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Ketorolac - Side Effects And Warnings.

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Ketorolac is a nonsteroidal anti-inflammatory drug used for the management of pain. Read below to know more about its side effects and warnings.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At September 19, 2022
Reviewed AtJune 12, 2024

What Is Ketorolac?

Ketorolac is used for the short-term treatment of moderate to severe pain in adults and children. It belongs to the class of nonsteroidal anti-inflammatory drugs (NSAIDs) and has a relatively low incidence of adverse effects. Its analgesic properties make it useful in pain management including headaches, soft tissue pain, postoperative pain, and ankylosing spondylitis. The anti-inflammatory works by blocking the production of prostaglandins that cause inflammation, pain, and fever. It should not be taken for long-term painful conditions like arthritis (joint disease).

When Can an Individual Take Ketorolac?

Ketorolac is the most commonly used drug for postoperative pain management. When used in combination with opioids, it results in a significant decrease in the opioid requirement and lowers adverse effects such as vomiting. It treats musculoskeletal pain, migraines, and sickle cell crises (blockage of blood flow due to obstruction of sickle cell in the blood). Non-steroidal anti-inflammatory drugs (NSAIDs), like Ketorolac, are effective for relieving pain associated with cancer that has metastasized to bones.

How Is Ketorolac Taken?

Ketorolac can be taken orally, intravenously (IV), in nasal sprays, or through intramuscular (IM) routes. The oral version should be administered only as a continuation following IV and IM Ketorolac. Ketorolac tablets and injections should not be taken for more than five days.

Ketorolac has very serious side effects that could be fatal. The increase in dose and length of treatment can increase the risk of side effects like bleeding in the stomach, kidney problems, heart attacks, and stroke. The dose description of Ketorolac is described below:

  • For Pain Management: For ages 17 to 64 years, the recommended dose is 20 mg once followed by 10 mg orally for four to six hours. The maximum dose is 40 mg/day. The recommended dose for ages 65 years and older is 10 mg once followed by 10 mg orally for four to six hours.

  • For Eye Inflammation: The recommended dose is 0.5 percent eye solution, one drop in the affected eye four times daily.

How Does Ketorolac Work in the Body?

Like the other NSAIDs, Ketorolac blocks the Cyclooxygenase enzyme (COX 1 and 2). This is required to convert arachidonic acid into prostaglandins resulting in a decrease in pain, fever, and inflammation. The body rapidly absorbs after oral administration with a bioavailability of 80 percent. After intramuscular administration, Ketorolac reaches maximum plasma concentration in 45 minutes. It is metabolized in the liver and is excreted around 60 percent in the urine.

Why Cannot One Lie Down After Taking Ketorolac?

It is advised to avoid lying down for about 15 to 30 minutes after taking Ketorolac. This reduces stomach upset and irritation. It can also prevent irritation that may lead to difficulty in swallowing.

What Happens if an Individual Overdoses Ketorolac?

Taking an overdose of Ketorolac may cause symptoms such as troubled breathing, drowsiness, nausea, and vomiting, which are generally reversible with supportive care. It can cause serious gastrointestinal adverse events including bleeding, ulceration, and perforation, which can be fatal.

Habit-Forming:

Ketorolac is not habit-forming and will not cause physical or mental dependence. It may be used sometimes with a narcotic to provide better pain relief.

What Precautions Should Be Taken Before Administering Ketorolac?

Before administering Ketorolac, it is important to tell the doctor if an individual has any of the following conditions:

  • Pregnancy and Breastfeeding - Ketorolac is contraindicated in pregnancy as it may result in low amniotic fluid and risk to the fetus. The medicine passes into breast milk and should be used with caution in lactating women. Ketorolac should be avoided during labor and delivery as it may increase the risk of uterine hemorrhage.

  • Allergies - Ketorolac is not indicated in individuals who are allergic to other NSAIDs or have had adverse reactions to it.

  • Asthma - Patients with a history of asthma or worsening breathing after taking NSAIDs should avoid taking Ketorolac as it may lead to anaphylactic reactions.

  • Hemorrhage - Ketorolac inhibits platelet function and is contraindicated in patients with a high risk of bleeding, suspected cerebrovascular bleeding, and anticoagulants.

  • Renal Disease - Patients with advanced renal impairment or at risk for renal failure should take Ketorolac cautiously as it may cause kidney failure or hyperkalemia.

  • Hepatic Impairment - Ketorolac use in patients with a history of impaired liver function can cause hepatotoxicity, failure, or jaundice.

  • Peptic Ulcer - The medicine is not recommended in patients with previous gastrointestinal (GI) bleeding. It can cause serious adverse events like ulceration and perforation of the stomach and small intestine.

  • Hypertension - Patients taking hypertensives should be monitored during the treatment for any cardiovascular event.

