Ketorolac is a powerful nonsteroidal anti-inflammatory drug (NSAID) that inhibits enzymes responsible for pain and inflammation. Unlike many common over-the-counter NSAIDs, ketorolac requires a prescription and is typically used for more severe pain that might otherwise require opioids. Due to the risk of serious side effects, its use is limited to a maximum of five days.
Primary Indications for Ketorolac
Ketorolac is mainly used for specific types of acute, moderately severe pain and is commonly administered in hospitals or emergency settings. Its uses include managing pain after surgery, where it can reduce the need for opioid pain relievers, and treating conditions like migraine headaches, kidney stone pain, musculoskeletal pain, and sickle cell crisis in emergency departments. Ophthalmic forms are used for eye inflammation and discomfort.
Forms of Administration and Their Restrictions
Ketorolac is available in several forms with strict guidelines. These include intravenous (IV) or intramuscular (IM) injection, oral tablets, nasal spray, and ophthalmic solution (eye drops). Dosage varies by form and patient factors, and the total treatment duration (excluding ophthalmic drops) must not exceed 5 days.
Comparison: Ketorolac vs. Ibuprofen
Both are NSAIDs, but ketorolac is more potent and used for shorter periods due to higher risks compared to ibuprofen.
| Feature | Ketorolac (e.g., Toradol) | Ibuprofen (e.g., Advil, Motrin) |
|---|---|---|
| Potency | Significantly more potent. | Less potent. |
| Intended Use | Short-term (≤ 5 days) for moderately severe acute pain, often post-surgery. | Mild-to-moderate pain, fever, inflammation; can be used longer with care. |
| Availability | Prescription only. | Over-the-counter and prescription. |
| Risks | Higher risk of serious GI bleeding, cardiovascular issues, kidney problems, especially with use >5 days. | Lower risk of GI bleeding and kidney issues, generally safer for longer use than ketorolac. |
Important Safety Warnings
Ketorolac has a boxed warning from the FDA. Risks include serious gastrointestinal bleeding, ulcers, and perforation, increased risk of heart attack and stroke (especially in patients with recent history or undergoing CABG), kidney damage (contraindicated in advanced kidney problems), and bleeding risk due to platelet inhibition (contraindicated in those with high bleeding risk or disorders). Severe allergic reactions can also occur in sensitive individuals.
Conclusion
Ketorolac is effective for managing moderately severe acute pain, particularly after surgery, and can help reduce reliance on opioid pain relievers. However, its powerful nature comes with significant risks to the gastrointestinal, cardiovascular, and renal systems. Therefore, its use is strictly limited to a maximum of five days. This critical limitation distinguishes it from less potent NSAIDs like ibuprofen. Safe use depends on strict adherence to these guidelines and careful patient selection. For more information, refer to the {Link: MedlinePlus Drug Information on Ketorolac https://medlineplus.gov/druginfo/meds/a693001.html}.
