Ketorolac

(kee-toh-roh-lack)

Trade/other name(s): Toradol

Why would this drug be used?

Ketorolac is used to treat short-term pain.

How does this drug work?

Ketorolac is a non-opioid pain medicine, meaning that it is not in the same family as morphine or codeine. It belongs to the general class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). Although its action is not fully understood, it helps block the body from making prostaglandins. (Prostaglandins are substances made by most of the cells in the body. They have a role in many body functions, including pain and inflammation.) Ketorolac helps prevent pain receptors from passing the pain message to the brain. This drug is used to reduce inflammation, and it is also often used to reduce fever by helping to enlarge blood vessels near the skin so that heat is lost from the body.

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods.
• About any reactions you have had when taking aspirin or other non-steroidal anti-inflammatory medicines in the past. If you have had problems with any of these medicines, you are more likely to have problems taking ketorolac.
• If you have any medical conditions such as asthma, nasal polyps, allergies, high blood pressure, lupus, kidney disease, inflammatory bowel disease, liver disease (including hepatitis), stroke, high cholesterol, diabetes, or heart disease. These conditions increase the risk of serious side effects from or reactions to ketorolac, and you may need a different medicine. If you take the drug, you may need to be watched more closely during treatment.
• If you have congestive heart failure or fluid retention (swelling, usually of the legs and feet). Ketorolac may worsen this problem.
• If you are taking blood pressure medicines. Ketorolac may cause some blood pressure medicines to stop working properly. In some cases, the combination of medicines may damage the kidneys.
• If you have ever had stomach or intestinal ulcers, especially if you had bleeding. Ketorolac can worsen these problems or make them come back.
• If you have ever had bleeding in the brain. Ketorolac may increase the risk that this will happen again.
• If you have hemophilia or any other bleeding problem, or if you are taking blood thinners such as warfarin or heparin. Ketorolac can increase your risk of bleeding from the stomach or intestine.
• If you have had a recent surgery, or if you plan to have surgery soon. Ketorolac can keep blood from clotting and allow bleeding during and just after surgery.
• If you have a seizure disorder and are taking phenytoin or phenobarbital. Some people on these medicines have had seizures while taking ketorolac.
• If you are pregnant. Taking ketorolac, especially later in pregnancy, can harm the baby and possibly delay delivery.
• If you are breast-feeding. Ketorolac is excreted in breast milk and may harm the baby.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If you take ketorolac while you are taking lithium, your lithium level may go up. This can increase your risk of toxic effects from lithium. You may need more frequent monitoring of lithium levels while on ketorolac.

Taking ketorolac while using "blood thinners" (such as warfarin and heparin) can increase your risk of serious bleeding. Pentoxifylline (Pentoxil or Trental, a drug taken to help blood circulation) can cause an increased bleeding risk as well.

Probenecid can cause ketorolac to build up in the body, and should not be taken during the time you are taking ketorolac.

Medicines for high blood pressure, such as diuretics (water pills) and ACE inhibitors (such as captopril, lisinopril, enalapril, benazepril, and others) may not work as well if taken during treatment with ketorolac. You may need more frequent blood pressure checks and possibly a change of medicines.

Methotrexate may have more toxic effects if ketorolac is taken during the same time.

Medicines that affect the brain, such as antidepressants and sedatives (nerve pills), have been reported to cause hallucinations in some people who were also taking ketorolac. The antidepressants known as selective serotonin reuptake inhibitors (Prozac, Paxil, Zoloft, and others) may also increase the risk of bleeding in the stomach or intestine.

Ketorolac, when taken along with certain muscle relaxants, has been reported to cause breathing to stop. Check with your doctor or pharmacist about this.

People taking phenytoin or phenobarbital to prevent seizures have occasionally had seizures while taking ketorolac.

Aspirin and other non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, ketoprofen, and others) can cause a higher risk of serious effects if taken with ketorolac.

A few cases have been reported in which people taking muscle relaxers along with ketorolac have stopped breathing.

Alcohol may increase your risk of stomach irritation or bleeding. Steroids that are taken by mouth, such as prednisone, prednisolone, hydrocortisone, betamethasone, budesonide, triamcinolone, can also increase this risk.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Ketorolac is given one of two ways: either as an injection in a muscle or vein, or by mouth as a pill. It is usually given as a single dose, or 4 times a day at least 4 to 6 hours apart for up to 5 days. You should take this pill with a full glass of water, together with food or with an antacid. It is also recommended that you sit up for 15 to 30 minutes after taking the pill. Your dose may vary depending on how often it is given.

Take this drug exactly as prescribed by your doctor. If you have any questions or do not understand these instructions, talk to your doctor or nurse.

Store this medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

Ketorolac is used for relief of short-term pain. It is not to be used for chronic or long-term pain.

Avoid aspirin or other non-steroidal anti-inflammatory drugs like ibuprofen while taking ketorolac. They may increase the risk of overdose, stomach irritation, and bleeding. It is easy to get aspirin or ibuprofen without knowing it, because they are often added to other medicines. Read the ingredient list on any remedies for headache, sinus, cold or flu before taking them, or check with your pharmacist.

Avoid ketorolac if you have a peptic or duodenal ulcer. It increases your risk for severe bleeding or holes in the intestine.

If your blood counts are low due to chemotherapy or radiation, check with your doctor or nurse before taking ketorolac. Having low blood counts may increase your chance of bleeding.

Ketorolac must be stopped at least a few days before any type of surgery. Make sure you tell your doctor or dentist at least a week before surgery if you are taking ketorolac to be sure of your instructions.

Call your doctor or nurse right away if you start to vomit blood or coffee-ground material, or notice blood in stool, or black, tarry stools. Talk to your doctor if you have pain in your belly or severe indigestion. You should stop taking ketorolac until after you discuss these symptoms with your doctor.

Call your doctor or nurse right away if you experience dizziness, ringing in your ears, nausea, vomiting, headache, or sweating. These symptoms may indicate that you've taken too much ketorolac. Until you talk to your doctor or nurse, stop taking the medicine.

If you notice any type of rash, especially if you also have flu-like symptoms, fever, or sores in your mouth, nose, or throat, stop the keterolac and call your doctor right away.

If you have signs of an allergic reaction, such as trouble breathing, itchy welts on the skin, or swelling of your mouth, face, or throat, get emergency help.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• heartburn
• drowsiness
• lightheadedness

Less common

• nausea
• loss of appetite
• bloating or swelling
• stomach ulcers*
• bleeding from the stomach or intestine*
• headache
• vomiting
• abdominal pain
• constipation
• diarrhea
• sores in mouth or on lips
• tiredness (fatigue)
• dizziness*
• confusion
• mood swings
• nervousness
• anxiety
• depression

Rare

• decreased hearing
• changes in vision
• double vision
• cataracts
• hepatitis
• kidney damage
• serious rash, itching, or blistering with fever
• itching
• low white blood cell count with increased risk of infection
• low platelet count with increased risk of bleeding
• low red blood cell count (anemia) with symptoms like tiredness (fatigue)
• liver damage with pain below the right side of the rib cage, or yellow skin or eyes (jaundice)
• high blood pressure
• allergic reaction*

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1989.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.