Ketorolac: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on July 28, 2023.

1. How it works

• Ketorolac helps to relieve pain and inflammation.
• Ketorolac works 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).

2. Upsides

• 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.

3. Downsides

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, nausea, 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.
• The maximum dose of ketorolac per day is 40mg. Dosages higher than this are not more effective and are associated with serious side effects.
• 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 or 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 it as a prophylactic analgesic before major surgery.
• May interact with several 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.
• Do not use it during labor and delivery because it may adversely affect the circulation of the baby and inhibit contractions of the uterus. Do not use in women more than 30 weeks gestation. Use of NSAIDs from 20 to 30 weeks of pregnancy has been associated with fetal harm and should only be considered if treatment is less than 2 days or a healthcare provider can monitor the amount of fluid in the womb around the baby.

Note: 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. View complete list of side effects

4. Bottom Line

• Ketorolac is a very strong NSAID that should only be considered for the short-term relief of acute, moderately severe pain that occurs following surgery. Ketorolac carries a high risk of severe gastrointestinal side effects and can increase bleeding. Ketorolac should not be taken for more than five days.

5. Tips

• 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.
• If you develop any serious or worrying side effects, such as shortness of breath, chest pain, weakness in one side of the body, swelling of the face or throat, indigestion or stomach pain, yellow skin or eyes, unusual weight gain, stop taking ketorolac and tell your doctor immediately.
• Tell your doctor if you are pregnant or intending to become pregnant, or planning to breastfeed. You should not use ketorolac if you are around 30 weeks or more gestation.
• Tell your doctor about all the medications or supplements you take. Do not start taking any new herbal remedies, supplements, or medications before checking with your doctor or pharmacist that these are compatible with ketorolac.

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.

7. Interactions

Medicines that interact with ketorolac may either decrease its effect, affect how long it works, 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:

• ACE Inhibitors/angiotensin receptor antagonists
• anticoagulants (blood thinners) such as apixaban, dabigatran, fondaparinux, heparin, or warfarin
• antidepressants, such as SSRIs (eg, citalopram, paroxetine, or fluoxetine)
• antiepileptics, such as carbamazepine or phenytoin
• aspirin
• corticosteroids, such as dexamethasone
• digoxin
• diuretics, such as furosemide or HCTZ
• duloxetine
• heparin
• lithium
• methotrexate
• muscle relaxants
• nonsteroidal anti-inflammatories (NSAIDs), such as celecoxib, diclofenac, etodolac, ibuprofen, meloxicam, nabumetone, or naproxen
• pentoxifylline
• probenecid
• psychoactive drugs such as alprazolam, fluoxetine, or thiothixene
• salicylate
• sertraline.

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.

References

• Ketorolac. Revised 03/2023. Bionpharma Inc. https://www.drugs.com/pro/ketorolac.html

Further information

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.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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