Ketorolac vs. ketoprofen

• Ketorolac and ketoprofen are nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat different types of pain.
• Ketorolac is used for short-term management (up to 5 days) of moderately severe acute pain that otherwise would require narcotics.
• Ketoprofen is used for the management of the signs and symptoms of rheumatoid arthritis, osteoarthritis, and primary dysmenorrhea (menstrual cramps).
• Brand names for ketorolac include Acuvail, Acular LS, Omidria, and Sprix. The Toradol brand of ketorolac has been discontinued in the U.S.
• Brand names for ketoprofen include Orudis, Oruvail, and Frotek.
• Side effects of ketorolac and ketoprofen that are similar include rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation, and indigestion.
• Side effects of ketorolac that are different from ketoprofen include itching, heartburn, and fluid retention.
• Side effects of ketoprofen that are different from ketorolac include vomiting, gas, loss of appetite, inflammation of mouth and lips, sleep problems (insomnia), nervousness, vision problems, or swelling in your hands or feet.

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) used only for short-term management (up to 5 days) of severe acute pain that might otherwise require narcotics. Ketorolac should not be used for minor or chronic pain. Other NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), but ketorolac is more effective than these other NSAIDs for reducing pain. Ketorolac reduces the production of chemicals that cells of the immune system make (prostaglandins) that cause redness, fever, and pain and that are also considered to be important in producing non-inflammatory pain. Ketorolac blocks the enzymes cyclooxygenase 1 and 2 that cells use to make prostaglandins, resulting in reduced signs and symptoms of pain, inflammation, redness, swelling, and fever.

Ketoprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for the management of the signs and symptoms of rheumatoid arthritis, osteoarthritis, and primary dysmenorrhea. Ketoprofen works by reducing hormones that cause inflammation and pain in the body.

Ketorolac

Common side effects from ketorolac include:

• Rash
• Ringing in the ears
• Headaches
• Dizziness
• Drowsiness
• Abdominal pain
• Nausea
• Diarrhea
• Constipation
• Indigestion
• Itching
• Heartburn
• Fluid retention

Rare side effects of ketorolac include:

• Abnormal thinking
• Serious allergic reactions
• Blurred vision
• Bronchospasm
• Jaundice
• Depression
• Difficulty concentrating
• Taste abnormality
• Euphoria
• Hemolytic-uremic syndrome
• High potassium blood levels
• Low sodium levels

Serious side effects of ketorolac include:

• Stomach ulcers
• Intestinal bleeding
• Reduced kidney function
• Liver failure

Other serious adverse events include:

• 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. Sometimes, the only signs or symptoms of bleeding may be:
  • Black tarry stools
  • Weakness
  • Dizziness upon standing (orthostatic hypotension)
• 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.

Ketoprofen

The most common side effects from ketoprofen are:

• Rash
• Ringing in the ears
• Headaches
• Dizziness
• Drowsiness
• Abdominal pain
• Nausea
• Diarrhea
• Constipation
• Heartburn
• Retention of fluid
• Shortness of breath

NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury.

Ketoprofen also may cause stomach and intestinal bleeding from ulcers. Sometimes, stomach ulceration and intestinal bleeding occur without any abdominal pain. Black tarry stools (due to blood in the stool), weakness, and dizziness upon standing (orthostatic hypotension) may be the only signs of the bleeding.

People who are allergic to other NSAIDs should not use ketoprofen. 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.

Individuals with asthma are more likely to experience allergic reactions to ketoprofen and other NSAIDs.

Other medical conditions that also have been associated with the use of NSAIDs include:

• Fluid retention (edema)
• Blood clots
• Heart attacks
• Hypertension (high blood pressure)
• Heart failure
• Hair loss
• Ringing in the ears

Ketorolac

• Treatment should begin 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 1 (10 mg) or 2 (20 mg) tablets initially followed by 1 (10 mg) tablet every 4 to 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.
• Oral ketorolac is not approved for individuals less than 17 years of age.

Ketoprofen

• The usual starting dose of ketoprofen is 50 or 75 mg with immediate release capsules every 6 to 8 hours or 200 mg with extended release capsules once daily.
• The maximum dose is 300 mg daily of immediate release capsules or 200 mg daily of extended release capsules.
• Ketoprofen should be taken with food in order to avoid stomach upset.
• Menstrual cramps are treated with 25 to 50 mg every 6 to 8 hours using immediate release capsules.
• Rheumatoid or osteoarthritis are treated with 75 mg three times daily or 50 mg four times daily using immediate release capsules or 200 mg daily of extended release capsules.

Ketorolac

• 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, Jantoven) -- should avoid ketorolac because ketorolac also thins the blood, and excessive blood thinning may lead to bleeding.

Ketoprofen

• Ketoprofen may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys, which may lead to lithium toxicity.
• Ketoprofen may reduce the blood pressure lowering effects of blood pressure medications. This occurs because prostaglandins play a role in reducing blood pressure.
• When NSAIDs are combined with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of methotrexate or aminoglycoside may increase because their elimination is reduced. This may lead to more methotrexate or aminoglycoside side effects.
• Individuals taking blood thinners or anticoagulants -- for example, warfarin (Coumadin) -- should avoid ketoprofen because ketoprofen also thins the blood, and excessive blood thinning may lead to bleeding.
• Combining NSAIDs such as ketoprofen with angiotensin receptor blockers (ARBs) -- for example valsartan (Diovan), losartan (Cozaar), irbesartan (Avapro) -- or angiotensin converting enzyme inhibitors (ACE inhibitors) -- for example, enalapril (Vasotec), captopril (Capoten) -- in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.
• Persons who have more than three alcoholic beverages per day are at increased risk of developing stomach ulcers when taking ketoprofen or other NSAIDs.

Ketorolac

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.

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

Ketoprofen

There are no adequate studies of ketoprofen in pregnant women. Therefore, ketoprofen is not recommended during pregnancy.

It is not known whether ketoprofen is excreted in breast milk.