  • Geriatrics - Ketorolac should be used with caution in the elderly as they have a high potential for adverse gastric effects and renal toxicity.

  • Smoking - Ketorolac may cause stomach and intestinal bleeding, and combining it with tobacco may increase the risk of gastric bleeding.

What Are the Side Effects of Ketorolac?

Like the other NSAIDs, Ketorolac shows a correlation with significant gastrointestinal, renal, and cardiovascular risks.

Some of the Common Side Effects of Ketorolac Include

  • Headaches.

  • Heartburn.

  • Diarrhea.

  • Bloating.

  • Vomiting.

  • Upset stomach.

  • Constipation.

  • Dizziness.

  • Drowsiness.

  • Sweating.

  • Ringing in the ears.

Serious Side Effects May Include,

  • Swelling of the face, fingers, and feet.

  • Severe stomach pain

  • Vomiting of blood.

  • Unusual weight gain.

  • Chest pain.

  • Flushing of skin.

  • Irregular heartbeat.

Black Box Warning of Ketorolac:

Ketorolac can cause serious gastrointestinal adverse events, including bleeding, ulcerations, and perforation of the stomach and intestines, which can be fatal. The drug increases the risk of cardiovascular events like myocardial infarction, and stroke. It is contraindicated for the treatment of perioperative pain, such as in coronary artery bypass grafting (CABG) and delivery. Hence, the Food and Drug Administration (FDA) issued a Black Box Warning with it in 2005.

Does Ketorolac Interact With Other Medicines?

When taking this medicine, the healthcare professional must know if an individual is taking any of the medicines listed below:

1. Drug Interactions:

  • Aspirin.

  • ACE inhibitors such as Captopril and Lisinopril.

  • Angiotensin II receptor blockers such as Losartan, Valsartan, Lithium, Methotrexate, and Probenecid

  • Corticosteroids like Prednisolone.

  • Cidofovir,

  • Furosemide.

  • Antiplatelet such as Dabigatran, Enoxaparin, and Warfarin.

  • Aspirin, Ibuprofen, Naproxen.

  • Antiepileptics such as Phenytoin, Carbamezepine.

2. Interactions with Diseases:

  • GI Toxicity.

  • Renal Dysfunction.

  • Diabetes Mellitus.

  • Hypertension.

  • Asthma.

  • Hemophilia or other bleeding disorders.

  • Systemic Lupus Erythematosus (autoimmune disease).

  • Colitis (colon inflammation), Stomach Ulcer.

  • Heart Failure.

3. Alcohol: Alcohol consumption with Ketorolac can increase the risk of stomach or intestinal bleeding. Do not drink alcohol while taking Ketorolac.

4. Food: Ketorolac should be taken with food to prevent gastric irritation. Avoid spicy food.

5. Caffeinated Beverages: Ketorolac may irritate the stomach, and it is best to avoid tea and coffee.

What Dietary Instructions Should an Individual Follow With Ketorolac?

The dietary instructions that an individual should follow while taking Ketorolac are as follows:

  • Avoid alcohol.

  • Do not take this medication on an empty stomach, because it may cause stomach upset. Take this medication with food or milk.

  • Stay hydrated.

  • Limit consumption of caffeine beverages because it will increase stomach acid production.

  • Avoid spicy and acidic foods.

  • Take a diet rich in fiber.

  • Try to take small and frequent meals.

What to Do In Case of Missing Dose?

Ketorolac is prescribed on a regular schedule for short-term pain relief. If an individual remembers soon after missing the dose, they should take it as soon as possible. If an individual misses the dose and it is almost time for the next dose, they should not double up the dose to make up for the missed dose, this may cause side effects such as gastrointestinal bleeding or kidney problems. People should set reminders or alarms on their mobile phones to adjust dosing.

How to Store and Dispose Ketorolac?

Proper storage and disposal of Ketorolac are important to ensure the medication is effective and prevent accidental ingestion. The drug should be stored at room temperature. It should not be stored in places where the temperature is very hot or very cold. Store the drug in a tight container and protect it from the moisture and light.

Do not flush the drug in the toilet. The medication should be sealed in a plastic bag and then disposed of in the household trash. Always remove personal information from the medication container before disposal.

Conclusion:

Ketorolac is a potent NSAID and is used for short-term pain relief. It is a good alternative for pain management in pediatrics and adults for whom opioid dependence is a concern. Due to increased bleeding risk, patients using Ketorolac should be closely monitored and get their complete blood count done periodically.

Frequently Asked Questions

1.

What Are the Uses of Ketorolac?

Ketorolac is a non-steroidal anti-inflammatory drug that treats moderate to severe pain. It is commonly administered before and after surgical procedures to help patients recover comfortably after surgeries. It helps reduce swelling, fever, and pain. However, it is not recommended for long-term use.

