Dosing & Uses
Dosage Forms & Strengths
tablet
- 10mg
injectable solution
- 15mg/mL
- 30mg/mL
prefilled syringe
- 15mg/mL
- 30mg/mL
- 60mg/2mL
Moderately Severe Acute Pain
Short-term (≤5 days) management of moderately severe acute pain that requires analgesia at opioid level; not indicated for minor or chronic painful conditions
IV: 30 mg as single dose or 30 mg q6hr; not to exceed 120 mg/day
IM: 60 mg as single dose or 30 mg q6hr; not to exceed 120 mg/day
PO: 20 mg once after IV or IM therapy, THEN 10 mg q4-6hr; not to exceed 40 mg/day
Dosing Considerations
Always begin with parenteral therapy; oral administration indicated only as continuation of IV/IM dosing, if necessary
Duration of therapy should not exceed 5 days
Dosage beyond maximum or labeled doses will not provide better efficacy but will increase risk of serious adverse events
Decrease daily dose in patients >65 years, <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 IM/IV
Hepatic impairment
- Not studied; use caution; discontinue if symptoms of liver toxicity develop
Moderately Severe Acute Pain (Off-label)
<2 years
- Safety and efficacy not established
2-16 years
- Single dose: 0.5 mg/kg IV/IM once; not to exceed 15 mg
- Multiple dose: 0.5 mg/kg IV/IM q6hr; not to exceed 5 days
>16 years, <50 kg
- IV: 15 mg as single dose or 15 mg q6hr; not to exceed 60 mg/day
- IM: 30 mg as single dose or 15 mg q6hr; not to exceed 60 mg/day
- PO: 10 mg once after IV/IM therapy, THEN 10 mg q4-6hr; not to exceed 40 mg/day
>16 years, >50 kg
- IV: 30 mg as single dose or 30 mg q6hr; not to exceed 120 mg/day
- IM: 60 mg as single dose or 30 mg q6hr; not to exceed 120 mg/day
- PO: 20 mg once after IV/IM therapy, THEN 10 mg q4-6hr; not to exceed 40 mg/day
Dosing Considerations
Not approved for use in pediatric patients
Duration of therapy should not exceed 5 days
Moderately Severe Acute Pain
Short-term (≤5 days) management of moderately severe acute pain that requires analgesia at opioid level; not indicated for minor or chronic painful conditions
IV: 15 mg as single dose or 15 mg q6hr; not to exceed 60 mg/day
IM: 30 mg as single dose or 15 mg q6hr; not to exceed 60 mg/day
PO: 10 mg once after IV or IM therapy, THEN 10 mg q4-6hr; 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 >65 years or <50 kg (see Black Box Warnings)
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (51)
- aceclofenac
aceclofenac, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- acemetacin
acemetacin, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- aminolevulinic acid oral
aminolevulinic acid oral, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
- aminolevulinic acid topical
ketorolac, aminolevulinic acid topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.
- apixaban
ketorolac and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.
- aspirin
aspirin, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- aspirin rectal
aspirin rectal, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- baricitinib
ketorolac will increase the level or effect of baricitinib by decreasing elimination. Avoid or Use Alternate Drug. Coadministration of baricitinib with strong organic anion transporter 3 (OAT3) inhibitors is not recommended.
- benazepril
ketorolac, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- captopril
ketorolac, captopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- celecoxib
celecoxib, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- choline magnesium trisalicylate
choline magnesium trisalicylate, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- diclofenac
diclofenac, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- diflunisal
diflunisal, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- enalapril
ketorolac, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ethanol
ketorolac, ethanol. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: The risk of GI bleeding may be increased when combining alcohol with ketorolac. Monitor for increased GI bleeding if a patient regularly consumes alcohol and NSAIDs. Limit alcohol consumption during treatment with an NSAID.
