Ketorolac - Side Effects And Warnings.

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.

When Can We 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. 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, in nasal sprays, intravenously, or through intramuscular 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.

How Does Ketorolac Work in the Body?

Like the other NSAIDs, Ketorolacl 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%. After intramuscular administration, Ketorolacreaches maximum plasma concentration in 45 minutes. It is metabolized in the liver and is excreted around 60 % in the urine.

Why Can’t 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 You Overdose Ketorolac?

Taking an overdose of Ketorolac may exhibit 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 your doctor if you have 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 - Ketorolacl 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 on 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 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 CABG and delivery. Hence, FDA issued a Black Box Warning with it in 2005.

Does Ketorolac Interact With Other Medicines?

When taking this medicine, it is important that your healthcare professional know if you are taking any of the medicines listed below:

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.

Interactions with Diseases:

• GI Toxicity.

• Renal Dysfunction.

• Diabetes Mellitus.

• Hypertension.

• Asthma.

• Hemophilia or other bleeding disorders.

• Systemic Lupus Erythematosus.

• Colitis, Stomach Ulcer.

• Heart Failure.

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

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

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

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.