Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term management of moderately severe acute pain that requires analgesic medication. It works by blocking the production of prostaglandins, which are substances in the body that play a role in inflammation and pain. Ketorolac is available in both oral tablet and injectable formulations and belongs to a class of medications known as NSAIDs.
Approved Uses of Ketorolac
Ketorolac has been approved by the U.S. Food and Drug Administration (FDA) for the short-term (5 days or less) management of moderately severe acute pain that requires analgesic medication such as post-surgical pain and relief of mild to moderate pain. The oral tablet form is approved for acute pain in adults while the injectable form is approved for acute pain in both adults and children. Ketorolac has shown effectiveness in reducing pain associated with dental extractions, episiotomies during childbirth, muscle strains, sprains and other orthopedic trauma.
Dosage and Administration
The dosing of ketorolac depends on the specific condition being treated and the formulation being used. The oral tablet form comes in 10 mg tablets and is usually administered every 4 to 6 hours as needed, not to exceed 40 mg per day. The injectable form is usually dosed at 30 to 60 mg given intravenously or intramuscularly every 6 hours as needed for moderate to severe acute pain. The maximum daily dose of the injectable form is 120 mg. Ketorolac treatment should not last longer than 5 days without consulting a doctor due to potential safety risks of longer-term use.
Potential Side Effects
Like all NSAIDs, ketorolac can cause certain side effects with both short and long-term use. Common side effects include nausea, vomiting, dyspepsia, abdominal pain, constipation, diarrhea, headache and drowsiness. More serious potential side effects include kidney dysfunction, liver damage, gastrointestinal bleeding or peptic ulcers. Ketorolac also increases the risk of heart attack or stroke and should not be used in patients with pre-existing heart disease or risk factors. Due to potential effects on the fetus, ketorolac is not recommended during pregnancy and breastfeeding.
Drug Interactions
Ketorolac can interact adversely with several types of medications if taken concurrently. Aspirin and other NSAIDs may increase the risks of side effects when taken with ketorolac. Blood thinners like warfarin have a higher risk of bleeding side effects. Blood pressure medications like ACE inhibitors or ARBs may cause excessively low blood pressure. Steroids can increase risk of stomach ulcers and corticosteroids can inhibit ketorolac's effects. Antacids may interfere with ketorolac absorption if taken within an hour of each other. Careful consideration of all medications is necessary when using ketorolac to avoid potential interactions.
Contraindications
Certain conditions completely prohibit the safe use of ketorolac. These contraindications include:
- Known hypersensitivity to ketorolac or other NSAIDs.
- Active bleeding disorders or prior history of stomach or intestinal ulcers.
- Severe impairment of kidney or liver function.
- Late-stage pregnancy.
- Patients undergoing coronary artery bypass graft (CABG) surgery.
Special Warnings and Precautions
While ketorolac may be used cautiously in some higher risk groups, doctors should monitor patients closely:
- Elderly adults are more susceptible to side effects like GI bleeding.
- Those with a history of asthma may be at higher risk of developing reaction called bronchospasm.
- Preexisting hypertension needs monitoring as ketorolac can cause blood pressure elevation.
- Fluid retention and edema have occurred, risking worsening of congestive heart failure.
- Long-term ketorolac use beyond 5 days is generally not recommended due to safety concerns.
Alternative Analgesic Options
For some patients, alternative analgesic options may be preferable to ketorolac due to safety risks. Milder over-the-counter painkillers like acetaminophen are generally safer than ketorolac or other prescription NSAIDs in those at higher risk. Opioid painkillers may need to be balanced with potential for dependence, addiction or side effects. Topical pain creams can help in localized areas. Non-pharmacological therapies including ice, rest, elevation and physical therapy are also important. Overall safety and risk profile of the individual patient should guide choice of acute pain management.
Ketorolac is effective for moderate to severe acute pain when used as directed for a short period. However, careful consideration of risks and patient safety is important due to potential side effects and interactions with this NSAID.
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