Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) with analgesic properties. It is used for short term management (up to 5 days) of moderately severe acute pain.

• Moderately severe acute pain
• Headache
• Acute pain requiring opioid-level analgesia

Ketorolac inhibits prostaglandin synthesis by competitive blocking cyclooxygenase (COX) enzyme. The prostaglandins cause the redness, fever, swelling, pain, and inflammation.

Patients aged 17 to 64 years require 20 mg PO once followed by 10 mg every 4 to 6 hours as recommended. Patients aged >65 years, those with renal impairment, and/or weight <50 kg require 10 mg PO once followed by 10 mg every 4 to 6 hours as recommended.

Ketorolac is rapidly absorbed, C_max (maximum peak concentration) being achieved between 20 to 60 minutes. Its bioavailability is estimated to range from 80 to 100%. The drug is extensively bound (>99%) to plasma proteins and has a volume of distribution (0.1 to 0.3 L/kg) comparable with those of other NSAIDs. Ketorolac is extensively metabolized through glucuronidation and oxidation; little if any drug is eliminated unchanged. The elimination half-life is between 4 and 6 hours.

• Allergy to aspirin or other NSAIDs
• Gastrointestinal bleeding
• Kidney or Liver disease
• Asthma
• Dehydration
• Pregnancy and lactation
• Postoperatively in patients with high risk of bleeding

• Aliskiren
• ACE inhibitors (such as captopril, lisinopril)
• Angiotensin II receptor blockers (such as valsartan, losartan),
• Corticosteroids (such as prednisone)
• Methotrexate
• Probenecid
• Cidofovir
• Diuretics (such as furosemide).
• Anti-platelet drugs such as clopidogrel and blood thinners such as dabigatran/enoxaparin/warfarin

Common (affecting between 1 in 10 to 1 in 100)

• Abdominal pain & dyspepsia
• Nausea & vomiting
• Drowsiness

Uncommon (affecting 1 in 100 to 1 in 1000)

• Edema
• Hypertension
• Pruritus
• Skin Reactions

Very rare (affecting less than 1 in 10,000)

• Peptic ulcer
• GI bleed/perforation
• Renal or liver failure
• Anaphylaxis

• It may increase the risk of serious cardiovascular events, myocardial infarction and stroke
• Not to be used in children younger than 17 years old; safety and effectiveness is not confirmed in this population
• Not be used by nursing mothers because it is excreted in breast milk

• Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with strong analgesic activity that has been evaluated in postoperative setting, in both hospital inpatients and outpatients. Ketorolac provides relief from mild to severe pain in patients after major abdominal, orthopedic or gynecological surgery or ambulatory laparoscopic or gynecological procedures and also provides a useful alternative, or adjuvant, to opioids¹.
• Ketorolac tromethamine controls postoperative pain better than Hydrocodone and Acetaminophen after anterior cruciate ligament reconstruction. With an effective loading dose administered before the subsequent oral dosage, better reduction in pain is there with Ketorolac tromethamine as compare to Hydrocodone and Acetaminophen².

1. Gillis JC, Brogden RN. Drugs. 1997 Jan;53(1):139-88
2. Barber FA, Gladu DE Arthroscopy. 1998 Sep;14(6):605-12 http://www.ncbi.nlm.nih.gov/pubmed/9754479
3. Mettu SR, Veerareddy PR. Drug Res (Stuttg). 2013 Nov; 63(11):586-90
4. Vemula SK, Veerareddy PR. Expert Opin Drug Deliv. 2013 Jan; 10(1):33-45
5. Johansson S, Josefsson G, Malstam J, Lindstrand A, Stenstroem A. J Int Med Res. 1989 Jul-Aug; 17(4):324-32
6. Drugs. com http://www.drugs.com/cdi/ketorolac-tablets.html
7. Empr. com http://www.empr.com/ketorolac-tablets/drug/2720/
8. Medicinenet.com http://www.medicinenet.com/ketorolac-oral/article.htm
9. Medscape http://reference.medscape.com/drug/ketorolac-343292