Ketorolac (Injection, Oral)

Overview

Ketorolac is used for treating moderate to severe pain. It's a short-term therapy medication for adults that should not be used for more than five days. This medicine is often used after several medical procedures, for example, surgery, to enable patients to get back to their normal activities in a painless way after the procedure. It's an anti-inflammatory drug, which means that it works by inhibiting the hormones that cause inflammation in the body. As a result, the effect produced reduces fever, pain, or swelling. It's not recommended to use Ketorolac for managing long-term chronic conditions like arthritis.

Dosage for Ketorolac depends on the patient's medical history, other chronic conditions, and overall responsiveness. You should not alter dosage or take medicine for an extended period; do not take the drug for more than five days. Any medication that is leftover after the dose is complete should be discarded accordingly. Also, do not share your medication with other people, even when they portray similar signs to you.

The medicine is available as an injection and in tablet form. Always take medicine as directed by your doctor; it's not recommended to take more than 40 mg in a day. For best results, the drug should be used immediately the inflammation occurs; if therapy is delayed, then it will be less efficient. Ketorolac may affect infants so avoid breastfeeding until treatment is complete.

Apart from the positive effects of the drugs, there are several side effects as well. Reports indicate that Ketorolac can increase the chances of a heart attack, which can be fatal. Patients who are at a higher risk of suffering from heart attacks may also experience other severe side effects. The elderly are at a higher risk of suffering from bleeding or stomach ulcers. You should not take Ketorolac if you also have kidney disease or ulcers.

Healthcare professionals must monitor progress by conducting frequent liver tests to ascertain the presence of complications and manage any potential harmful effects.

Condition treated

  • Inflammation / pain

Type Of Medicine

  • Painkiller

Side Effects

Ketorolac is a safe drug to use even though patients have reported several side effects. Some signs may show immediately once you start using the drugs while others may take a few days to become visible. Mild discomfort is not a cause for concern because it might be your body's reaction to therapy.

If you have any of the following symptoms; seek medical attention immediately:

Allergic reactions cause some other symptoms. These are usually serious and require urgent medical attention; they include the following:

  • Difficulty breathing
  • Hives
  • Swollen throat, tongue, lips, or face

In normal circumstances, it's not recommended to stop taking medicine even if the symptoms appear. However, you should call a doctor or go to a hospital immediately if the following signs appear:

  • Muscle weakness
  • Problems with balance
  • Poor vision
  • Chest pain
  • Slurred speech
  • Tarry, bloody, or black stools
  • Vomiting blood that resembles coffee grounds
  • Quick weight gain
  • Swelling of face, ankles, fingers, or feet
  • Appetite loss
  • Yellow eyes or skin
  • Urinating less
  • Blistering skin
  • Mouth sores
  • Pale skin
  • Severe tingling
  • Stiff neck
  • Easy bruising
  • Increased light sensitivity
  • Seizures

Some less common side effects include the following:

  • High blood pressure
  • Ulcers or sores in the mouth or on the lips
  • Cloudy or bloody urine
  • Blue fingernails or lips
  • Hoarseness
  • Scaly, thick, red, or burning skin
  • Dark urine
  • Fainting
  • Irregular, troubled, noisy, or fast breathing
  • Fever without a sore throat or chills
  • Hallucinations
  • Urinating frequently or increased urine amount
  • Hearing loss
  • Light-colored stools
  • Unusual behavior or sudden mood changes
  • Muscle pain or cramps
  • Indigestion
  • Nose bleeding
  • Lower back pain
  • Unquenchable thirst
  • Chest tightness
  • Painful or swollen gland
  • Severe restlessness
  • A runny nose
  • Swollen or puffy eyes or eyelids
  • Unusual tiredness

Some side effects usually disappear within one or two days since they're a reaction of the body to the drugs. These side effects are less severe and include the following:

  • Bruising or burning at the injection area
  • Constipation
  • Indigestion
  • Feeling full in the stomach

Dosage

Ketorolac is first given as an injection by a certified healthcare professional in a setting such as a clinic or a hospital. The injection is given through an IV bag, and the rest of the dose is taken orally. Ketorolac is available as an intravenous solution of 30 mg per ml or a tablet of 10 mg. The dosage prescribed depends mainly on the type of condition being treated and other factors such as the patient's response to the medicine.

  • Dose for pain in adults

This dose is a combination of intravenous and oral forms of Ketorolac. For adults who weigh above 110 lbs, the dose is 31.5 mg to be delivered after 8 hours. However, for adults who weigh less than 110 lbs, the dose is 15.75 mg to be delivered after 8 hours. The maximum number of doses that patients can take per day for both cases is four.

On the other hand, Ketorolac can also be given as a single dose. For adults weighing more than 110 lbs, the dose is 30 mg given through an IV injection. For multiple-dose therapy using the intravenous route, adults weighing 110 lbs or more are given 30 mg IV after 6 hours for as long as the doctor deems it necessary. The maximum dose per day, in this case, is 60 mg. For adults weighing less than 110 lbs, the dose is 15 mg IV given after 6 hours with a maximum dose of 60 mg per day.

