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Ketorolac Tromethamine

Class: Other Nonsteroidal Anti-inflammatory Agents
VA Class: CN103
Chemical Name: (±)-5-Benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid compd. with 2-Amino-2-(hydroxymethyl)-1,3-propanediol (1:1)
Molecular Formula: C15H13O3•C4H11NO3
CAS Number: 74103-07-4

Medically reviewed by Last updated on Nov 11, 2019.


    Appropriate Use
  • Indicated for short-term (≤5 days in adults) management of moderately severe acute pain that requires analgesia at opiate level.1 Not indicated for use in minor or chronic painful conditions.1

  • A potent NSAIA; administration associated with risks.1 Serious NSAIA-related adverse effects can occur in patients in whom the drug is indicated, especially when the drug is used inappropriately.1 Increasing the dose beyond the recommended dose will not result in improved efficacy and increases the risk of serious adverse effects.1

    GI Effects
  • Can cause peptic ulcers, GI bleeding, and/or perforation.1 Contraindicated in patients with active peptic ulcer disease, recent GI bleeding or perforation, or a history of peptic ulcer disease or GI bleeding.1

  • Serious GI events can occur at any time and may not be preceded by warning signs and symptoms.198 Geriatric individuals are at greater risk for serious GI events.198 (See GI Effects under Cautions.)

    Renal Effects
  • Contraindicated in patients with advanced renal impairment and those at risk of renal failure because of volume depletion.1

    Hematologic Effects
  • Inhibits platelet function.1 Contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, or incomplete hemostasis and in patients at a high risk of bleeding.1

  • Contraindicated as prophylactic analgesic before major surgery; contraindicated as intraoperative analgesic during procedures where hemostasis is critical.1 Increased risk of bleeding in these patients.1

    Cardiovascular Risk
  • Increased risk of serious (sometimes fatal) cardiovascular thrombotic events (e.g., MI, stroke).198 502 508 Risk may occur early in treatment and may increase with duration of use.500 502 505 506 508 (See Cardiovascular Thrombotic Effects under Cautions.)

  • Contraindicated in the setting of CABG surgery.508

    Sensitivity Reactions
  • Hypersensitivity reactions (e.g., bronchospasm, anaphylactic shock) reported; appropriate counteractive measures must be available when administering the first dose.1 Contraindicated in patients with known hypersensitivity to ketorolac, aspirin, or other NSAIAs.1

    Intrathecal or Epidural Administration
  • Contraindicated for intrathecal or epidural administration because of alcohol content in parenteral formulation.1

    Labor and Delivery
  • Contraindicated during labor and delivery.1 (See Pregnancy under Cautions.)

  • Contraindicated in nursing women.1

    Concomitant Use with NSAIAs
  • Contraindicated in patients receiving aspirin or other NSAIAs because of cumulative risk of serious adverse effects.1

    Dosage and Administration
  • Oral formulation is used as continuation therapy in adults; total combined duration of parenteral and oral therapy in adults should not exceed 5 days because of increased risk of serious adverse effects.1

  • Maximum daily oral dosage (40 mg) is lower than the maximum daily parenteral dosage (120 mg).1

    Special Populations
  • Adjust dosage in patients ≥65 years of age, adults weighing <50 kg, and those with moderately increased Scr.1 Daily parenteral dosage should not exceed 60 mg in these patients.1 (See Dosage and Administration.)

  • Administer only a single parenteral dose in children; maximum 30 mg IM or 15 mg IV.1


Prototypical NSAIA;1 2 3 21 32 33 70 91 92 93 96 140 pyrrolizine carboxylic acid derivative;2 3 21 32 33 70 91 92 93 96 140 structurally related to tolmetin and indomethacin.2 33 47 70 83

Uses for Ketorolac Tromethamine


Consider potential benefits and risks of ketorolac therapy as well as alternative therapies before initiating therapy with the drug.198 Use lowest effective dosage and shortest duration of therapy consistent with the patient’s treatment goals.198

Short-term (i.e., up to 5 days) management of moderately severe, acute pain that requires analgesia at opiate level in adults; mainly used in the postoperative setting.1 47 48 49 50 51 52 54 55 56 57 58 59 60 61 68 70 71 72 73 74 75 76 91 99 101 159 161 162 165 196 197

Management of moderately severe, acute pain in children 2–16 years of age (single IV or IM dose); studies usually have evaluated pain in the postoperative setting (e.g., pain following tonsillectomy).1 196 197 Limited data available to support administration of >1 parenteral dose in pediatric patients.1 196 197

Parenteral ketorolac has been used concomitantly with opiate agonist analgesics (e.g., meperidine, morphine) for the management of moderate to severe postoperative pain without apparent adverse drug interactions.1 91 Combined use can result in reduced opiate analgesic requirements.1 49 (See Syringe Compatibility under Stability.)

