Ketorolac is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Ketorolac works by reducing hormones that cause inflammation and pain in the body. Ketorolac is used short-term (5 days or less) to treat moderate to severe pain. Ketorolac may also be used for other purposes not listed in this medication guide.
Ketorolac or ketorolac tromethamine is a non-steroidal anti-inflammatory drug (NSAID) in the family of heterocyclic acetic acid derivative, often used as an analgesic. Ketorolac acts by inhibiting the bodily synthesis of prostaglandins. Ketorolac in its oral (tablet or capsule) and intramuscular (injected) preparations is a racemic mixture of both (S)-(−)-ketorolac, the active isomer, and (R)-(+)-ketorolac. An ophthalmic (i.e., eye-drop) solution of ketorolac is available and is used to treat eye pain and to relieve the itchiness and burning of seasonal allergies. The FDA has approved an intranasal formulation of ketorolac tromethamine for short-term management of moderate to moderately severe pain requiring analgesia at the opioid level.
Some people may wonder, “What is ketorolac used for?” Ketorolac is used to provide short-term relief of moderate to severe pain. While ketorolac is most often used for relieving pain following a procedure, it may also be used to treat pain caused by kidney stones, back pain, and cancer pain. Ketorolac is licensed for use in children two years of age and older; however, children should only receive single doses of the drug.
Ketorolac tromethamine (Toradol®) is a prescription medication that has been licensed for the short-term relief of moderate to severe pain. Short-term is defined as no longer than five days. Ketorolac is most often used for pain relief following a procedure but may also be used for such things as back pain, cancer pain, or pain caused by kidney stones.
NASHVILLE, TN -- March 5, 2001 -- Women with gynecologic malignancies who are treated with the non-steroidal anti-inflammatory ketorolac consume less morphine while they are in hospital, are able to resume normal eating habits sooner, and they have shorter hospital stays than women not using ketorolac.
Researchers reported these findings March 4 at the 32nd annual meeting of the Society for Gynecologic Oncology.
Thirty-five of the patients in this study had cervical cancer, 46 had endometrial cancer and six had uterine sarcomas. Three-quarters of the patients had stage 1-2 disease and one-quarter were stage 3-4. The mean age of the women in the study group was 52, and their hospital charts were compared with charts for three women who said they did not use ketorolac during this time period.
Over the course of treating their malignancies, the women who used ketorolac had a mean morphine consumption of 76.2 units, as compared with 105.8 units for those who did not use ketorolac. It's interesting to note that their pain scores were no different, despite this 28 percent reduction in morphine usage.
There were also significantly fewer cases of fever in the study group (5.7 percent versus 19 percent) compared with the non-ketorolac group.
“Our study revealed a decreased incidence of post-operative fever,” said principal investigator Dr. Laura Berghahn, of the department of obstetrics and gynecology, biostatistics and medical informatics. “Prostaglandins might play a large role in post-op fever, and the inhibition of cyclo-oxygenase by ketorolac may prevent the often unnecessary work-up and treatment for post-op fever.”
A significant finding was that the women who used ketorolac were able to resume their normal eating habits sooner than those who did not -- 2.8 versus 4.0 days. They were also able to return to a standard diet sooner, possibly because their lower morphine consumption meant fewer gastrointestinal side effects, such as nausea and vomiting, Dr. Berghahn said.
The women were also discharged from hospital approximately half a day sooner than controls, she added, although any data dealing with length of hospital stay will be confounded by the fact that there has been a trend across the United States toward shorter hospital stays.
The study had some limitations, Dr. Berghahn said. Researchers did not control the amount of ketorolac the women took. Patients in the study were asked if they had ever used the NSAID while their disease was being treated. Also, this was a retrospective study and subject to patient bias -- those who were feeling well at the time they responded to the questionnaire were more likely to respond with positive answers.
Perhaps more important, the study did not address the issue of gastrointestinal side effects, including bleeding ulcers and gastric perforations, which are well known with virtually all NSAIDs, Dr. Berghahn said.
The homogeneity of the study population was noteworthy, however, because all of the patients were treated at the same institution, by the same surgeon and with the same nursing team.
Despite the seeming benefit of ketorolac, the rate of post-operative infections and hospital re-admission was not different between the two groups.
Ketorolac is only intended for short-term (up to 5 days) treatment of moderately severe pain. It should not be used to treat minor or long-term pain. Do not use more of Ketorolac than prescribed. Do not use Ketorolac to treat children.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking ketorolac and seek medical attention or call your doctor at once if you have any of these serious side effects:
chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance;
black, bloody, or tarry stools;
coughing up blood or vomit that looks like coffee grounds;
swelling or rapid weight gain;
urinating less than usual or not at all;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
the first sign of any mouth sores or skin rash, no matter how mild;
pale skin, easy bruising, severe tingling, numbness, pain, muscle weakness; or
fever, headache, neck stiffness, chills, increased sensitivity to light, purple spots on the skin, and/or seizure (convulsions).
