Generic Name: ketorolac
Brand Name: Toradol (discontinued brand)
Drug Class: NSAIDs
What is ketorolac, and what is it used for?
Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used for short-term (less than 5 days) management of acute pain that requires opioid level of pain relief (analgesia).
Ketorolac relieves pain by inhibiting inflammatory activity in the body. Ketorolac is typically used as a pain reliever before or after medical procedures or after surgeries.
Ketorolac controls inflammation by inhibiting the activity of enzymes known as cyclooxygenases (COX-1 and COX-2), essential for biosynthesis of prostaglandin. Prostaglandin is a fatty compound that promotes inflammation, leading to symptoms including pain, fever and swelling. Ketorolac also inhibits the movement and aggregation of inflammatory cells, and the release of proinflammatory proteins (cytokines). Ketorolac inhibits platelet aggregation, which can increase the risk of bleeding, a major side effect of the drug.
Warnings
- Do not use ketorolac for treating minor or chronic pain
- Do not use for perioperative pain in major surgeries and coronary artery bypass graft (CABG) surgery
- Do not use during labor and delivery, it may adversely affect fetal circulation, inhibit uterine contractions and increase the risk of uterine hemorrhage
- Do not use in patients with known or suspected hypersensitivity to ketorolac, aspirin or other NSAIDs
- Do not use simultaneously with other NSAIDs because of the cumulative risk
- Do not use ketorolac concomitantly with the following drugs:
- probenecid
- pentoxifylline
- Do not administer as epidural or intrathecal injections into the spine due to the alcohol content in ketorolac
Gastrointestinal risk:
- Do not use in patients with active peptic ulcer disease, recent gastrointestinal (GI) bleeding or perforation, or history of peptic ulcer disease or GI bleeding.
- Ketorolac can cause serious GI adverse events, including bleeding, ulceration, and gastric or intestinal perforation
- GI adverse events may occur at any time during use and without warning symptoms
- Elderly patients are at greater risk for serious GI events
Cardiovascular risk:
- Ketorolac may increase the risk of serious cardiovascular clotting (thrombotic) events, heart attack (myocardial infarction), and stroke
- Risk for the above may increase with duration of use
- Do not use ketorolac in patients with existing cardiovascular disease or risk factors for such disease, they may have greater cardiovascular risk
- Ketorolac has the potential to trigger heart failure by prostaglandin inhibition which can lead to sodium and water retention, increase in blood pressure, and reduced response to diuretics
- Patients treated with NSAIDs such as ketorolac following heart attack are reported to be more likely to die in the first year of heart attack compared to patients not treated with NSAIDs after first heart attack
Renal risk:
- Do not use in patients with advanced renal impairment and in patients at risk for renal failure due to blood volume depletion (hypovolemia)
Risk of bleeding:
- Do not use in patients with bleeding disorders such as suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, and those at a high risk of bleeding. Ketorolac inhibits platelet functions and increases bleeding risks
What are the side effects of ketorolac?
Common side effects of ketorolac include:
- Headache
- Increase in liver enzymes
- Gastrointestinal symptoms such as:
- Abdominal pain
- Indigestion (dyspepsia)
- Nausea
- Vomiting
- Constipation
- Diarrhea
- Gas (flatulence)
- Heartburn
- Gastrointestinal fullness
- Gastrointestinal ulcers
- Sore and inflamed mouth (stomatitis)
- Dizziness
- Drowsiness (somnolence)
- Abnormal kidney function
- Increase in blood urea nitrogen (BUN)
- Increase in serum creatinine
- Swelling (edema)
- High blood pressure (hypertension)
- Pain at injection site
- Skin reactions such as:
- Excessive sweating (diaphoresis)
- Itching (pruritus)
- Skin rash
- Blood disorders such as:
- Low red blood cell count (anemia)
- Increased bleeding time
- Bruising (purpura)
- Ringing in ears (tinnitus)
Serious side effects include:
- Gastrointestinal bleeding
- Gastrointestinal perforation
- Congestive heart failure
- Heart attack (myocardial infarction), rare
- Liver failure
- Kidney failure
- Coma (rare)
Less common side effects include:
- Fever
- Infections
- Sepsis
- Changes in appetite
- Changes in weight
- Dry mouth
- Blood in vomit
- Rectal bleeding
- Dark, tarry stools (melena)
- Gastrointestinal inflammation (esophagitis, gastritis, hepatitis)