Ketorolac Tromethamine Dosage and Administration


  • Current principles of pain management indicate that analgesics, including ketorolac, should be administered at regularly scheduled intervals, although the drug also has been administered on an as-needed basis (i.e., withholding subsequent doses until pain returns).1 91 140

  • Consider potential benefits and risks of ketorolac therapy as well as alternative therapies before initiating therapy with the drug.198


Administer IV, IM, or orally in adults; administer IV or IM in children 2–16 years of age.1

Initiate therapy in adults with parenteral (IV or IM) ketorolac; oral formulation is used as continuation therapy, as required.1 154 Administer IV or IM as a single dose or every 6 hours; administer orally every 4–6 hours.1

In children 2–16 years of age, administer as a single IV or IM dose.1

Switch patients to alternate analgesic therapy as soon as clinically possible.1 154

Oral Administration

Manufacturer makes no specific recommendations regarding administration with meals; high-fat meal may decrease rate but not extent of absorption and reduce peak plasma concentrations.1

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Rate of Administration

Administer over ≥15 seconds.1

IM Administration

Administer IM slowly and deeply into the muscle.1

For drug compatibility information, see Compatibility under Stability.


Available as ketorolac tromethamine; dosage expressed in terms of the salt.1

To minimize the potential risk of adverse cardiovascular and/or GI events, use lowest effective dosage and shortest duration of therapy consistent with the patient’s treatment goals.198 Adjust dosage based on individual requirements and response; attempt to titrate to the lowest effective dosage.198

For breakthrough pain, supplement with low doses of opiate analgesics (unless contraindicated) as needed rather than higher or more frequent doses of ketorolac.1 142

Pediatric Patients

Single Dose

Children 2–16 years of age: One dose of 0.5 mg/kg (maximum 15 mg).1


Children 2–16 years of age: One dose of 1 mg/kg (maximum 30 mg).1



When switching from parenteral to oral therapy, the first oral dose is 20 mg, followed by 10 mg every 4–6 hours (maximum 40 mg in a 24-hour period).1

Weight <50 kg: When switching from parenteral to oral therapy, 10 mg every 4–6 hours (maximum 40 mg in a 24-hour period).1

Single Dose

30 mg.1

Weight <50 kg: 15 mg.1


60 mg.1

Weight <50 kg: 30 mg.1

Multiple Dose
IV or IM

30 mg every 6 hours.1

Weight <50 kg: 15 mg every 6 hours.1

Prescribing Limits

Pediatric Patients


Only a single parenteral dose is recommended.1

Single Dose

15 mg.1


30 mg.1



Total combined duration of parenteral and oral therapy should not exceed 5 days.1 137 142 143 154


All adults: Maximum 40 mg in a 24-hour period.1

Multiple Dose
IV or IM

Maximum 120 mg in a 24-hour period.1

Weight <50 kg: Maximum 60 mg in a 24-hour period.1

Special Populations

Hepatic Impairment

Need for dosage adjustment not fully established;1 70 evidence in patients with cirrhosis suggests that dosage adjustment may not be necessary.137

Renal Impairment


Safety not established in patients with Scr >5 mg/dL and/or those undergoing dialysis.1


When switching from parenteral to oral therapy, 10 mg every 4–6 hours (maximum 40 mg in a 24-hour period).1

Single Dose

15 mg.1


30 mg.1

Multiple Dose
IV or IM

15 mg every 6 hours.1 Maximum 60 mg in a 24-hour period.1

Geriatric Patients

Dosage recommendations are the same as those for patients with moderately increased Scr or for those weighing <50 kg.1

Cautions for Ketorolac Tromethamine


  • Peptic ulcer disease, recent GI bleeding or perforation, or history of peptic ulcer disease or GI bleeding.1

  • Advanced renal impairment or risk of renal failure secondary to volume depletion.1

  • Labor and delivery.1

  • Nursing women.1

  • Known hypersensitivity to ketorolac or any ingredient in the formulation.1

  • History of asthma, urticaria, or other sensitivity reactions precipitated by aspirin or other NSAIAs.1