Less serious side effects may include:
upset stomach, mild nausea or vomiting, diarrhea, constipation;
mild heartburn, stomach pain, bloating, gas;
dizziness, headache, drowsiness;
sweating; or
ringing in your ears.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.
You must not use Ketorolac during pregnancy or if you are trying to become pregnant due to possible harm to the unborn baby and interference with normal labor/delivery.
Tell your doctor before using Ketorolac if you are breast-feeding. It is not known whether using Ketorolac during breastfeeding is dangerous. Ketorolac is excreted into breast milk in small amounts after oral dosing with 10 mg four times daily. Ketorolac is considered compatible with breast-feeding by the The American Academy of Pediatrics. However, the manufacturer considers the use of ketorolac contraindicated in nursing mothers because of the potential adverse effects of prostaglandin-inhibiting drugs on neonates.
Do not use this medication if you are allergic to ketorolac, aspirin, or other NSAIDs, or if you have:
severe kidney disease;
a bleeding or blood clotting disorder;
a closed head injury or bleeding in your brain;
a stomach ulcer or a history of stomach or intestinal bleeding.
Do not take ketorolac if you are also taking pentoxifylline (Trental) or probenecid (Benemid). Do not take ketorolac with aspirin or other NSAIDs such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), or piroxicam (Feldene).
Taking an NSAID can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use an NSAID. Do not use this medicine just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).
NSAIDs can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking an NSAID. Older adults may have an even greater risk of these serious gastrointestinal side effects.
Before taking ketorolac, tell your doctor if you are allergic to any drugs, or 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;
asthma;
polyps in your nose;
if you have recently had surgery; or
if you smoke.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take ketorolac. Do not give this medicine to anyone younger than 18 years old.
The following sections explain in detail how the drugs mentioned below can cause potentially negative interactions when combined with ketorolac.
ACE Inhibitors
Combining ketorolac with an ACE inhibitor can increase the risk of kidney problems, especially in people who already have kidney problems, and can decrease the effectiveness of the ACE inhibitor for lowering blood pressure.
ARBs
Combining ketorolac with an ARB can increase the risk of kidney problems, especially in people who already have kidney problems, and can decrease the effectiveness of the ARB for lowering blood pressure.
Beta Blockers
Combining ketorolac with a beta blocker may interfere with the beta blocker's ability to lower blood pressure. Check with your healthcare provider before taking these medications together.
Bile Acid Sequestrants
Bile acid sequestrants can bind to ketorolac in the digestive tract and delay its absorption into the body. To avoid this drug interaction, ketorolac should be taken at least one hour before or four to six hours after the bile acid sequestrant has been taken.
Corticosteroids
Using corticosteroids with ketorolac can increase the risk of bleeding. Your healthcare provider may choose to monitor you more closely or adjust your dose of these drugs.
Cyclosporine
Ketorolac may increase the level of cyclosporine in the blood, increasing the risk of serious cyclosporine side effects. In addition, this combination may increase the risk of kidney damage. Check with your healthcare provider before taking these medications together.
Digoxin
Ketorolac may increase the level of digoxin in your bloodstream, increasing the risk of dangerous digoxin side effects. If you are taking digoxin, check with your healthcare provider before starting or stopping ketorolac.
Diuretics
Combining ketorolac with a diuretic can increase the risk of kidney problems, especially in people who already have kidney problems, and can decrease the effectiveness of the diuretic.
Lithium
Taking ketorolac and lithium together may increase the levels of lithium in your body by reducing the kidneys' ability to remove lithium. Your healthcare provider may need to adjust your dose of these drugs and monitor the level of lithium in your blood.
“Blood Thinners” and Other Similar Drugs
Combining ketorolac with anticoagulants (“blood thinners”), antiplatelet drugs, or other medications that increase the risk of bleeding may lead to serious bleeding problems, including dangerous internal bleeding. Do not combine ketorolac with such medications without your healthcare provider's approval and supervision.
Methotrexate
Ketorolac may increase the risk of methotrexate toxicity. Do not combine these medications without your healthcare provider's supervision and approval.
Probenecid
Probenecid may increase the level of ketorolac in the blood, increasing the risk of side effects. Do not take these medications together.
SSRIs or SNRIs
Combining a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI) with ketorolac may increase the risk of bleeding. Check with your healthcare provider before taking ketorolac with an SSRI or SNRI.
Seizure Medicines
There have been sporadic cases of seizures reported in people taking anti-seizure medicines and ketorolac. If you are taking seizure medicines, make sure to discuss it with your healthcare provider before starting ketorolac therapy.
Herbal and/or Nutritional Supplements
Several herbal and nutritional supplements can also interact with ketorolac and may increase the risk of bleeding. If you are taking any natural or herbal supplements, make sure to discuss this with your healthcare provider before starting ketorolac therapy.
It is possible that not every ketorolac drug interaction was discussed in this article. Therefore, you should talk with your pharmacist or doctor about drug interactions with ketorolac that may apply to you.