- Nasal bleeding (epistaxis)
- Palpitations
- Irregular heartbeat (arrhythmia)
- Rapid or slow heartbeat (tachycardia or bradycardia)
- Chest pain
- Fainting (syncope)
- Pale skin (pallor)
- Flushing
- Hives (urticaria)
- Light sensitivity
- Bronchospasm
- Shortness of breath (dyspnea)
- Throat/tongue swelling
- Blurred vision
- Hearing loss
- Abnormal taste
- Bladder infection (cystitis)
- Painful urination (dysuria)
- Urinary retention
- Urinary frequency
- Blood in urine (hematuria)
- Damage to blood vessels in the kidney (hemolytic-uremic syndrome)
- Confusion
- Depression
- Abnormal thinking
- Anxiety
- Euphoria
- Insomnia
- Abnormal dreams
- Lack of concentration
- Tremors
- Vertigo
Rare side effects include:
- Hypersensitivity reactions including
- Swelling of tissue under the skin and mucous membranes (angioedema)
- Severe allergic reaction (anaphylaxis)
- Severe skin reactions including:
- Exfoliative dermatitis
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
- Exacerbation of inflammatory bowel diseases (ulcerative colitis, Crohn’s disease)
- High blood glucose levels (hyperglycemia)
- High blood potassium levels (hyperkalemia)
- Low blood sodium levels (hyponatremia)
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

QUESTION
Medically speaking, the term "myalgia" refers to what type of pain? See AnswerWhat are the dosages of ketorolac?
Tablet
- 10 mg
Injectable solution
- 15 mg/mL
- 30 mg/mL
Prefilled syringe
- 15 mg/mL
- 30 mg/mL
- 60 mg/mL
Moderately Severe Acute Pain
- Short-term (up to 5 days) management of moderately severe acute pain that requires analgesia at opioid level; not indicated for minor or chronic painful conditions
Adult
- Intravenous (IV): 30 mg as a single dose or 30 mg every 6 hours; not to exceed 120 mg/day
- Intramuscular (IM): 60 mg as a single dose or 30 mg every 6 hours; not to exceed 120 mg/day
- Oral: 20 mg once after IV or IM therapy, THEN 10 mg every 4-6 hours; not to exceed 40 mg/day
Dosing Considerations
- Always begin with parenteral therapy; oral administration indicated only as a continuation of intravenous/intramuscular (IV/IM) dosing, if necessary
- Use the lowest effective dose for the shortest duration based on individual patient needs, to minimize risk of gastrointestinal adverse events
- Duration of therapy should not exceed 5 days
- Dosage beyond maximum or labeled doses will not provide better efficacy but will increase the risk of serious adverse events
- Decrease daily dose in patients over 65 years, less than 50 kg, or with moderately elevated serum creatinine
Dosing Modifications
Renal impairment
- Severe: Contraindicated
- Moderate (moderately elevated serum creatinine): Use 50% of recommended dosage; not to exceed 60 mg/day intramuscular/intravenous (IM/IV)
Hepatic impairment
- Not studied; use caution; discontinue if symptoms of liver toxicity develop
Geriatric
- Intravenous (IV): 15 mg as a single dose or 15 mg every 6 hours; not to exceed 60 mg/day
- Intramuscular (IM): 30 mg as a single dose or 15 mg every 6 hours; not to exceed 60 mg/day
- Oral: 10 mg once after IV or IM therapy, THEN 10 mg every 4-6 hours; not to exceed 40 mg/day
Dosing considerations
- Long-term use should be avoided because of asymptomatic, pathologic gastrointestinal (GI) conditions; duration of therapy should not exceed 5 days
- Dosage adjustment required for patients over 65 years or less than 50 kg
Pediatric
(Off-label)
Children below 2 years of age
- Safety and efficacy not established
Children 2-16 years of age
- Single-dose: 0.5 mg/kg IV/IM once; not to exceed 15 mg
- Multiple-dose: 0.5 mg/kg IV/IM every 6 hours; not to exceed 5 days
Children above 16 years of age, less than 50 kg
- Intravenous (IV): 15 mg as a single dose or 15 mg every 6 hours; not to exceed 60 mg/day
- Intramuscular (IM): 30 mg as a single dose or 15 mg every 6 hours; not to exceed 60 mg/day
- Oral: 10 mg once after IV/IM therapy, then 10 mg every 4-6 hours; not to exceed 40 mg/day
Children above 16 years of age, greater than 50 kg
- Intravenous (IV): 30 mg as a single dose or 30 mg every 6 hours; not to exceed 120 mg/day
- Intramuscular (IM): 60 mg as a single dose or 30 mg every 6 hours; not to exceed 120 mg/day
- Oral: 20 mg once after IV/IM therapy, then 10 mg every 4-6 hours; not to exceed 40 mg/day
Dosing Considerations
- Not FDA-approved for use in pediatric patients
- Duration of therapy should not exceed 5 days
Overdose
- Overdose can cause several symptoms including lethargy, abdominal pain, nausea and vomiting, hypertension and acute renal failure.
