ketorolac

Pronunciation

Generic Name: ketorolac (nasal) (KEE toe ROLE ak (NAY sul))
Brand Name: Sprix

What is ketorolac nasal?

Ketorolac is a non steroidal anti inflammatory drug (NSAID). This medicine works by reducing substances in the body that cause pain, fever, and inflammation.

Ketorolac nasal (for the nose) is used short-term (5 days or less) to treat moderate to severe pain.

Ketorolac may also be used for purposes not listed in this medication guide.

What is the most important information I should know about ketorolac nasal?

Do not use this medicine for longer than 5 days. You should not use ketorolac nasal if you have severe kidney disease, a bleeding or blood clotting disorder, bleeding in your brain, a stomach ulcer or history of stomach bleeding, or if you are breast-feeding a baby.

Slideshow: 2014 Update: First Time Brand-to-Generic Switches

Ketorolac may increase your risk of heart attack or stroke, especially if you use it long term or have heart disease. Do not use this medicine just before or after any surgery, especially heart bypass surgery (coronary artery bypass graft, or CABG).

Ketorolac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine.

Pentoxifylline or probenecid can interact with ketorolac nasal and should not be used at the same time.

What should I discuss with my healthcare provider before using ketorolac nasal?

Ketorolac may increase your risk of heart attack or stroke, especially if you use it long term or have heart disease. Do not use this medicine just before or after any surgery, especially heart bypass surgery (coronary artery bypass graft, or CABG).

Ketorolac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults.

You should not use this medicine if you are allergic to ketorolac, or if you have:

  • severe kidney disease;

  • a bleeding or blood clotting disorder;

  • asthma, or "aspirin triad syndrome," a severe allergic reaction caused by taking aspirin, or other NSAIDs (Advil, Aleve, Celebrex, Indocin, Naprosyn, Orudis, Voltaren, and others);

  • a closed head injury or bleeding in your brain;

  • a stomach ulcer, perforation, or a history of stomach or intestinal bleeding; or

  • if you are breast-feeding a baby.

Pentoxifylline or probenecid can interact with ketorolac nasal and should not be used at the same time.

Do not use ketorolac nasal if you are already taking aspirin or other NSAIDs, or using other forms of ketorolac (such as injections or pills you take by mouth).

To make sure ketorolac nasal is safe for you, tell your doctor if you have:

  • a history of heart attack, stroke, or blood clot;

  • heart disease, congestive heart failure, high blood pressure;

  • liver or kidney disease,

  • ulcerative colitis or Crohn's disease;

  • polyps in your nose;

  • if you take a blood thinner (warfarin, Coumadin);

  • if you have recently had surgery; or

  • if you smoke.

FDA pregnancy category D. Ketorolac nasal may be harmful to an unborn baby if the mother uses the medication after 30 weeks of pregnancy. Using ketorolac nasal during labor can increase the risk of bleeding during childbirth. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Ketorolac nasal can pass into breast milk and may harm a nursing baby. Do not breast feed a baby while taking this medication.

Do not give this medicine to anyone younger than 18 years old.

How should I use ketorolac nasal?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

This medication comes with patient instructions for safe use, and directions for priming the nasal spray. Ask your doctor or pharmacist if you have any questions.

Ketorolac nasal is usually given every 6 to 8 hours. Follow your doctor's instructions.

To use the ketorolac nasal spray:

  • Gently blow your nose before using the nasal spray.

  • The first time you use a new bottle, remove the clip and plastic cover and prime the unit by pumping 5 sprays into the air, away from your face, until a fine mist appears.

  • Tilt your head forward slightly and insert the tip of bottle into your nostril, pointing it away from the center of your nose. Breathe through your mouth while spraying gently into your nostril. Do not inhale or sniff while spraying. If your nose runs, gently sniff to keep the nasal spray from leaking out.

  • Use only the number of sprays prescribed by your doctor.

  • Put the plastic cap back on the bottle and store it in a dry place, out of direct sunlight.

Avoid getting this medication in your eyes. If this does happen, rinse with water or saline solution. Call your doctor if you have eye irritation for longer than 1 hour.

Do not use this medication for longer than 5 days unless your doctor has told you to.

Each bottle of this medicine contains 8 sprays for use within a 24-hour period. Throw the bottle away within 24 hours after your first use, even if there is still some medicine left in the bottle.

