ketorolac (Toradol - brand discontinued in the US) (cont.)

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PRESCRIBED FOR: Ketorolac is used for short-term management (up to 5 days) of moderately severe acute pain that otherwise would require narcotics. It most often is used after surgery.

DOSING: Treatment should be started with ketorolac injection. Tablets are used only if treatment is continued after patients begin to eat and drink. The total duration of therapy should not exceed 5 days because of the potential for gastrointestinal bleeding and other side effects. The recommended adult intravenous single dose is 15 to 60 mg. Multiple intravenous doses of 15 or 30 mg every 6 hours, not to exceed 60 or 120 mg a day, also may be used. Following intravenous therapy, the recommended dose is one or two tablets initially followed by 1 tablet every 4-6 hours, not to exceed 40 mg daily. The smaller dose is used for patients with poor kidney function or those older than 65 years.

DRUG INTERACTIONS: Probenecid (Benemid) should not be combined with ketorolac because it reduces the elimination of ketorolac by the kidneys. This may lead to increased levels of ketorolac in the body and increased side effects from ketorolac.

Ketorolac may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the elimination of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.

Concomitant use of ketorolac and angiotensin converting enzyme (ACE) inhibitors may reduce the function of the kidneys.

Individuals taking oral blood thinners or anticoagulants [for example, warfarin (Coumadin) should avoid ketorolac because ketorolac also thins the blood, and excessive blood thinning may lead to bleeding.

PREGNANCY: There are no adequate studies in pregnant women. Ketorolac should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. NSAIDs may cause cardiovascular side effects during late pregnancy.

NURSING MOTHERS: Ketorolac should not be used by nursing mothers because it is excreted in breast milk.

SIDE EFFECTS: Common side effects from ketorolac include rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation, heartburn, and fluid retention. NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury. Ketorolac may cause ulcers and bleeding in the stomach and intestines, particularly with use for more than five days. Sometimes, stomach ulceration and intestinal bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of the bleeding. NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients with preexisting impairment of kidney function or congestive heart failure, and use of NSAIDs in these patients should be done cautiously. Liver failure has also been associated with ketorolac. People who are allergic to aspirin and other NSAIDs should not use ketorolac. Individuals with asthma or nasal polyps are more likely to experience allergic reactions to NSAIDs.

Reference: FDA Prescribing Information

Medically Reviewed by a Doctor on 7/10/2014

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