- There is no specific antidote for ketorolac and overdose must be treated with symptomatic and supportive care, such as administering activated charcoal and/or inducing vomiting (emesis).
What drugs interact with ketorolac?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Severe interactions of ketorolac include:
- None
- Ketorolac has serious interactions with at least 47 different drugs.
- Ketorolac has moderate interactions with at least 228 different drugs.
- Ketorolac has mild interactions with at least 78 different drugs.
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.
Pregnancy and breastfeeding
- There are no adequate and well-controlled studies of ketorolac in pregnant women. Use ketorolac with caution during the first and second trimester of pregnancy only if the potential benefits outweigh the potential risk to the fetus.
- Use ketorolac only in life-threatening emergencies in late pregnancy (third trimester), it may cause fetal harm by interfering with the fetal blood circulation (premature closure of ductus arteriosus).
- Do not use ketorolac during labor and delivery, it may adversely affect fetal blood circulation, inhibit uterine contractions and increase the risk for uterine hemorrhage.
- Ketorolac may impair fertility and is not recommended for use in women trying to conceive.
- Ketorolac is excreted in breast milk, avoid use in nursing mothers
What else should I know about ketorolac?
- Use with caution before, during and after surgeries, or tonsillectomy in children; ketorolac may interfere with stoppage of bleeding (hemostasis).
- Use with caution in patients with gastric perforation, kidney/liver impairment or disease, or hypertension (may cause new onset of hypertension or worsening of existing hypertension), and patients on blood thinners (anticoagulant).
- Long-term administration of NSAIDs may result in kidney damage or injury; patients at the greatest risk include elderly individuals, those with impaired renal function, low blood volume (hypovolemia), heart failure, liver dysfunction, or salt depletion; and those taking medication such as diuretics, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers.
- Ketorolac may increase the risk of hyperkalemia (elevated potassium in blood), especially in renal disease, patients with diabetes, the elderly, and when used simultaneously with other medications capable of inducing hyperkalemia.
- Use of ketorolac is associated with a risk of severe skin reactions.
- Oral ketorolac should be used only as continuation after initial intravenous therapy.
- There is insufficient data supporting safe use of multiple-dose parenteral treatment in children; use with caution.
- Ketorolac may cause drowsiness, blurred vision, and dizziness; may impair the ability to drive or operate heavy machinery.
Summary
Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used for short-term acute pain relief that requires opioid level of pain relief (analgesia). Ketorolac is not used for treating minor or chronic pain. Serious side effects include gastrointestinal bleeding, gastrointestinal perforation, congestive heart failure, heart attack (myocardial infarction), liver failure, kidney failure, and coma (rare). Common side effects include headache, increase in liver enzymes, gastrointestinal symptoms, and others. Consult your doctor before taking ketorolac if pregnant or breastfeeding.
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Neuropathic Pain
Neuropathic pain is a chronic condition that leads to ongoing pain symptoms. Patients can be predisposed to developing neuropathic pain who have conditions such as diabetes, cancer, stroke, HIV, vitamin deficiencies, shingles, and multiple sclerosis. Patient history and nerve testing are used to diagnose neuropathic pain. Antidepressants, antiseizure medications, and other types of medications are used to treat neuropathic pain. Many people with neuropathic pain are able to attain some level of relief.
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Kidney Pain vs. Back Pain
The signs and symptoms of kidney pain and back pain depend upon the underlying cause. Doctors may use blood tests, X-rays, CT, and/or MRI to diagnose kidney pain and back pain. Treatment may include rest, ice, stretching, muscle strengthening, and pain-relieving medications.
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How Do I Know If Back Pain Is Cancer?
After considering your medical history and symptoms, your doctor will rule out other causes of back pain before determining if it’s a result of cancer or not.
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Pain From Liver Cancer
Patients suffering from liver cancer usually complain of a throbbing or stabbing sensation in the upper right side of the abdomen or the back of the shoulder. There may or may not be a swelling that doesn’t subside. The pain may be severe; it is graded 7/10 in intensity. Some patients may not have any symptoms in the early stages of liver cancer.