  • Use as a prophylactic analgesic before major surgery; intraoperative use when hemostasis is critical.1

  • In the setting of CABG surgery.508

  • Suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, or incomplete hemostasis; high risk of bleeding.1

  • Concomitant use with aspirin or NSAIAs.1

  • Neuraxial (epidural or intrathecal) administration.1

  • Concomitant use with probenecid.1



Duration of Therapy

Total combined duration of parenteral and oral therapy in adults should not exceed 5 days.1 137 142 143 154

Only single doses of parenteral ketorolac are recommended in pediatric patients.1

Cardiovascular Thrombotic Effects

NSAIAs (selective COX-2 inhibitors, prototypical NSAIAs) increase the risk of serious adverse cardiovascular thrombotic events (e.g., MI, stroke) in patients with or without cardiovascular disease or risk factors for cardiovascular disease.500 502 508

Findings of FDA review of observational studies, meta-analysis of randomized controlled trials, and other published information500 501 502 indicate that NSAIAs may increase the risk of such events by 10–50% or more, depending on the drugs and dosages studied.500

Relative increase in risk appears to be similar in patients with or without known underlying cardiovascular disease or risk factors for cardiovascular disease, but the absolute incidence of serious NSAIA-associated cardiovascular thrombotic events is higher in those with cardiovascular disease or risk factors for cardiovascular disease because of their elevated baseline risk.500 502 506 508

Increased risk may occur early (within the first weeks) following initiation of therapy and may increase with higher dosages and longer durations of use.500 502 505 506 508

In controlled studies, increased risk of MI and stroke observed in patients receiving a selective COX-2 inhibitor for analgesia in first 10–14 days following CABG surgery.508

In patients receiving NSAIAs following MI, increased risk of reinfarction and death observed beginning in the first week of treatment.505 508

Increased 1-year mortality rate observed in patients receiving NSAIAs following MI;500 508 511 absolute mortality rate declined somewhat after the first post-MI year, but the increased relative risk of death persisted over at least the next 4 years.508 511

Some systematic reviews of controlled observational studies and meta-analyses of randomized studies suggest naproxen may be associated with lower risk of cardiovascular thrombotic events compared with other NSAIAs.202 203 204 206 500 501 502 503 506 FDA states that limitations of these studies and indirect comparisons preclude definitive conclusions regarding relative risks of NSAIAs.500

Use NSAIAs with caution and careful monitoring (e.g., monitor for development of cardiovascular events throughout therapy, even in those without prior cardiovascular symptoms) and at the lowest effective dosage for the shortest duration necessary.198 500 508

Some clinicians suggest that it may be prudent to avoid NSAIA use, whenever possible, in patients with cardiovascular disease.505 511 512 516 Avoid use in patients with recent MI unless benefits of therapy are expected to outweigh risk of recurrent cardiovascular thrombotic events; if used, monitor for cardiac ischemia.508 Contraindicated in the setting of CABG surgery.508

No consistent evidence that concomitant use of low-dose aspirin mitigates the increased risk of serious adverse cardiovascular events associated with NSAIAs.198 502 508 (See Specific Drugs under Interactions.)

GI Effects

Serious GI toxicity (e.g., bleeding, ulceration, perforation) can occur with or without warning symptoms; increased risk in those with a history of GI bleeding or ulceration, geriatric patients, smokers, those with alcohol dependence, those in poor general health, and those receiving >90 mg of parenteral ketorolac tromethamine daily.1 91 124 125 141 149 150 192 193 195 (See Contraindications under Cautions.)

Hematologic Effects

May inhibit platelet aggregation and prolong bleeding time.1 2 23 24 34 65 70 91 141 Use with caution and careful monitoring in patients with coagulation disorders.1 (See Contraindications under Cautions.)

Hematomas and other signs of wound bleeding reported in patients receiving the drug perioperatively; undertake postoperative administration with caution when hemostasis is critical.1 (See Contraindications under Cautions.)

Increased risk of intramuscular hematoma following IM administration in patients receiving anticoagulants.1 154

Administer with caution in patients receiving therapeutic doses of anticoagulants (e.g., heparin, warfarin).1 154 Concurrent use with prophylactic low-dose heparin (2500–5000 units every 12 hours), warfarin, or dextrans not studied extensively, but also may be associated with increased risk of bleeding.1 154 Administer with caution when the potential benefits justify the possible risks.1 91 145 154 (See Specific Drugs under Interactions.)

