Ketorolac is a non-opioid pain reliever that belongs to a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). It is known for its strong analgesic properties, which are comparable to some opioids, but without the risk of physical dependence. The medication works by inhibiting the body's production of prostaglandins, substances that cause inflammation, pain, and fever. Due to its potency and associated risks, ketorolac is only prescribed for specific, short-term applications and is not used for mild or chronic pain.
Systemic Use for Moderate to Severe Pain
One of the most common uses for ketorolac is in the management of moderate to severe acute pain, particularly in a hospital or clinical setting.
Post-Operative Pain Management
Following surgery, many patients experience significant pain. Ketorolac is a valuable tool in this scenario, often administered initially via intravenous (IV) or intramuscular (IM) injection to provide rapid and effective pain relief. This initial parenteral dosing can be followed by a short course of oral tablets, but the total duration of therapy is strictly limited to a combined 5-day period.
- Opioid-Sparing Strategy: A significant benefit of using ketorolac for post-operative pain is its ability to reduce a patient's reliance on opioid painkillers. By effectively managing pain, it lowers the required dose of more addictive narcotics and mitigates their common side effects, such as constipation and sedation.
- Various Surgical Procedures: Ketorolac is used for pain management after a wide range of surgical procedures, including general, orthopedic, and dental surgeries.
Nasal Spray for Acute Pain
In addition to oral and injectable forms, ketorolac is available as a nasal spray (Sprix) for the short-term treatment of moderate to moderately severe pain. This formulation provides an alternative delivery method for patients who cannot tolerate or prefer not to use oral tablets, with the same 5-day usage limit as other systemic forms.
Ophthalmic Use for Eye Conditions
Ketorolac is also available in an ophthalmic (eye drop) formulation for treating specific eye conditions, where the systemic side effect risks are significantly reduced.
Seasonal Allergic Conjunctivitis
Ketorolac eye drops are used to treat itchy eyes caused by seasonal allergies. The anti-inflammatory action helps reduce the itching and swelling associated with the allergic reaction.
Post-Surgical Eye Inflammation
Eye drops containing ketorolac are also prescribed to manage inflammation, pain, and swelling following specific eye surgeries, including:
- Cataract Surgery: Used for a defined period, typically starting one day before or one day after surgery and continuing for up to two weeks.
- Corneal Refractive Surgery: Prescribed for pain and burning sensation following procedures like LASIK.
Ketorolac vs. Other NSAIDs: A Comparison
Ketorolac is a powerful NSAID, but it differs from others in several key ways, including potency, safety warnings, and available formulations.
| Feature | Ketorolac | Ibuprofen (Advil, Motrin) | Naproxen (Aleve) |
|---|---|---|---|
| Potency | Very potent analgesic; used for moderate-to-severe pain. | Mild to moderate pain, fever, and inflammation. | Mild to moderate pain, fever, and inflammation. |
| Available Forms | Injection (IV/IM), oral tablet, nasal spray, eye drops. | Oral tablets, capsules, liquids; also topical gels. | Oral tablets, capsules, liquids; also topical gels. |
| Duration of Use | Strictly limited to a maximum of 5 days (systemic use) due to increased risk of side effects. | Typically used for longer periods than ketorolac, but still with caution. | Used for longer periods than ketorolac, but with similar NSAID precautions. |
| Black Box Warnings | Boxed warning on significant risks of GI bleeding, cardiovascular events, and renal failure. | Standard NSAID boxed warnings, less strict duration limits than ketorolac. | Standard NSAID boxed warnings, less strict duration limits than ketorolac. |
Safety Profile and Restrictions
Due to its high potency, ketorolac carries a higher risk of adverse effects compared to other NSAIDs, leading to its strict limitations on usage.
Significant Side Effects and Risks
- Gastrointestinal (GI) Bleeding: Ketorolac can cause serious GI bleeding, ulceration, or perforation, especially with prolonged use, in older patients, or those with a history of GI issues.
- Cardiovascular Risks: It carries an increased risk of serious cardiovascular thrombotic events, including heart attack and stroke, and is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.
- Renal Impairment: The drug can cause kidney failure and is contraindicated in patients with advanced renal disease or those at risk of kidney failure.
Contraindications and Precautions
Ketorolac should not be used by patients with certain pre-existing conditions or in specific situations. Contraindications include:
- Active peptic ulcer disease or recent GI bleeding.
- Advanced renal impairment.
- During labor and delivery, as it may affect fetal circulation and inhibit uterine contractions.
- A history of asthma, urticaria, or allergic reactions to aspirin or other NSAIDs.
- Those at high risk of bleeding, including cerebrovascular bleeding or incomplete hemostasis.
Conclusion
Ketorolac is a powerful and effective non-opioid analgesic used for the short-term treatment of specific conditions requiring potent pain relief. Its use is primarily indicated for moderately severe acute pain, especially in post-operative settings where it can serve as a crucial part of a pain management strategy, reducing the need for addictive opioids. Additionally, it provides targeted relief for eye inflammation and allergic conjunctivitis in its ophthalmic form. However, the medication's significant risks, including potential harm to the GI tract, cardiovascular system, and kidneys, necessitate strict adherence to the prescribed 5-day limit and careful patient selection. Patients should always discuss the risks and benefits with their healthcare provider to ensure ketorolac is the appropriate and safest treatment option for their condition.
For more detailed information, consult the MedlinePlus drug information page on ketorolac: https://medlineplus.gov/druginfo/meds/a693001.html.
