Ketorolac

Ketorolac is a prescription-only NSAID used for short-term management of significant acute pain. Here's when it's used:

• Moderate-to-severe acute pain — the kind that would otherwise need an opioid-level painkiller
• Postoperative pain — most commonly after surgery, when strong pain relief is needed
• Opioid-sparing therapy — it can be used alongside opioids like morphine to reduce how much opioid is needed

It is not for minor pain, chronic (long-term) conditions, or use in children.

Ketorolac blocks enzymes called COX-1 and COX-2 — these enzymes produce prostaglandins, which are chemicals your body releases to create pain, inflammation, and fever. By blocking this process, ketorolac reduces pain signals at the nerve level and dampens inflammation at the site of injury or surgery.

Importantly, ketorolac has no sedating or anxiety-relieving effects. Its pain relief is purely anti-inflammatory in nature. The peak pain-relieving effect kicks in within 2–3 hours of dosing.

Ketorolac treatment must always begin with an injection — either into a vein (IV) or a muscle (IM). Oral tablets are only used as a follow-up step if continued treatment is necessary after the injections. You cannot start treatment with the tablets alone.

• IV injections are given slowly over at least 15 seconds; IM injections go deep into the muscle
• Pain relief from an injection typically begins within about 30 minutes and lasts 4–6 hours
• A high-fat meal can slow absorption of the oral tablet slightly, though the total amount absorbed stays the same
• The total combined treatment (injections + tablets) must not exceed 5 days — switch to a different pain reliever as soon as possible

The most common side effects — reported in roughly 1 in 10 to 1 in 100 patients — include:

• Nausea and vomiting
• Stomach pain, heartburn, or indigestion
• Diarrhea or constipation
• Headache
• Dizziness or drowsiness
• Swelling (edema)
• Rash or itching
• Elevated liver enzymes (found on a blood test)

More serious reactions — including GI ulcers and bleeding, acute kidney failure, severe allergic reactions, liver failure, and increased bleeding — are less common but can be life-threatening. Seek immediate medical attention if you notice signs of any of these.

• GI bleeding and ulcers: Ketorolac can cause fatal stomach or intestinal bleeding, ulcers, or perforation — often with no warning symptoms. Risk is higher in older adults, smokers, alcohol users, and those on steroids or blood thinners.
• Heart attack and stroke: Like all NSAIDs, ketorolac raises cardiovascular risk. This can occur early in treatment. Do not use around CABG (heart bypass) surgery.
• Kidney damage: Ketorolac can impair kidney function, especially if you are dehydrated or already have kidney problems. Dehydration should be corrected before use.
• Bleeding risk: Ketorolac reduces platelet function (how your blood clots), so bleeding may take longer to stop. It is contraindicated in patients with bleeding disorders or suspected brain hemorrhage.
• Do not exceed 5 days: Higher doses or longer use will not improve pain relief but will significantly increase the risk of all the above complications.
• Not for children: Ketorolac is not approved for pediatric patients.

Ketorolac interacts with several important medications. Always give your full medication list to your care team before starting:

• Aspirin and other NSAIDs — combining them increases the risk of serious GI bleeding and other NSAID-related harms; avoid together
• Warfarin and heparin (blood thinners) — ketorolac can amplify bleeding risk; requires very careful monitoring
• Probenecid (for gout) — contraindicated; do not use together
• Pentoxifylline (for circulation) — contraindicated; do not use together
• Corticosteroids (like prednisone) — combined use raises the risk of GI bleeding
• High-dose salicylates — can raise the level of free (active) ketorolac in the blood, increasing side effect risk
• Alcohol — increases the risk of stomach ulcers and bleeding

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

• You have a current or past stomach ulcer, GI bleed, or intestinal perforation — ketorolac is contraindicated
• You have ever had an allergic reaction (asthma, hives, anaphylaxis) to aspirin or any other NSAID
• You have advanced kidney disease or are dehydrated — ketorolac is contraindicated
• You are pregnant, especially near your due date — ketorolac can harm fetal circulation and increase bleeding during labor and delivery
• You are breastfeeding — ketorolac passes into breast milk
• You are an older adult — you face a higher risk of serious GI and kidney complications
• You are scheduled for or recovering from coronary artery bypass graft (CABG) surgery — ketorolac is contraindicated in this setting
• You have a bleeding disorder, history of stroke, or cerebrovascular disease
• You have low albumin (blood protein) levels — this can increase the amount of active drug in your system
• You are taking blood thinners, other NSAIDs, steroids, probenecid, or pentoxifylline

Taking too much ketorolac most often causes nausea, vomiting, stomach pain, drowsiness, and lethargy — symptoms that usually improve with supportive care. More serious but rare outcomes can include GI bleeding, high blood pressure, kidney failure, or breathing problems.

There is no specific antidote. If an overdose is suspected, seek emergency medical help immediately. Treatment is focused on managing symptoms; activated charcoal may be used if the person is seen within a few hours of ingesting a large amount.

Ketorolac relieves pain by reducing prostaglandins — chemicals that sensitize pain nerves and fuel inflammation — in the tissues where pain originates. It does not cause sedation or reduce anxiety; its entire pain-relieving action is peripheral (at the site of inflammation), not in the brain.

The peak analgesic (pain-relieving) effect occurs within 2 to 3 hours of dosing. At recommended doses, the main difference between higher and lower doses is how long the pain relief lasts, not how strong it is at its peak.

Ketorolac is completely absorbed when taken orally — 100% bioavailability — and this matches what you get from an injection. A high-fat meal slightly delays the peak concentration but doesn't reduce the total amount absorbed. The drug is very strongly bound to blood proteins (about 99%), and it is primarily broken down in the liver and eliminated through the urine.

Peak blood levels from an oral dose are reached in roughly 44 minutes on average. The drug follows predictable (linear) behavior at recommended doses — meaning blood levels rise proportionally with dose. Patients with low albumin (blood protein) may have more free, active drug in their system, which can increase the effect and risk of side effects.

Store at 20° to 25°C (68° to 77°F). Protect from light.