Condition: Pain, 3/4/2009 4:51:18 PM
Reviewer: dmorales67, 35-44 Female on Treatment for less than 1 month (Patient)
Comment: I had a sprained shoulder and it eased the pain tremendously BUT I did react in a negative way with stomach pains - bad ones, and stool turned into water. I think I was given too much.
Review by Anonymous: User Rating: 10
Toradol (ketorolac) for Pain: I had a severe toothache that hurt so bad I couldn't even think. Over the years I have had morphine, Lortab, Tylox, you name it; nothing I tried completely killed the pain. Toradol did.
Condition: Pain, 12/17/2009 3:21:14 PM
Reviewer: jjanmus@....net, 65-74 Female on Treatment for less than 1 month (Patient)
Comment: I was given an injection of this medication in the emergency room for severe pain in the leg. I was not able to put any pressure on the leg when I went in which means that I could not walk at all. The medication began to take effect in about 15 minutes. It did not relieve the pain completely, but I was able to limp out, had very little pain that night and the next day. It has been over 24 hours, I am walking 90% better and I have not had to take anything else for pain yet.
Review by Anonymous: User Rating: 9.0
Toradol (ketorolac) for Pain: I was given Toradol via IV in the ER to relieve pain from kidney stone attack and it worked wonders for me! It made the pain go away completely within about 20 minutes and didn't make me feel doped up or sick to my stomach. I also didn't experience any side effects from it.
Review by Anonymous: User Rating: 5.0
Toradol (ketorolac) for Pain: I was given Toradol for tendonitis in my achilles tendon (very painful). It really helped with the pain and made the inflammation go down, however it made me nauseated. I had to quit taking it and move to a narcotic pain killer that did not work on the inflammation.
Condition: Pain, 1/15/2008 7:53:41 PM
Reviewer: th, 35-44 Male on Treatment for less than 1 month (Patient)
Comment: I have a fully torn rotator cuff and have experienced EXTREME pain. I have taken pain medication but could not sleep... This drug was the only thing that gave me relief until the operation.
Review by Anonymous: User Rating: 9.0
Toradol (ketorolac) for Pain: I had what was found to be an upper back inflammation, with a great deal of pain. It was first thought that I was having a heart attack or an embolism. As morphine-related medicines make me sick (nausea and headache), they gave me Toradol injections while I was in the hospital (for 24 hours) and it knocked the pain better than anything I had taken up to that point. I still had a little pain but it was tolerable, and this medicine didn't make me sick. I would recommend it especially for those who can't take narcotic pain relievers. Don't know about the oral dose as I didn't get that, just injections through an IV.
Condition: Pain, 11/3/2007 8:59:26 AM
Reviewer: couz_usa, 45-54 Male on Treatment for less than 1 month (Patient)
Comment: Sciatica problem in left leg. After trying Vicodin, a ... dr. tended to the pain in my leg. after two injections over a four day period, I was finally pain free
Review by Anonymous: User Rating: 8.0
Toradol (ketorolac) for Pain: Taking it for Shingles pain. Seems to work well, but makes me tired and a bit dizzy. Doctor also prescribed an anti-seizure medicine, Gabapentin, so not sure which helped more. The combination seems to work really well for the nerve pain from Shingles. I would ask my Dr. for these if I ever get shingles again. I went from pretty bad pain to it feeling like someone is tickling me, and it's slightly unpleasant.
Review by ...2048: User Rating: 1.0
Toradol (ketorolac) for Pain: Used Toradol for intractable Migraine Headaches. It did not cut the pain at all.
Review by Anonymous: User Rating: 1.0
Toradol (ketorolac) for Pain: I was given an injection of Toradol for a severe headache in the ER. I was told I had to have the injection in the posterior as it would be sore the next day. All I can say was it was like having a shot of liquid pain. Was given a prescription for the tablets and they haven't done anything.
Review by Anonymous: User Rating: 9.0
Toradol (ketorolac) for Pain: Had full kidney stone blockage in ureter. The pain was so severe that neither Morphine or Dilaudid could handle it. When they added Toradol to the Dilaudid it knocked the pain out almost completely. ...
Review by Anonymous: User Rating: 10
Toradol (ketorolac) for Pain: I could not move my neck. Within 3 minutes I had full range of motion. It did not take all the pain away but reduce it by about 50%, and allowed me to have movement.
Review by Anonymous:
Toradol (ketorolac) for Pain: I was prescribed this medication by a dentist, to alleviate pain from a toothache. It did nothing for me.
Review by Anonymous: User Rating: 10
Toradol (ketorolac) for Postoperative Pain: Where has this drug been my entire life? I had rectal surgery and used Toradol for the post-op pain. Wonderful!! Got rid of the pain and no narcotic effect. Was clear-headed and could function. No side-effects for me.
Review by Mimi412: User Rating: 10
ketorolac for Pain: I have severe cramps every month. The Doctor gave me 10mg of Ketorolac and it worked better than the Vicodin that I have taken. It really took the pain away quickly and for a long period of time! I have no negative side affects. This medicine really works. ... Hope this feedback helps someone.