The oral tablets are a continuation of the dose. Adults weighing 110 lbs should take a 20 mg tablet once then follow it up with a 10 mg tablet after every 6 hours as required. Adults weighing less than 110 lbs should take a 10 mg pill after 6 hours as required. The maximum dose is 50 mg per day.

  • Dose for pain in the elderly

The dose combination of the intravenous and oral forms of this drug must not be used for more than five days. 15.75 mg of Ketorolac is given to the patient after every 8 hours and the maximum number of doses that should be given is four per day.

When Ketorolac is used as a single dose for treating pain in the elderly, the dose is given as a 30 mg or 15 mg injection via an IV bag. For multiple doses, on the other hand, 15 mg of the medicine is given through the intravenous route after 6 hours as required. The maximum dose of the drug that can be given per day is 60 mg.

The dosage for the oral therapy is a 10 mg tablet that should be swallowed after 6 hours as required. The maximum dose is 40 mg per day.

The dose should not be increased when dealing with severe pain; you should ask your doctor how best to supplement the effects of the medicine using opioids.

  • Dose for pain in adolescents

The dose for patients who are 17 years or older and weigh more than 110 lbs is a 31.5 mg pill to be taken after every 8 hours. For patients weighing less than 110 lbs, the dose is 15.75 mg to be taken after every 8 hours. The maximum number of doses that can be taken is four.

For the oral continuation, patients weighing more than 110 lbs should take a 20 mg tablet once, which is to be followed by a 10 mg tablet after every 6 hours as required. Patients who weigh less than 110 lbs should take one (10 mg) tablet every 6 hours as required. The maximum dose is 40 mg per day.

The single dose treatment (given through IV injection) is 30 mg or 15 mg, for patients weighing less than 110 lbs; and 60 mg or 30 mg, for patients weighing more than 110 lbs. For multiple doses, then again, 30 mg is given after every 6 hours as required. The maximum dose for the intravenous route is 120 mg per day.

Interactions

Ketorolac interacts with a total of 1,823 drugs (both generic and brand names). It's important to discuss with your doctor for a list of all possible over-the-counter, supplements, herbal products, and street drugs that may interact with this drug.

Some of the prescription medication that interacts with Ketorolac includes:

  • Acalabrutinib

The interaction between these two drugs may increase the risk of bleeding. Out of the 612 patients observed, 50% exhibited various grades of bleeding. For patients who are using a combination of acalabrutinib and Ketorolac, they should be closely monitored to ensure bleeding complications are prevented.

  • Apixaban

Using Ketorolac and apixaban together may cause severe bleeding that may be fatal. However, doctors may still prescribe the combination as the best therapy option but under strict surveillance. Seek immediate medical attention if you experience strange bruising or bleeding.

  • Ardeparin

Apart from increasing the risk of bleeding, the combination of ardeparin and Ketorolac also cause other side effects. These include a chronic migraine, weakness or dizziness when being treated with the medications, bloody urine and stools, and unusual swelling.

  • Teriflunomide

Reports indicate that teriflunomide may cause liver injury, and when you use it together with Ketorolac, that threat is increased. Seek urgent medical attention if you start showing symptoms of liver damage such as fatigue, dark colored urine, yellow eyes or skin, itching, skin rash, and joint pain.

  • Ibuprofen

Ketorolac and ibuprofen interact to cause unpleasant effects such as stomach pain, bloody stool, shallow breathing, and nausea. Avoid using pain, allergy, or cold medicine when using Ketorolac since most of these prescription medications contain ibuprofen. Consult your doctor to avoid taking an overdose of this drug accidentally.

  • Lithium

Using Ketorolac together with lithium may lead to blood intoxication. Symptoms of excess lithium levels in the body include increased urination, diarrhea, dizziness, muscle weakness, blurred vision, tremors, and inability to coordinate muscles. Consult your doctor in case you start exhibiting any of these signs so that alternative medication may be prescribed or the dosage altered.

Ketorolac interacts with a total of 12 diseases including the following:

  • Renal dysfunction

The use of anti-inflammatory drugs such as Ketorolac is linked to renal toxicities. Patients who are at a higher risk of suffering from these toxicities include those with liver dysfunction or heart failure. Since the kidney is responsible for eliminating Ketorolac from the body, the dosage should be reduced by half to prevent accumulation of the drug.

Treatment with Ketorolac should be avoided if you have a history of sensitivity to anti-inflammatory drugs and aspirin. If you have preexisting asthma, a doctor may still prescribe Ketorolac although treatment must be administered cautiously. However, high doses may cause severe side effects, so it's recommended to start therapy with lower dosages.

Therapy with Ketorolac should be administered vigilantly under the care of a professional healthcare provider. Patients with preexisting anemia should be monitored, especially in chronic therapy, to ensure that therapy will not cause a significant amount of blood loss.

