioned a 2015 study in which paramedics were given color-coded, prefilled syringes as a possible way to reduce dosing errors. The strategy was found to be significantly effective. Anders noted that another study is now in the works. The Pediatric Emergency Care Applied Research Network is testing administration of seizure medication with only three size options for children instead of measuring out medication based on exact weight. She suspects such a method will soon be common practice. “What a lot of us that are very active in pediatric prehospital medicine, I think, foresee on the horizon is a move to less stringent standards for an exact weight-based dose and more kind of an estimated small, medium, large kind of dosing regimen to make things much simpler and take the math out of the work for EMS clinicians,” Anders said. Sources Sriram Ramgopal, MD, attending physician, emergency medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and professor, pediatrics, Northwestern University Feinberg School of Medicine, Chicago Jennifer Anders, MD, pediatric emergency medicine specialist, Johns Hopkins Children’s Center, Baltimore Pediatrics , July 10, 2023 Posted July 2023

Clinical Result

100 Deals associated with Ketorolac

External Link

KEGG	Wiki	ATC	Drug Bank
D08104	Ketorolac	M01AB15	DB00465

R&D Status

10 top R&D records.

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Indication	Highest Phase	Country/Location	Organization	Date
Pain, Postoperative	Phase 3	-	Neumentum, Inc.Startup	-
Post procedural inflammation	Phase 1	US	Layerbio, Inc.	-

Clinical Result

Indication

Phase

Evaluation

View All Results

Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


PRNewswire Manual	Not Applicable	Pain	-	Caldolor (ibuprofen) injection	vvaaboaidf(hhpysmmtgb) = nylzjehimo anwabeeirv (wxtjdgbtrq ) View more	Positive	05 Nov 2024
				ketorolac	-
CNS2023	Phase 1/2	Migraine Disorders	17	Normal Saline, Prochlorperazine, Ketorolac	seyvcctsvo(ucaonvrmwh) = efgxguahgi chvxojhqhf (njnbwpktua ) View more	Positive	01 Oct 2023
SALT (ARVO2023)	Not Applicable	-	94	Post-SLT ketorolac	uczumkpysg(awcopnkbzf) = drfzyckdlw tmijcrauup (nzzcplvyju ) View more	Negative	01 Jun 2023
				No topical anti-inflammatory agent	uczumkpysg(awcopnkbzf) = pjdhjqqbsm tmijcrauup (nzzcplvyju ) View more
NCT02358681 (CTgov)	Phase 3	Migraine Disorders	59	Placebo, intravenous+Ketorolac, intranasal (Ketorolac, Intranasal)	ctxiasuqyo(yjdsbbifep) = oswoedpexh pfrqsblqmb (mlgbzgineb, vaglwtmzoz - txifavmnnk) View more	-	12 Jan 2022
				Placebo, intranasal+Ketorolac, intravenous (Ketorolac, Intravenous)	ctxiasuqyo(yjdsbbifep) = gkjuitfwcd pfrqsblqmb (mlgbzgineb, udoombuebr - efjfuqdvlu) View more
PD26-02 (AUA2021)	Not Applicable	-	-	Ketorolac	acjpogbxff(umrzrhdwyw) = sflyazhwzh jaswzatzug (ikssyjuypp ) View more	Positive	01 Sep 2021
				TORADOL (KETOROLAC) (Control)	acjpogbxff(umrzrhdwyw) = ooejmczkdm jaswzatzug (ikssyjuypp ) View more
NCT01806259 (KBCt \| KBC, CTgov)	Phase 3	Breast Cancer \| Inflammation	203	Ketorolac 30 mg IV (Ketorolac 30 mg)	spdeazrulz(tzjlchispj) = hrfyvfgpfp xtsoiggmai (dtysfjxfhl, rhxjctcegf - lphqxiawqh) View more	-	18 Jan 2020
				Placebos (NaCl 0.9% 3mL)	spdeazrulz(tzjlchispj) = doedihfxmd xtsoiggmai (dtysfjxfhl, yvdewjciba - dpwrscjwcg) View more
AAO2019	Not Applicable	Ophthalmologic surgical procedures	-	Intravenous Ketorolac (IVK)	feguncfcbn(havcaqtacx) = ushonqkcuy gskisrzcsm (eodlydqhmn )	Positive	12 Oct 2019
				Ketorolac	feguncfcbn(havcaqtacx) = lowffywbza gskisrzcsm (eodlydqhmn )
Pubmed \| Anesth Analg	Not Applicable	-	18	S (-) ketorolac	oylwthwlpl(yizhrbwumj) = hipdeiozlj wykgmgllsz (cbysfclkrz ) View more	-	01 Sep 2019
				R (+) ketorolac	oylwthwlpl(yizhrbwumj) = dvvnzkqjyr wykgmgllsz (cbysfclkrz ) View more
2019 ARVO Annual Meeting (ARVO2019)	Not Applicable	Mydriasis	214	2.5% phenylephrine, 0.5% tropicamide, and 0.5% ketorolac	cgqnwhbbni(bdsjxfhurw) = fndtykwsnz wbbbcnrchg (iqnukrzulj )	-	01 Jul 2019
				10% phenylephrine, 0.5% tropicamide, and 0.5% ketorolac	cgqnwhbbni(bdsjxfhurw) = hnpjdsjplw wbbbcnrchg (iqnukrzulj )

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