Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve moderate to severe pain, usually after surgery or dental procedures. It is given by injection or orally for short periods.
Also known as: ketorolac tromethamine, toradol
Injectable NSAID + antimetabolite: methotrexate renal clearance reduced. Risk of toxicity.
Ketorolac reduces renal blood flow and tubular secretion of methotrexate, increasing serum levels and prolonging half-life.
Blood count, methotrexate levels.
Pancytopenia, mucositis.
Avoid combination during high-dose methotrexate treatment. If necessary, monitor blood count and methotrexate levels.
DailyMed/FDA — approved Ketorolac label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0749f61d-12e6-4280-8f41-bd4df81e7ae6
Injectable NSAID + anticoagulant: increased bleeding risk. Platelet inhibition + anticoagulant effect.
Ketorolac strongly inhibits COX-1, reducing platelet aggregation. Combined with warfarin, the risk of GI and other bleeding is significantly increased.
INR, signs of bleeding (bruising, haematuria, melaena).
Major bleeding, Hb drop >2 g/dL.
Avoid combination. If unavoidable, monitor INR daily and signs of bleeding. Maximum ketorolac duration: 5 days.
DailyMed/FDA — approved Ketorolac label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0749f61d-12e6-4280-8f41-bd4df81e7ae6
Food delays oral absorption but does not affect extent. Parenteral form is not affected.
Oral form: take with food. Injectable form: not applicable.
Significant renal excretion. Accumulation in renal impairment. Risk of aggravated nephrotoxicity.
eGFR 30-50: reduce dose by 50%. eGFR <30: avoid. Monitor creatinine and electrolytes.
DailyMed/FDA — approved Ketorolac label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0749f61d-12e6-4280-8f41-bd4df81e7ae6
CONTRAINDICATED in pregnancy (3rd trimester). Risk of premature ductus arteriosus closure.
3rd trimester: CONTRAINDICATED. 1st-2nd trimester: avoid.
Excreted in breast milk in low concentrations. Avoid during breastfeeding.
May affect fertility. Do not use as contraception.
DailyMed/FDA — approved Ketorolac label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0749f61d-12e6-4280-8f41-bd4df81e7ae6
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Non-selective inhibition of COX-1 and COX-2, reducing prostaglandin synthesis. Analgesic activity superior to most oral NSAIDs. Moderate anti-inflammatory and antipyretic activity.
Competitive and reversible inhibition of COX-1 and COX-2, blocking the conversion of arachidonic acid to prostaglandins and thromboxanes.
Oral absorption: ~100% bioavailability. IM: rapid absorption (peak in 30-60 min). Food reduces rate but not extent of absorption.
Metabolised in the liver by CYP2C9 and CYP3A4. Inactive metabolites. Renal excretion (60%) and biliary (40%).
2.5-8.6 h (single dose). Does not accumulate significantly with short-term use.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