Store the unopened nasal spray bottles in a refrigerator. Do not freeze.

After opening a bottle, store it at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using ketorolac nasal?

Ask your doctor before using ketorolac nasal if you take an antidepressant such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed easily.

Ask a doctor or pharmacist before using any cold, allergy, or other pain medication. Many medicines available over the counter contain aspirin or other medicines similar to ketorolac. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.

Ketorolac nasal side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Get emergency medical help if you have heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; or signs of a stroke--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance.

Stop using ketorolac nasal and call your doctor at once if you have:

  • bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  • slow heart rate;

  • pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;

  • little or no urinating;

  • swelling, rapid weight gain;

  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • pain or irritation in your nose;

  • runny nose;

  • watery eyes;

  • throat irritation; or

  • mild rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Ketorolac dosing information

Usual Adult Dose for Pain:

In adults, the use of oral ketorolac is only indicated as continuation therapy to IV or IM dosing of ketorolac. The manufacturer recommends that the oral formulation should not be given as an initial dose.

Parenteral:
Single dose administration:
IM: Patients less than 65 years of age: one dose of 60 mg. Patients who are renally impaired, and/or less than 50 kg (110 pounds): one dose of 30 mg.
IV: Patients less than 65 years of age: one dose of 30 mg. Patients who are renally impaired, and/or less than 50 kg (110 pounds): One dose of 15 mg.

Multiple dose administration:
Patients less than 65 years of age: 30 mg IM or IV every 6 hours as needed. The maximum daily dose should not exceed 120 mg.
Patients who are renally impaired, and/or less than 50 kg (110 pounds): 15 mg IM or IV every 6 hours as needed. The maximum dose should not exceed 60 mg.

Oral:
10 mg orally 4 times a day as needed. The maximum daily dose should not exceed 40 mg.
Patients less than 50 kg: The maximum daily dose should not exceed 40 mg.

Nasal Spray:
For adult patients less than 65 years of age: 31.5 mg (one 15.75 mg spray in each nostril) every 6 to 8
hours.
Maximum daily dose: 126 mg

Usual Geriatric Dose for Pain:

In adults, the use of oral ketorolac is only indicated as continuation therapy to IV or IM dosing of ketorolac. The manufacturer recommends that the oral formulation should not be given as an initial dose.

Parenteral:
Single dose administration:
IM: Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): one dose of 30 mg.
IV: Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): One dose of 15 mg.

Multiple dose administration:
Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): 15 mg IM or IV every 6 hours as needed. The maximum dose should not exceed 60 mg.

Oral:
10 mg orally 4 times a day as needed. The maximum daily dose should not exceed 40 mg.
Patients less than 50 kg: The maximum daily dose should not exceed 40 mg.

Nasal Spray:
65 years of age or greater, renally impaired patients, and patients less than 50 kg (110 lbs): 15.75 mg (one 15.75 mg spray in only one nostril) every 6 to 8 hours.
Maximum daily dose: 63 mg

Usual Pediatric Dose for Pain:

Greater than or equal to 1 month and less than 2 years:
Multiple dose treatment: IV:
0.5 mg/kg every 6 to 8 hours. Do not exceed 48 to 72 hours of treatment.
Children 2 to 16 years and Children greater than 16 years who are less than 50 kg: Do not exceed adult doses
Single-dose treatment:
Manufacturer's recommendations:
IM: 1 mg/kg as a single dose
Maximum dose: 30 mg
IV: 0.5 mg/kg as a single dose
Maximum dose: 15 mg

Multiple-dose treatment:
IM or IV: 0.5 mg/kg every 6 hours. Do not exceed 5 days of treatment.
Oral: No pediatric studies exist.

Children greater than 16 years and greater than 50 kg:
Single-dose treatment:
IM: 60 mg as a single dose
IV: 30 mg as a single dose
Multiple-dose treatment:
IM or IV: 30 mg every 6 hours
Maximum dose: 120 mg/day
Oral:
Initial dose: 20 mg
Maintenance dose: 10 mg every 4 to 6 hours
Maximum dose: 40 mg/day

What other drugs will affect ketorolac nasal?

Other drugs may interact with ketorolac, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about ketorolac nasal.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.01. Revision Date: 2014-01-23, 12:40:13 PM.

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