Increased risk of bleeding following tonsillectomy in pediatric patients.1 174 196 197 Consider the increased risk when using ketorolac in pediatric patients undergoing tonsillectomy.1

Renal Effects

Direct renal injury, including renal papillary necrosis, reported in patients receiving long-term NSAIA therapy.1 154 Interstitial nephritis and nephrotic syndrome reported in patients receiving ketorolac.1

Potential for overt renal decompensation.1 154 Increased risk of renal toxicity in patients with renal or hepatic impairment or heart failure; in patients with volume depletion; in geriatric patients; and in those receiving a diuretic, ACE inhibitor, or angiotensin II receptor antagonist.1 91 147 154 201 205 (See Renal Impairment and also Contraindications under Cautions, and Renal Impairment under Dosage and Administration.)

Correct hypovolemia before initiating ketorolac therapy.1


Hypertension and worsening of preexisting hypertension reported;1 91 198 either event may contribute to the increased incidence of cardiovascular events.198 Use with caution in patients with hypertension; monitor BP.198

Impaired response to ACE inhibitors, angiotensin II receptor antagonists, β-blockers, and certain diuretics may occur.198 508 509 (See Specific Drugs under Interactions.)

Heart Failure and Edema

Fluid retention and edema reported.1 70 91 140 508

NSAIAs (selective COX-2 inhibitors, prototypical NSAIAs) may increase morbidity and mortality in patients with heart failure.500 501 504 507 508

NSAIAs may diminish cardiovascular effects of diuretics, ACE inhibitors, or angiotensin II receptor antagonists used to treat heart failure or edema.508 (See Specific Drugs under Interactions.)

Manufacturer recommends avoiding use in patients with severe heart failure unless benefits of therapy are expected to outweigh risk of worsening heart failure; if used, monitor for worsening heart failure.508

Some experts recommend avoiding use, whenever possible, in patients with reduced left ventricular ejection fraction and current or prior symptoms of heart failure.507

Sensitivity Reactions

Hypersensitivity Reactions

Anaphylactoid reactions (e.g., anaphylaxis, angioedema) reported.1

Immediate medical intervention and discontinuance for anaphylaxis.1

Avoid in patients with aspirin triad (aspirin sensitivity, asthma, nasal polyps); caution in patients with asthma.1 2

Dermatologic Reactions

Serious skin reactions (e.g., exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis) reported; can occur without warning.1 91 198 Discontinue at first appearance of rash or any other sign of hypersensitivity (e.g., blisters, fever, pruritus).198

General Precautions

Hepatic Effects

Severe reactions including jaundice, fatal fulminant hepatitis, liver necrosis, and hepatic failure (sometimes fatal) reported rarely with NSAIAs.1 198

Elevations in ALT or AST reported.1 91

Monitor for symptoms and/or signs suggesting liver dysfunction; monitor abnormal liver function test results.198 Discontinue ketorolac if associated with abnormal liver function test results.1

Specific Populations


Category C.1 Avoid use in the third trimester because of possible premature closure of the ductus arteriosus.1 133 140 154 May inhibit uterine contractions during labor and delivery.1 (See Contraindications under Cautions.)


Distributed into milk; contraindicated in nursing women.1

Pediatric Use

Safety and efficacy of parenteral ketorolac administered as a single dose established in children 2–16 years of age.1 Safety and efficacy not established in children <2 years of age.1

Bleeding reported following tonsillectomy.1 174 196 197 (See Hematologic Effects under Cautions.)

Geriatric Use

Geriatric patients appear to tolerate NSAIA-induced adverse effects less well than younger adults.1 Fatal adverse GI effects reported more frequently in geriatric patients than younger adults.1

Caution and reduced dosages advised.1 (See Geriatric Patients under Dosage and Administration.)

Hepatic Impairment

Severe hepatic reactions possible.1 Use with caution in patients with hepatic impairment or a history of liver disease.1 91 92 154 (See Hepatic Impairment under Dosage and Administration.)

Renal Impairment

Use with caution in patients with renal impairment or a history of kidney disease; monitor closely.1 91 92 154 (See Contraindications under Cautions.)

Clearance may be decreased.1 Dosage adjustment necessary in patients with moderately elevated Scr.1 (See Renal Impairment under Dosage and Administration.)