- etodolac
etodolac, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- fenoprofen
fenoprofen, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- flurbiprofen
flurbiprofen, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- fosinopril
ketorolac, fosinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ibuprofen
ibuprofen, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- ibuprofen IV
ibuprofen IV, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- indomethacin
indomethacin, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- ketoprofen
ketoprofen, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- lisinopril
ketorolac, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- lornoxicam
lornoxicam, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- meclofenamate
meclofenamate, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- mefenamic acid
mefenamic acid, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- meloxicam
meloxicam, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- methotrexate
ketorolac increases levels of methotrexate by decreasing renal clearance. Avoid or Use Alternate Drug. Concomitant administration of NSAIDs with high dose methotrexate has been reported to elevate and prolong serum methotrexate levels, resulting in deaths from severe hematologic and GI toxicity. NSAIDs may reduce tubular secretion of methotrexate and enhance toxicity. .
- methyl aminolevulinate
ketorolac, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.
- moexipril
ketorolac, moexipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- nabumetone
nabumetone, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- naproxen
naproxen, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- oxaprozin
oxaprozin, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- parecoxib
parecoxib, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- pemetrexed
ketorolac increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug. Interrupt dosing in all patients taking NSAIDs with long elimination half-lives for at least 5d before, the day of, and 2d following pemetrexed administration. If coadministration of an NSAID is necessary, closely monitor patients for toxicity, especially myelosuppression, renal toxicity, and GI toxicity.
- perindopril
ketorolac, perindopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- piroxicam
piroxicam, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- probenecid
probenecid increases levels of ketorolac by decreasing renal clearance. Contraindicated.
- quinapril
ketorolac, quinapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ramipril
ketorolac, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- salicylates (non-asa)
salicylates (non-asa), ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- salsalate
salsalate, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- sulfasalazine
sulfasalazine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- sulindac
sulindac, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- tacrolimus
ketorolac, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.
- tolfenamic acid
tolfenamic acid, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- tolmetin
tolmetin, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- trandolapril
ketorolac, trandolapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
Monitor Closely (235)
- acebutolol
acebutolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of acebutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - aceclofenac
aceclofenac and ketorolac both increase anticoagulation. Use Caution/Monitor.
aceclofenac and ketorolac both increase serum potassium. Use Caution/Monitor. - acemetacin
acemetacin and ketorolac both increase anticoagulation. Use Caution/Monitor.
acemetacin and ketorolac both increase serum potassium. Use Caution/Monitor. - agrimony
ketorolac and agrimony both increase anticoagulation. Use Caution/Monitor.
- albuterol
ketorolac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfalfa
ketorolac and alfalfa both increase anticoagulation. Use Caution/Monitor.
- alfuzosin
ketorolac decreases effects of alfuzosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- aliskiren
ketorolac will decrease the level or effect of aliskiren by Other (see comment). Use Caution/Monitor. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.
- alteplase
ketorolac and alteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- American ginseng
ketorolac and American ginseng both increase anticoagulation. Use Caution/Monitor.
- amiloride
amiloride and ketorolac both increase serum potassium. Modify Therapy/Monitor Closely.
- antithrombin alfa
antithrombin alfa and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- antithrombin III
antithrombin III and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- arformoterol
ketorolac increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- argatroban
argatroban and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- asenapine
ketorolac decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- aspirin
aspirin and ketorolac both increase anticoagulation. Use Caution/Monitor.
aspirin and ketorolac both increase serum potassium. Use Caution/Monitor. - aspirin rectal
aspirin rectal and ketorolac both increase anticoagulation. Use Caution/Monitor.
aspirin rectal and ketorolac both increase serum potassium. Use Caution/Monitor. - aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate and ketorolac both increase anticoagulation. Use Caution/Monitor.
aspirin/citric acid/sodium bicarbonate and ketorolac both increase serum potassium. Use Caution/Monitor. - atenolol
atenolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of atenolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - azficel-T
azficel-T, ketorolac. Other (see comment). Use Caution/Monitor. Comment: Patients taking NSAIDS may experience increased bruising or bleeding at biopsy and/or injection sites. Concomitant use of NSAIDs is not recommended.
- azilsartan
ketorolac, azilsartan. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
ketorolac decreases effects of azilsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. - bemiparin
bemiparin and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- benazepril
benazepril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- bendroflumethiazide
ketorolac increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- betaxolol
betaxolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of betaxolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - betrixaban
ketorolac, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.
