← Search & browse all drugs
MUSCULO-SKELETAL SYSTEM › ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS › ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS, NON-STEROIDS › Acetic acid derivatives and related substances
ketorolac
M01AB15
Forms & Strengths
- Tablet: 10 mg
- Injection: 15 mg/mL, 30 mg/mL
- Nasal spray: 15.5 mg/spray (Sprix)
Adult Dosing
- IV/IM: 30 mg every 6 hours as needed; max 120 mg/day
- Oral (continuation from IV/IM): 10 mg every 4-6 hours; max 40 mg/day
- Nasal spray: 31.5 mg (one spray in each nostril) every 6-8 hours; max 63 mg/day
- Limit total duration of use (IV, IM, oral, nasal combined) to a maximum of 5 days
Pediatric Dosing
- Safety and efficacy in pediatric patients < 17 years of age have not been established
- Not recommended for use in neonates or children for acute pain management due to lack of safety data
Indications
- Short-term (<= 5 days) management of moderately severe acute pain requiring analgesia at the opioid level
- Post-operative pain management
Mechanism of Action
- Nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis
- Acts by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, decreasing the formation of precursors of prostaglandins and thromboxanes
Contraindications
- Active peptic ulcer disease or recent gastrointestinal bleeding/perforation
- Advanced renal impairment or risk of renal failure due to volume depletion
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Prophylactic analgesia before any major surgery
- CABG surgery setting
- Concomitant use with other NSAIDs, pentoxifylline, probenecid, or anticoagulant therapy due to high bleeding risk
- Obstetric analgesia during labor and delivery
Adverse Reactions
- Gastrointestinal bleeding, ulceration, perforation
- Acute renal failure, interstitial nephritis
- Hypertension, edema
- Increased bleeding time, hematoma, operative site bleeding
- Anaphylaxis, bronchospasm, severe skin reactions
- Nausea, dyspepsia, gastrointestinal pain, dizziness, headache
Drug Interactions
- Anticoagulants (warfarin, heparin) and antiplatelets (aspirin, clopidogrel): significantly increased risk of severe bleeding
- ACE inhibitors and ARBs: increased risk of renal impairment and reduced antihypertensive efficacy
- Diuretics: decreased diuretic efficacy and increased nephrotoxicity risk
- Lithium: decreased renal clearance resulting in elevated lithium toxicity
- Methotrexate: decreased renal elimination leading to severe methotrexate toxicity
- SSRIs and SNRIs: increased risk of upper gastrointestinal bleeding
Curated Content: Needs Vetting Before Put to Clinical Use