Patients with underlying renal insufficiency are at risk of developing acute renal failure; consider risks and benefits before instituting therapy in these patients.1 154

Common Adverse Effects

Headache,1 23 70 91 34 somnolence or drowsiness,1 23 47 50 51 53 61 70 91 134 140 dizziness,1 23 50 53 70 91 dyspepsia,1 50 70 91 140 nausea,1 23 47 50 51 53 70 91 134 140 GI pain, 1 53 140 diarrhea,1 91 140 edema.1

Interactions for Ketorolac Tromethamine

Does not induce or inhibit hepatic enzymes involved in drug metabolism; unlikely to alter its own metabolism of that or other drugs metabolized by CYP isoenzymes.1

Protein-bound Drugs

Could be displaced from binding sites by, or could displace from binding sites, some other protein-bound drugs.1 91

Drugs Affecting Hemostasis

Possible increased risk of bleeding complications;1 carefully monitor patients receiving therapy that affects hemostasis.1 91 145 154

Specific Drugs




ACE inhibitors

Increased risk of renal impairment1

Reduced BP response to ACE inhibitor198

Monitor BP198


No alteration in the protein binding of ketorolac1 91

Angiotensin II receptor antagonists

Reduced BP response to angiotensin II receptor antagonist205

Possible deterioration of renal function in individuals with renal impairment205

Monitor BP205


No effect on the extent of oral ketorolac absorption1


Seizures reported in patients receiving carbamazepine or phenytoin1

Phenytoin does not alter the protein binding of ketorolac1 91

CNS agents (alprazolam, fluoxetine, thiothixene)

Hallucinations reported in patients receiving fluoxetine, thiothixene, or alprazolam1


Possible increased risk of bleeding1

Carefully monitor patients1 91 145 154


No alteration in the protein binding of either drug1 91 140

Diuretics (furosemide, thiazides)

Reduced natriuretic effect1 104 198


Increased risk of bleeding complications1

Increased bleeding time when administered with heparin 5000 units; concurrent use with heparin 2500–5000 units sub-Q every 12 hours not studied extensively1

Extreme caution advised in patients receiving therapeutic doses of heparin;1 91 145 154 carefully monitor patients1 91 145 154


Increased plasma lithium concentrations1 157 158

Monitor for lithium toxicity1 158


Increased plasma methotrexate concentrations in patients receiving other NSAIAs; studies with ketorolac have not been undertaken1

Caution advised198

Nondepolarizing skeletal muscle relaxants

May potentiate the effects of the muscle relaxant resulting in apnea1


NSAIAs including aspirin: Potential for increased risk of GI toxicity1 154 198

Aspirin: No consistent evidence that low-dose aspirin mitigates the increased risk of serious cardiovascular events associated with NSAIAs198 502 508

Therapeutic anti-inflammatory concentrations of salicylates (300 mcg/mL) may displace ketorolac from binding sites; ibuprofen, naproxen, or piroxicam does not alter the protein binding of ketorolac1 91

Concomitant use contraindicated1 154


Increased plasma concentrations and AUC of ketorolac1

Concomitant use contraindicated1 154

Thrombolytic agents

Possible increased risk of bleeding1

Carefully monitor patients1 91 145 154


No alteration in the protein binding of ketorolac1 91


Increased risk of bleeding complications;1 concurrent use not studied extensively1

Possible slight displacement of warfarin (but not ketorolac) from binding sites;1 91 other pharmacokinetic interactions unlikely1

Extreme caution advised in patients receiving therapeutic doses of warfarin;1 91 145 154 carefully monitor patients1 91 145 154

Ketorolac Tromethamine Pharmacokinetics



Rapidly and completely absorbed following IM administration.1 2 36 37 38 140 173

Rapid and almost completed absorbed following oral administration; 1 2 36 37 38 70 95 173 bioavailability reported to be 80–100%.1 2 36 37 38 70 95 173


IM administration: Onset in 10 minutes, with peak analgesia at 75–150 minutes.1 47 50 51 53

Oral administration: Onset in 30–60 minutes, with peak analgesia at 1.5–4 hours.55 56 57 58 59 60 61 137 138


Oral or IM administration: 6–8 hours.47 50 51 53 55 56 57 58 59 60 61 137 138


Food decreases rate but not extent of absorption.1 2 70 83

Special Populations

Rate of absorption from GI tract may be decreased in patients with hepatic43 70 or renal44 70 impairment and in geriatric individuals.43 70