- bimatoprost
bimatoprost, ketorolac. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- bisoprolol
bisoprolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of bisoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - bivalirudin
bivalirudin and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- budesonide
ketorolac, budesonide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- bumetanide
ketorolac increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
ketorolac decreases effects of bumetanide by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis. - candesartan
candesartan and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of candesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
candesartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - captopril
captopril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- carbenoxolone
ketorolac increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carvedilol
carvedilol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - celecoxib
celecoxib and ketorolac both increase anticoagulation. Use Caution/Monitor.
celecoxib and ketorolac both increase serum potassium. Use Caution/Monitor. - celiprolol
celiprolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of celiprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - chlorothiazide
ketorolac increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpropamide
ketorolac increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- chlorthalidone
ketorolac increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- choline magnesium trisalicylate
ketorolac and choline magnesium trisalicylate both increase anticoagulation. Use Caution/Monitor.
ketorolac and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor. - cinnamon
ketorolac and cinnamon both increase anticoagulation. Use Caution/Monitor.
- ciprofloxacin
ketorolac, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.
- citalopram
citalopram, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.
- clomipramine
clomipramine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.
- clopidogrel
clopidogrel, ketorolac. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- cordyceps
ketorolac and cordyceps both increase anticoagulation. Use Caution/Monitor.
- cortisone
ketorolac, cortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- cyclopenthiazide
ketorolac increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclosporine
ketorolac, cyclosporine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- dabigatran
dabigatran and ketorolac both increase anticoagulation. Use Caution/Monitor. Caution is advised, both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.
- dalteparin
dalteparin and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- deferasirox
deferasirox, ketorolac. Other (see comment). Use Caution/Monitor. Comment: Combination may increase GI bleeding, ulceration and irritation. Use with caution.
- defibrotide
defibrotide increases effects of ketorolac by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Defibrotide may enhance effects of platelet inhibitors.
- deflazacort
ketorolac, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- dexamethasone
ketorolac, dexamethasone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- diclofenac
diclofenac and ketorolac both increase anticoagulation. Use Caution/Monitor.
diclofenac and ketorolac both increase serum potassium. Use Caution/Monitor. - diflunisal
diflunisal and ketorolac both increase anticoagulation. Use Caution/Monitor.
diflunisal and ketorolac both increase serum potassium. Use Caution/Monitor. - digoxin
ketorolac and digoxin both increase serum potassium. Use Caution/Monitor.
- dobutamine
ketorolac increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dong quai
ketorolac and dong quai both increase anticoagulation. Use Caution/Monitor.
- dopexamine
ketorolac increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxazosin
ketorolac decreases effects of doxazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- drospirenone
drospirenone and ketorolac both increase serum potassium. Modify Therapy/Monitor Closely.
- duloxetine
duloxetine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- edoxaban
edoxaban, ketorolac. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding, monitor closely. Promptly evaluate any signs or symptoms of blood loss.
- eltrombopag
eltrombopag increases levels of ketorolac by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF, ketorolac. Either increases toxicity of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of emtricitabine and tenofovir with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.
- emtricitabine
emtricitabine, ketorolac. Either increases levels of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of emtricitabine with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.
- enalapril
enalapril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- enoxaparin
enoxaparin and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- ephedrine
ketorolac increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
ketorolac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
ketorolac increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epoprostenol
ketorolac and epoprostenol both increase anticoagulation. Use Caution/Monitor.
- eprosartan
eprosartan and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of eprosartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
eprosartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - escitalopram
escitalopram, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- esmolol
esmolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ethacrynic acid
ketorolac increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- etodolac
etodolac and ketorolac both increase anticoagulation. Use Caution/Monitor.
etodolac and ketorolac both increase serum potassium. Use Caution/Monitor. - fennel
ketorolac and fennel both increase anticoagulation. Use Caution/Monitor.
- fenoprofen
fenoprofen and ketorolac both increase anticoagulation. Use Caution/Monitor.
fenoprofen and ketorolac both increase serum potassium. Use Caution/Monitor. - feverfew
ketorolac and feverfew both increase anticoagulation. Use Caution/Monitor.