2.

Does 10 mg Ketorolac Induce Sleep?

The common side effects of Ketorolac include nausea, vomiting, diarrhea, constipation, dizziness, and drowsiness. Hence ketorolac should be avoided while driving or performing any physical activity. However, 10 mg is the minimum drug dose, not sufficient to cause such side effects.

3.

Is Ketorolac Effective Than Ibuprofen?

Ketorolac and Ibuprofen are non-steroidal anti-inflammatory drugs. However, Ketorolac is more effective than Ibuprofen in relieving pain. Therefore, especially during surgeries, intravenous Ketorolac at the end is recommended to control postoperative pain instead of oral Ibuprofen.

4.

Are Ketorolac and Tramadol Similar?

Ketorolac and Tramadol belong to different drug groups. Ketorolac is a non-steroidal anti-inflammatory drug, and Tramadol is a narcotic pain reliever. However, the two drugs can be used in combination to relieve pain. But they can also lead to side effects, such as nausea, vomiting, abdominal pain, and dizziness.

5.

Why Should a Person Not Lie Down After Ketorolac Intake?

Ketorolac tablets should be taken with food or as an antacid with a full glass of water to avoid stomach upset. In addition, it is also advised not to lie down for at least 15 to 30 minutes after Ketorolac intake to prevent throat irritation and trouble swallowing.

6.

Is Ketorolac a Dangerous Medication?

Ketorolac is considered to be a high-risk medication. This is because they show a higher risk of heart attack or stroke in individuals who take the medication than in those who do not. These events are sudden, without symptoms, and may lead to death. Hence, the administration of Ketorolac is restricted to five days only.

7.

How Long Does It Take for Ketorolac to Act?

Ketorolac acts by blocking the nerves that transmit pain. It works fast, and the person can feel the effect within 15 to 20 minutes after the drug intake, which may last up to six hours. Therefore, oral Ketorolac is taken every six hours or when required to ease the pain.

8.

Why Should Ketorolac Be Taken Only for Five Days?

The administration of Ketorolac through oral and intravenous routes is limited to five days as it can cause serious side effects when administered at a high dose and for a long time. The serious side effects can increase the risk of cardiac thrombotic events, renal failure, ulcers, and bleeding.

9.

How Long Does It Take for Ketorolac to Stay In the Body?

Ketorolac is a non-steroidal anti-inflammatory drug taken by mouth for pain relief. It can stay as long as six hours in the body and should be taken every four to six hours. It can also be taken during pain or on a schedule at the same time every day.

10.

What Are the Drugs Commonly Interacting With Ketorolac?

The drugs that commonly interact with Ketorolac are angiotensin-converting enzyme inhibitors (Captopril), angiotensin II receptor blockers (Losartan), Methotrexate, corticosteroids (Prednisone), anti-platelet drugs (Warfarin, Enoxaparin), and diuretics (Cidofovir, Furosemide).

11.

Can I Take Two Doses of Ketorolac 10 mg at a Time?

The maximum daily dose of Ketorolac is 120 mg per day. Therefore, 10 mg to 30 mg of Ketorolac can be taken every four to six hours. However, some people are directed to take two tablets for the first dose only and then take the next single dose after four to six hours after the first dose. In the case of intravenous administration, 10 mg of Ketorolac is sufficient to provide the benefits of higher doses of oral Ketorolac.

12.

Is Ketorolac Prescribed for Tooth Pain?

Ketorolac can be used as a postoperative pain relief medication. However, it is also used as an intracanal medication during root canal treatment in teeth with irreversible pulp infection. In addition, it is also administered to individuals with severe toothache.

13.

Can I Consume Alcohol After Taking Ketorolac?

Individuals taking Ketorolac must avoid consuming alcohol as it can lead to serious side effects, such as loss of alertness, dizziness, drowsiness, vomiting, coughing up blood, and stomach bleeding characterized by black and bloody stools.

14.

Who Are All Contraindicated for Ketorolac Intake?

Ketorolac is contraindicated in the following conditions.
 - Individuals older than 65 years of age. 
 - Anemia.
 - Heart attack.
 - High blood pressure.
 - Asthma.
 - Stomach ulcer.
 - Kidney problems.
 - Liver problems.
 - Pregnancy.
 - Tobacco smoking.
 - Bleeding problems. 

15.

What Does the Ketorolac Black Box Warning Suggest?

The United States Food and Drug Administration issued a black box warning for Ketorolac in 2005. It stated that Ketorolac tromethamine can cause gastrointestinal symptoms such as bleeding, ulcers, perforation of infections, and can be fatal. They also added that these events might occur unpredictably during drug use.
Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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