Not distributed widely.1 2 37 70 140 Crosses the blood-brain barrier poorly.1 91

Crosses the placenta;1 2 41 65 91 173 distributed into milk.1 40 70 91 92

Plasma Protein Binding

>99%.1 2 37 38 70



Metabolized in the liver by hydroxylation; 1 91 also undergoes conjugation with glucuronic acid.1 37 38 173

Elimination Route

Excreted in urine (92%) as parent drug (60%) or metabolites (40%) and in feces (6%).1 38 70 173


4–6 hours in adults;1 2 36 37 38 70 80 91 97 140 173 3.8–6.1 hours in pediatric patients.1 173 197

Special Populations

Hepatic impairment (e.g., cirrhosis) does not appear to substantially affect half-life.1 2 43 173 In patients with cirrhosis, half-life of about 4.5–5.4 hours reported.1 43 91 173

Renal impairment: Half-life is about 9–10 hours (range: 3.2–19 hours);1 2 44 91 173 in patients undergoing dialysis, half-life of about 13.6 hours (range: 8–39.1 hours) reported.1

Geriatric individuals: Half-life is about 5–7 hours (range: 4.3–8.6 hours).1 2 42 70 80 91 173








15–30°C; protect from light.1


For information on systemic interactions resulting from concomitant use, see Interactions.


Solution CompatibilityHID


Dextrose 5% in sodium chloride 0.9%

Dextrose 5% in water

Plasma-Lyte A, pH 7.4

Ringer’s injection

Ringer’s injection, lactated

Sodium chloride 0.9%

Drug Compatibility
Syringe Compatibility1HID


Sufentanil citrate


Haloperidol lactate

Hydroxyzine HCl

Meperidine HCl

Morphine Sulfate


Prochlorperazine edisylate

Promethazine HCl

Thiethylperazine maleate



Hydromorphone HCl

Ketorolac tromethamine 1 mg/mL tested.HID

Y-Site CompatibilityHID


Dexmedetomidine HCl

Fentanyl citrate

Hetastarch in lactated electrolyte injection (Hextend)

Hydromorphone HCl

Methadone HCl

Morphine sulfate

Remifentanil HCl

Sufentanil citrate



Fenoldopam mesylate


  • Inhibits cyclooxygenase-1 (COX-1) and COX-2.91

  • Pharmacologic actions similar to those of other prototypical NSAIAs; 2 21 32 33 91 exhibits anti-inflammatory, analgesic, and antipyretic activity.1 2 21 32 33 70 91 140

Advice to Patients

  • Importance of reading the medication guide for NSAIAs that is provided each time the drug is dispensed.198

  • Risk of serious cardiovascular events (e.g., MI, stroke).198 500 508

  • Risk of GI bleeding and ulceration.1 167 181

  • Risk of bleeding following tonsillectomy.1

  • Risk of serious skin reactions.198 Risk of anaphylactoid and other sensitivity reactions.1

  • Risk of hepatotoxicity.1

  • Risk of kidney failure.1

  • Importance of seeking immediate medical attention if signs and symptoms of a cardiovascular event (chest pain, dyspnea, weakness, slurred speech) occur.198 500 508

  • Importance of notifying clinician if signs and symptoms of GI ulceration or bleeding, unexplained weight gain, or edema develops.1

  • Importance of discontinuing ketorolac and contacting clinician if rash or other signs of hypersensitivity (blisters, fever, pruritus) develop.198 Importance of seeking immediate medical attention if an anaphylactic reaction occurs.1

  • Importance of discontinuing therapy and contacting clinician immediately if signs and symptoms of hepatotoxicity (nausea, fatigue, lethargy, pruritus, jaundice, upper right quadrant tenderness, flu-like symptoms) occur.198

  • Risk of heart failure or edema; importance of reporting dyspnea, unexplained weight gain, or edema.508

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 Importance of avoiding ketorolac in late pregnancy (third trimester).1

  • Importance of not exceeding recommended duration of therapy.1

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1

  • Importance of informing patients of other important precautionary information.1 (See Cautions.)


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Ketorolac Tromethamine


Dosage Forms


Brand Names



Tablets, film-coated

10 mg*

Ketorolac Tromethamine Tablets


Injection, for IM or IV use

15 mg/mL*

Ketorolac Tromethamine Injection

30 mg/mL*

Ketorolac Tromethamine Injection

Injection, for IM use

30 mg/mL*

Ketorolac Tromethamine Injection

AHFS DI Essentials™. © Copyright 2020, Selected Revisions November 21, 2016. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.


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