ketorolac

Generic Name: ketorolac (KEE toe ROLE ak)Brand Names: Toradol, Toradol IM, Toradol IV/IM

What is ketorolac?

Ketorolac is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Ketorolac works by reducing hormones that cause inflammation and pain in the body.

Ketorolac is used short-term (5 days or less) to treat moderate to severe pain.

Ketorolac may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about ketorolac?

This medicine can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use ketorolac. Do not use this medicine just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

Seek emergency medical help if you have symptoms of heart or circulation problems, such as chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.

This medicine can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking ketorolac. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

Do not drink alcohol while taking ketorolac. Alcohol can increase the risk of stomach bleeding caused by ketorolac.

What should I discuss with my healthcare provider before taking ketorolac?

Do not use this medication if you are allergic to ketorolac, aspirin, or other NSAIDs, or if you have:

• severe kidney disease;

• a bleeding or blood clotting disorder;

• a closed head injury or bleeding in your brain;

• a stomach ulcer or a history of stomach or intestinal bleeding; or

• if you are breast-feeding a baby.

Do not take ketorolac if you are also taking pentoxifylline (Trental) or probenecid (Benemid). Do not take ketorolac with aspirin or other NSAIDs such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), or piroxicam (Feldene).

Taking an NSAID can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use an NSAID. Do not use this medicine just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

NSAIDs can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking an NSAID. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Before taking ketorolac, tell your doctor if you are allergic to any drugs, or if you have:

• a history of heart attack, stroke, or blood clot;

• heart disease, congestive heart failure, high blood pressure;

• liver or kidney disease,

• ulcerative colitis or Crohn's disease;

• asthma;

• polyps in your nose;

• if you have recently had surgery; or

• if you smoke.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take ketorolac.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking ketorolac during labor can increase the risk of bleeding during childbirth. Do not take ketorolac during pregnancy unless your doctor has told you to.

This medication can affect fertility (your ability to have children). Do not take ketorolac while you are trying to get pregnant.

Ketorolac can pass into breast milk and may harm a nursing baby. Do not take this medicine without telling your doctor if you are breast-feeding a baby. Do not give this medicine to anyone younger than 18 years old.

How should I take ketorolac?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. Ketorolac is not for treating minor aches and pains.

Ketorolac is usually given first as an injection, and then as an oral (by mouth) medicine. Ketorolac injection is given through a needle into a muscle or a vein. Your doctor, nurse, or other healthcare provider will give you this injection.

The ketorolac tablet should be taken with a full glass of water. Ketorolac is normally given for 5 days or less, including both the injection and oral forms combined. Long-term use of ketorolac can damage your kidneys or cause bleeding. If you need to have any type of surgery, tell the surgeon ahead of time if you have recently used ketorolac. Store ketorolac tablets at room temperature away from moisture and heat.

See also: Ketorolac dosage in more detail

What happens if I miss a dose?

Since ketorolac is taken as needed for pain, you may not be on a dosing schedule. And if you receive ketorolac injection in a hospital setting, it is not likely that you will miss a dose.

If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea, vomiting, stomach pain, drowsiness, black or bloody stools, coughing up blood, urinating less than usual, shallow breathing, and fainting.

What should I avoid while taking ketorolac?

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Many medicines available over the counter contain aspirin or other medicines similar to ketorolac (such as ibuprofen, ketoprofen, or naproxen). If you take certain products together you may accidentally take too much of this type of medication. Read the label of any other medicine you are using to see if it contains aspirin, ibuprofen, ketoprofen, or naproxen. Do not drink alcohol while taking ketorolac. Alcohol can increase the risk of stomach bleeding caused by ketorolac.

Ketorolac side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking ketorolac and seek medical attention or call your doctor at once if you have any of these serious side effects:

• chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance;

• black, bloody, or tarry stools;

• coughing up blood or vomit that looks like coffee grounds;

• swelling or rapid weight gain;

• urinating less than usual or not at all;

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;

• the first sign of any mouth sores or skin rash, no matter how mild;

• pale skin, easy bruising, severe tingling, numbness, pain, muscle weakness; or

• fever, headache, neck stiffness, chills, increased sensitivity to light, purple spots on the skin, and/or seizure (convulsions).

Less serious side effects may include:

• upset stomach, mild nausea or vomiting, diarrhea, constipation;

• mild heartburn, stomach pain, bloating, gas;

• dizziness, headache, drowsiness;

• sweating; or

• ringing in your ears.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Ketorolac Dosing Information

Usual Adult Dose for Pain:

In adults, the use of oral ketorolac is only indicated as continuation therapy to IV or IM dosing of ketorolac. The manufacturer recommends that the oral formulation should not be given as an initial dose.Parenteral: Single dose administration:IM: Patients less than 65 years of age: one dose of 60 mg. Patients who are renally impaired, and/or less than 50 kg (110 pounds): one dose of 30 mg.IV: Patients less than 65 years of age: one dose of 30 mg. Patients who are renally impaired, and/or less than 50 kg (110 pounds): One dose of 15 mg.Multiple dose administration: Patients less than 65 years of age: 30 mg IM or IV every 6 hours as needed. The maximum daily dose should not exceed 120 mg. Patients who are renally impaired, and/or less than 50 kg (110 pounds): 15 mg IM or IV every 6 hours as needed. The maximum dose should not exceed 60 mg.Oral: \t10 mg orally 4 times a day as needed. The maximum daily dose should not exceed 40 mg.Patients less than 50 kg: The maximum daily dose should not exceed 40 mg.

Usual Geriatric Dose for Pain:

In adults, the use of oral ketorolac is only indicated as continuation therapy to IV or IM dosing of ketorolac. The manufacturer recommends that the oral formulation should not be given as an initial dose.Parenteral: Single dose administration:IM: Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): one dose of 30 mg.IV: Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): One dose of 15 mg.Multiple dose administration: Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): 15 mg IM or IV every 6 hours as needed. The maximum dose should not exceed 60 mg.Oral: 10 mg orally 4 times a day as needed. The maximum daily dose should not exceed 40 mg.

Usual Pediatric Dose for Pain:

2 to 16 years:IM dosing: a single dose of 1 mg/kg up to a maximum of 30 mg.IV dosing: a single dose of 0.5 mg/kg up to a maximum of 15 mg.Study (n=54)Greater than or equal to 3 years: 0.6 mg/kg IV once post surgery.

What other drugs will affect ketorolac?

Tell your doctor if you are taking an antidepressant such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor). Taking any of these drugs with ketorolac may cause you to bruise or bleed easily.

Before taking ketorolac, tell your doctor if you are taking any of the following drugs:

• a blood thinner such as warfarin (Coumadin);

• lithium (Eskalith, Lithobid);

• methotrexate (Rheumatrex, Trexall);

• thiothixene (Navane);

• alprazolam (Xanax);

• diuretics (water pills) such as furosemide (Lasix);

• muscle relaxers;

• steroids (prednisone and others);

• seizure medications such as carbamazepine (Carbatrol, Tegretol) or phenytoin (Dilantin);

• a heart or blood pressure medication such as candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro, Avalide), losartan (Cozaar, Hyzaar), valsartan (Diovan), telmisartan (Micardis), or olmesartan (Benicar); or

• aspirin or other NSAIDs such as etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others; or

• an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace), and others.

This list is not complete and there may be other drugs that can interact with ketorolac. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about ketorolac.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 8.02. Revision Date: 4/12/2009 4:36:47 PM.