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When to Worry About Breast Pain
The easiest way to tell whether breast pain is something to worry about or not is to determine whether it is cyclic or noncyclic.
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Which Exercises to Avoid With Lower Back Pain?
Doctors recommend strengthening exercises to help relieve low back pain, however, here are eight workouts to avoid potentially worsening your chronic pain.
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What Is Kidney Cancer Pain Like?
A small tumor in the kidney that may be painless and often an accidental finding on sonography. The patients suffering from advanced kidney cancer may usually complain of back pain, which may be described as a dull ache to a sharp stabbing pain below the ribs on the back or one side of the flank. If there is a sudden persistent pain that lasts more than a few days, a doctor visit is recommended to rule out kidney cancer.
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What Foods Trigger Fibromyalgia Pain?
Foods that trigger fibromyalgia pain vary from one person to the next. But in general, processed foods, refined carbohydrates, unhealthy fats and red meats can worsen your symptoms.
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When Should I Be Worried About Lower Back Pain?
Lower back pain may be serious if the pain lasts for over a week, radiates to other parts of the body, or is accompanied by other symptoms.
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How Do You Get Rid of Gout Pain Fast?
Learn what medical treatments can help ease your gout symptoms and speed up your recovery.
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What Is the Home Remedy for Knee Pain? 10 Effective Measures
Knee pain can be a recent malady—due to an injury or may be occurring for several years due to a joint condition such as osteoarthritis. Whatever be the reason, some home remedies will often work for both types of knee pain.
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Pain Relief Options for Childbirth
Women experience and tolerate pain differently. For some pregnant women, focused breathing is all they need to get through labor and childbirth; but for others, numbing of the pain is desired. There are a number of different medications a woman can take during labor and childbirth. It is important for you to learn what pain relief options are available. Please discuss the options with your health care professional well before your "birth day" so that when you are in labor you understand the choices.
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What Is the Most Common Treatment for Chronic Pain?
Chronic pain is long-lasting and persistent and lasts for months or years. The most common treatments for chronic pain are NSAIDs, acetaminophen, COX-2 inhibitors, antidepressants and anti-seizure medicines, and opioids.
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What Are the Best Exercises for Sciatica Pain Relief?
What is sciatica? Learn what exercises and home remedies can help ease your sciatica symptoms and speed up your recovery.
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How Do You Make Wisdom Teeth Pain Go Away?
Learn what medical treatments can ease your wisdom teeth pain and other symptoms to speed your recovery.
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Heel Pain: Causes, Treatments, and Prevention
Heel pain is most often caused by plantar fasciitis. Plantar fasciitis or heel spur syndrome is the tissue swelling over the sole of the foot. The other causes of heel pain include vitamin deficiency, medical problems, and physical activity.
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How Do I Know if My Knee Pain Is Arthritis?
If you have knee pain from arthritis you might notice symptoms including stiffness and swelling, increased pain and swelling in the morning or after sitting, increased pain after activity, 'locking' or 'sticking' of the knee, and weakness or buckling in the knee.
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What Are the 7 Best Exercises for Knee Pain?
Knee pain is a common problem that can have a number of different causes. The seven best exercises for knee pain are the single-leg lift, leg stretch, hamstring curls, sit to stand, seated leg lift, heel step up and quad stretch with towel roll.
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How Do I Know If My Knee Pain Is Serious?
Some knee pain may subside with adequate rest and other physical therapies, which can be done at home; however, knee pain that doesn’t dissolve easily with rest should be considered serious and requires medical attention. Knee pain is the most common complaint of the musculoskeletal system.
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Where Is the Pain With Liver Cancer?
A patient with liver cancer usually complains of pain in the right abdomen, lower back or shoulder. They complain of throbbing or stabbing pain that does not subside. Usually, the patient also has pain in the right side of the abdomen. Pain may be severe at 7/10 in intensity. Pain and other symptoms only develop in the later stages.
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When Should I Be Concerned About Lower Abdominal Pain?
Learn the eight warning signs of abdominal pain which may indicate a serious medical condition.
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What are the Best Stretches for Back Pain Relief at Home?
Learn what stretches can help you deal with back pain and manage this condition at home.
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Pain Management: Neuropathic Pain
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
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What Are the Best Exercises for Back Pain?
When you are experiencing back pain, you may want to rest, but being active is good for the back. Exercising can strengthen the muscles of the back and those that support posture, as well as improve overall body health. Strengthening the muscles provides support to the spine and slowly reduces back pain.
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Where Do You Feel Lung Cancer Pain?
