Ketorolac: Difference between revisions

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{{MedTemplate

| generic = Ketorolac

| generic = Ketorolac (tromethamine)

| brand = Toradol

| brand = Toradol (IV/IM, US brand discontinued), Sprix (nasal spray), Acular and Acuvail (ophthalmic)

| ~~classes~~ = ~~NSAID~~

| structure =

| ~~intro~~ = ~~Ketorolac is a non~~-steroidal anti-inflammatory ~~drug~~ (NSAID) ~~used for~~ short-term moderate-to-severe pain ~~control~~, ~~often~~ as ~~a non~~-~~opioid option~~ in ~~postoperative settings~~.

| classes = [[:Category:NSAIDs|Non-steroidal anti-inflammatory (NSAID)]], [[:Category:Analgesics|Analgesic (opioid-sparing parenteral)]]

| uses = <vote slug="moderate-severe-acute-pain-use">Moderate-to-severe acute pain, short-term (FDA)</vote>, <vote slug="post-surgical-pain-use">Postoperative pain, opioid-sparing (FDA)</vote>, <vote slug="acute-migraine-ketorolac-use">Acute migraine (off-label, IV/IM)</vote>, <vote slug="post-cataract-inflammation-use">Post-cataract surgical inflammation (FDA, ophthalmic)</vote>, <vote slug="allergic-conjunctivitis-use">Seasonal allergic conjunctivitis (FDA, ophthalmic)</vote>

| starting_dose = IM: 60 mg single dose or 30 mg every 6 hours. IV: 30 mg every 6 hours. Oral (continuation only): 10-20 mg every 4-6 hours. Sprix nasal: 31.5 mg every 6-8 hours. '''Maximum 5 days total combined use'''

| preparations = Tablets 10 mg; injection 15 mg/mL and 30 mg/mL; nasal spray 15.75 mg/spray (Sprix); ophthalmic solution 0.4%, 0.45%, 0.5%

| fda_max = 120 mg/day (IV/IM); 40 mg/day (oral); '''5-day maximum total combined therapy''' to mitigate the GI bleeding, AKI, and platelet dysfunction risks

| pill_id =

| routes = Oral (continuation only), IV, IM, intranasal, ophthalmic

| onset = 30 minutes (IM); 30-60 minutes (oral)

| duration = 4-6 hours

| halflife = 5-6 hours<ref name="toradol-label">FDA Prescribing Information, Toradol (ketorolac tromethamine), Roche/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019645s022lbl.pdf</ref>

| bioavailability = ~100% (oral, but oral use is limited to continuation from parenteral)<ref name="toradol-label" />

| pregnancy = Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning; contraindicated from 30 weeks. Specifically contraindicated in labor and delivery due to inhibition of uterine contractions<ref name="toradol-label" />

| legal = [[USLegal:Prescription only|Rx-only]] in US

| mechanism = <vote slug="ketorolac-mech-claim">Non-selective COX-1/COX-2 inhibitor with '''unusually potent analgesic effect''': the IV dose has been shown comparable to morphine for moderate-to-severe acute pain in postoperative trials, the basis of its opioid-sparing role. Anti-inflammatory effect is similar to other NSAIDs at the molar level; the analgesic potency is the distinguishing feature.</vote> '''Stricter dose-duration limits than any other NSAID''' (≤5 days, parenteral as primary route, continuation oral only) based on documented elevated risk of GI bleeding, acute kidney injury, and platelet dysfunction with prolonged use. Acute kidney injury risk is particularly elevated in dehydrated postoperative patients and contraindicates ketorolac in volume-depleted states. Not appropriate for chronic pain in elderly<ref name="toradol-label" />.

}}

== References ==

[[Category:NSAIDs]]

[[Category:Analgesics]]

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