Ketorolac: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Dec 11, 2019.
1. How it works
- Ketorolac helps to relieve pain and inflammation by blocking the effects of the enzymes cyclooxygenase (COX)-1 and COX-2.
- Ketorolac belongs to a group of medicines known as nonsteroidal anti-inflammatory drugs (NSAIDs).
- Effective for the short-term (up to five days) relief of moderately severe acute pain. Usually reserved for pain that requires analgesia at the opioid level, such as that following surgery.
- May be used in combination with opioids for superior pain relief.
- Oral ketorolac is usually only used as continuation therapy following IV or IM dosing of ketorolac (total dosing of both oral, IM, and IV ketorolac should not exceed five days).
- Ketorolac eye drops may be used to treat inflammation and pain that occurs following eye surgery.
- A nasal ketorolac preparation is also available and can be used for the relief of moderate-to-moderately severe pain.
- Generic ketorolac tablets and eye drops are available.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Dyspepsia, abdominal pain and a headache. Other side effects include flatulence, dizziness, high blood pressure, sweating, rashes, tinnitus and other gastrointestinal upsets.
- Ketorolac eye drops may cause stinging or irritation when first applied and they may increase the likelihood of eye infections. Continued use may result in corneal damage and vision loss. Ketorolac eye drops should not be used for more than five days at a time.
- Stomach-related adverse effects such as bleeding, ulceration, and perforation which may be fatal are more likely to happen with ketorolac than with most other NSAIDs. Older patients or those taking other medicines that affect the stomach are at a greater risk. Should not be used by people with active peptic ulcer disease or gastrointestinal bleeding. Combining with alcohol may increase the risk of stomach ulcers or bleeding.
- Should not be used to treat mild pain nor long-standing or chronic pain.
- Not indicated for pediatric patients.
- NSAIDs (such as ketorolac) have been associated with an increased risk of stroke or heart attack. The risk may be higher for patients with pre-existing conditions and at higher dosages. Avoid ketorolac during or after coronary artery bypass (CABG) surgery.
- May affect kidney function and should not be used by people with moderate-to-severe kidney problems or in those who are dehydrated.
- Can affect blood clotting so should not be used in patients with or at high risk of bleeding. Never use as a prophylactic analgesic before major surgery.
- May interact with a number of other drugs and should never be taken at the same time as other NSAIDs such as aspirin or ibuprofen.
- Dosage may need adjusting in people over the age of 65 or under 50kg in body weight or with mild kidney dysfunction.
- Avoid in patients with asthma or who report allergic-type reactions after taking aspirin or other NSAIDs. Caution in patients with inflammatory bowel diseases.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- Use only the lowest dose for the shortest possible length of time. Do not shorten the dosing interval of four to six hours. Do not exceed the upper daily maximum dosage of 40mg; additional pain-relieving effects of ketorolac are doubtful and serious adverse effects are more likely.
- Take oral tablets with food to reduce stomach-related adverse effects.
- Do not take ketorolac (any type of preparation) for longer than five days. Your doctor should switch you to an alternative analgesic as soon as possible.
6. Response and Effectiveness
- Peak concentrations of ketorolac are reached within two to three hours. The effects of oral ketorolac may last for four to six hours.
Medicines that interact with ketorolac may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with ketorolac. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with ketorolac include:
- anticoagulants (blood thinners) such as apixaban, dabigatran, fondaparinux, heparin, or warfarin
- corticosteroids, such as dexamethasone
- nonsteroidal anti-inflammatories (NSAIDs), such as celecoxib, diclofenac, etodolac, ibuprofen, meloxicam, nabumetone, or naproxen
Alcohol can increase the likelihood of gastrointestinal side effects with ketorolac, and possibly liver and kidney damage.
Note that this list is not all-inclusive and includes only common medications that may interact with ketorolac. You should refer to the prescribing information for ketorolac for a complete list of interactions.
Ketorolac Revised 06/2019. Drugs.com https://www.drugs.com/ppa/ketorolac-nasal.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use ketorolac only for the indication prescribed.
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