In its early stages, lung cancer typically does not produce any signs and symptoms. However, if it does, you will experience coughing and wheezing that do not go away within three weeks.
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What Is Middle Back Pain a Symptom Of?
Middle back pain is a common complaint in middle-aged individuals who sit for long hours at work. It is felt between the shoulder blades. The problem may be simply poor posture or something more serious.
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Leg Pain Causes
Leg pain can occur as a result of conditions that affect the bones, joints, muscles, tendons, ligaments, blood vessels, nerves, or skin of the leg
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What Helps Pain After Surgery?
After surgery, it's important to work with your healthcare team to make your recovery as pain-free as possible. Communicate with your doctor and nurses to help them adjust your pain management plan.
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How Can I Relieve Back Pain at Home?
You can relieve back pain at home with these tips for both short-term and long-term relief.
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Should You Avoid Pain Relievers Before Getting the COVID-19 Vaccine?
Both the CDC and WHO do not recommend taking pain relievers before getting the COVID-19 vaccine, as it is still unknown whether they interfere with vaccine effectiveness.
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What Is Lung Cancer Pain Like?
Lung cancer, also known as lung carcinoma, is defined as an uncontrolled growth of tumor cells in the lungs. The principal role of the lungs is to allow gaseous exchange between the air and blood and facilitate the availability of oxygen for cellular functions.
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What’s Causing My Tooth Pain?
What's causing my tooth pain? Learn the signs of tooth pain and what might be causing it.
Treatment & Diagnosis
- Sinus Surgery (Endoscopic) Procedure
- Tonsillectomy and Adenoidectomy Surgery
- Knee Replacement Surgery and Recovery Time
- LASIK Eye Surgery
- How Do You Treat Saphenous Nerve Pain?
- What Is the Safest Form of Bariatric Surgery?
- Lap Band Surgery
- How Dangerous Is Bariatric Surgery?
- Questions To Ask Before Surgery
- Heart Valve Disease Surgery
- Ulcerative Colitis Surgery
- Muscle Pain (Myalgia)
- Complex Regional Pain Syndrome (CRPS)
- Chronic Pain
- Neuropathic Pain
- Chronic Pain: Implantable Pain Control Devices
- Pain Management
- Mind-Body-Pain Connection: How Does It Work?
- Chronic Pain and Fatigue - What You Can Do
- Bariatric Surgery -- Is It Right for You?
- Headaches and Migraine: Easing the Pain -- Seymour Diamond, MD
- Pain Management: Routes to Relief
- Chronic Pain Treatments for Mind and Body
- Cancer Pain Management with Ann Reiner
- Pain Awareness and Management
- Meditation for Stress and Pain with Karen Eastman, Ph.D., Lobsang Rapgay, Ph.D., and Lonnie Zeltz
- Plastic Surgery -- What Can It Do for You?
- Pain: Managing the Pains and Aches of Office Life
- Chronic Pain: Dealing With Back and Neck Pain
- Plastic Surgery Choices
- Pain Management: Painkiller Addiction
- Fibromyalgia: Dreaming of a Pain-Free Christmas
- Pain Management: Dealing with Back Pain
- Plastic Surgery with Michael Powell, MD
- Headaches FAQs
- Tummy Trouble FAQs
- Back Pain FAQs
- Pain FAQs
- Chest Pain FAQs
- Opioid Dependence FAQs
- Weight Loss Surgery FAQs
- Pain and Stress: Endorphins: Natural Pain and Stress Fighters
- Pain Management: OTC NSAIDs - Doctors Dialogue
- Pain Management Over-The-Counter
- GERD Surgery - No Good?
- Pregnancy - Labor Pain And Walking
- Pain (Acute and Chronic)
- Painful Periods Related to Stress
- Gastric Bypass Surgery? Questions to Ask Yourself
- Shingles Pain
- Shingles: A Painful Rash -- Is It Shingles?
- Doctors Answer Pain Questions
- What Pain Medication Can I Take While on Warfarin?
- What's The Difference Between Myofascial Pain and Fibromyalgia?
- Does Aspirin Make Ulcers Worse?
- Does Pain Medication Affect Men and Women Differently?
- What Is Breakthrough Pain?
- 8 Tips to Pick the Right Plastic Surgeon
- Lupus: Pain in Neck & Back
- Pain Relievers and High Blood Pressure
Medications & Supplements
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https://reference.medscape.com/drug/ketorolac-343292#0
https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019645s019lbl.pdf
https://www.uptodate.com/contents/ketorolac-systemic-drug-information