Patients who are suffering from hypertension should not take Ketorolac because the drug interacts with the disease to cause numerous cardiovascular events. If your doctor decides to use the drug, your blood pressure must be monitored at all times to ensure safety.

  • Fluid retention

Patients with a fluid retention condition should not use Ketorolac to avoid severe side effects that may be fatal at times. If your doctor deems it necessary to use Ketorolac for your therapy, then your cardiovascular status and blood pressure must be closely monitored during the first treatment and for the entire period. Tell your healthcare provider if you have a history of fluid retention or heart failure.

Avoid drinking and smoking when using this drug to prevent severe side effects from occurring. Ketorolac also interacts with alcohol, which consequently leads to stomach bleeding. Seek medical assistance if you start bleeding in the intestines or stomach. There are numerous other over-the-counter medication and diseases that interact with Ketorolac so discuss with your doctor to get the complete list for your case.

Warnings

Ketorolac is an anti-inflammatory drug that should only be used to treat moderate pain in adults for a short period. The medicine should not be used to treat chronic or minor painful conditions because its potency could lead to numerous health risks. When using the drug, observe the following precautions:

  • The oral tablets must not be taken as the initial dose; the IV injection should be used to start the therapy, and the combined use of both forms of medication should not be more than five days.
  • The Ketorolac IV injection should be administered slowly into the muscles.
  • The patient's blood pressure must be monitored when starting therapy and through the entire period. Any signs of bleeding in the stomach should be treated immediately.
  • Drink plenty of fluids when receiving therapy. If your urine becomes significantly less, seek urgent medical assistance.
  • Discontinue the use of Ketorolac immediately if there are symptoms of liver damage or regular tests reveal abnormal results.
  • For patients who are older than 65 years and weigh 110 lbs, the dosage given should not exceed 60 mg IV per day.
  • This medication should not be used by patients who are also suffering from peptic ulcers or those with a hitory of stomach bleeding.
  • Ketorolac should not be used before or after major surgery because it can increase the risk of bleeding.
  • Caution should be exercised when administering the first injection of this drug to avoid allergic reactions or hypersensitivity.
  • Ketorolac tablets should be taken after meals to prevent any potential side effects on the stomach.
  • Do not smoke or take alcohol during therapy as they may interact with the medication to increase the severity of the side effects.
  • Do not take Ketorolac if you're breastfeeding or pregnant.
  • Avoid prolonged exposure to the sun and tanning booths because the medication makes the skin sensitive and more prone to blisters and com/health/burns/">sunburns.
  • Keep the drug away from the reach of children and pets.
  • If your tablets are smelly, crumbly, spotted, or discolored, do not use them. Go to your doctor for a prescription replacement.
  • In case of an overdose, call the local poison control unit or take the victim to the nearest hospital immediately.

Storage

Tablets should be stored at room temperature and away from light; do not store the medicine under refrigeration. According to the FDA, water, light, and air are destructive to the medication so ensure that you store your drugs in a cool and dry place to prevent damages. Instead of storing your medicine in a bathroom cabinet where it's prone to moisture, keep your pills in a locked cabinet in the bedroom.

Parents with toddlers should insist on childproof containers when purchasing their prescription medication at pharmacies. Test the containers to ensure that they're adult-proof as well. Ketorolac should only be stored in their original containers to avoid confusion, especially when it comes to identifying expiration dates.

When traveling by plane, carry the medication on the carry-on luggage since cargo compartments may either be too cold or hot for the medicine. When driving, keep the medicine in a cool place, like the back seat, but not inside the glove compartment. Always ensure that your medications are in their original containers so that the security personnel at the airport can quickly identify them.

Keep a list of all the medications you use, and your medical history if possible, in your wallet or purse so that you can get swift treatment in case of an emergency.

Dispose of unused, expired, or unneeded medication according to local guidelines. You should not flush them down your toilet.

Summary

Ketorolac is an NSAID that is used for treating pain in adults (moderate to severe). The medication should only be used for a short-time period because prolonged use may lead to adverse side effects. The first dose is usually administered as an injection, and the rest is taken through the oral route; the tablets should be taken after 6 hours with plenty of water. In case of stomach upset during treatment, it's recommended to take medicine with milk or food. Avoid lying down for 15 minutes after you've taken the drug.

The dosage prescribed is based on several factors such as the patient's preexisting medical conditions, medical history, and allergies. The dose should be taken as required, which means that it's advisable to start taking Ketorolac when the pain first starts to occur. Consult your doctor if the condition does not improve, or the pain does not go away. Also, inform your doctor of all allergic reactions that you may have before therapy commences. Problems during treatment often occur due to kidney disease, heart failure, or dehydration.

Although Ketorolac is active medicine for treating pain in adults, it also causes several side effects. This drug usually makes patients drowsy or dizzy so avoid operating heavy machinery or driving during therapy. Prolonged use of Ketorolac may cause liver damage; do not use this drug for more than five days.