- fish oil triglycerides
fish oil triglycerides will increase the level or effect of ketorolac by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.
- fludrocortisone
ketorolac, fludrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- fluoxetine
fluoxetine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- flurbiprofen
flurbiprofen and ketorolac both increase anticoagulation. Use Caution/Monitor.
flurbiprofen and ketorolac both increase serum potassium. Use Caution/Monitor. - fluvoxamine
fluvoxamine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.
- fondaparinux
fondaparinux and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- formoterol
ketorolac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- forskolin
ketorolac and forskolin both increase anticoagulation. Use Caution/Monitor.
- fosinopril
fosinopril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- furosemide
ketorolac increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- garlic
ketorolac and garlic both increase anticoagulation. Use Caution/Monitor.
- gemifloxacin
gemifloxacin, ketorolac. Other (see comment). Modify Therapy/Monitor Closely. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.
- gentamicin
ketorolac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ginger
ketorolac and ginger both increase anticoagulation. Use Caution/Monitor.
- ginkgo biloba
ketorolac and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.
- glimepiride
ketorolac increases effects of glimepiride by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glipizide
ketorolac increases effects of glipizide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glyburide
ketorolac increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- green tea
green tea, ketorolac. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.
- heparin
heparin and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- horse chestnut seed
ketorolac and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.
- hydralazine
ketorolac decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- hydrochlorothiazide
ketorolac increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydrocortisone
ketorolac, hydrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- ibrutinib
ibrutinib will increase the level or effect of ketorolac by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.
- ibuprofen
ibuprofen and ketorolac both increase anticoagulation. Use Caution/Monitor.
ibuprofen and ketorolac both increase serum potassium. Use Caution/Monitor. - ibuprofen IV
ibuprofen IV will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
ibuprofen IV and ketorolac both increase anticoagulation. Use Caution/Monitor.
ibuprofen IV and ketorolac both increase serum potassium. Use Caution/Monitor. - imatinib
imatinib, ketorolac. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents.
- indapamide
ketorolac increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- indomethacin
indomethacin and ketorolac both increase anticoagulation. Use Caution/Monitor.
indomethacin and ketorolac both increase serum potassium. Use Caution/Monitor. - irbesartan
irbesartan and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of irbesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
irbesartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - isoproterenol
ketorolac increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketoprofen
ketoprofen and ketorolac both increase anticoagulation. Use Caution/Monitor.
ketoprofen and ketorolac both increase serum potassium. Use Caution/Monitor. - labetalol
labetalol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of labetalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - latanoprost
latanoprost, ketorolac. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- latanoprostene bunod ophthalmic
latanoprostene bunod ophthalmic, ketorolac. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- levalbuterol
ketorolac increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levofloxacin
levofloxacin, ketorolac. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.
- levomilnacipran
levomilnacipran, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.
- lisinopril
lisinopril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- lithium
ketorolac increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.
- lornoxicam
ketorolac and lornoxicam both increase anticoagulation. Use Caution/Monitor.
ketorolac and lornoxicam both increase serum potassium. Use Caution/Monitor. - losartan
losartan and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of losartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
losartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - meclofenamate
meclofenamate and ketorolac both increase anticoagulation. Use Caution/Monitor.
meclofenamate and ketorolac both increase serum potassium. Use Caution/Monitor. - mefenamic acid
ketorolac and mefenamic acid both increase anticoagulation. Use Caution/Monitor.
ketorolac and mefenamic acid both increase serum potassium. Use Caution/Monitor. - melatonin
melatonin increases effects of ketorolac by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.
- meloxicam
ketorolac and meloxicam both increase anticoagulation. Use Caution/Monitor.
ketorolac and meloxicam both increase serum potassium. Use Caution/Monitor. - mesalamine
mesalamine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive nephrotoxicity.
- metaproterenol
ketorolac increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methyclothiazide
ketorolac increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- methylprednisolone
ketorolac, methylprednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- metolazone
ketorolac increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metoprolol
metoprolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of metoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - milnacipran
milnacipran, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- mipomersen
mipomersen, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- mistletoe
ketorolac increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moexipril
moexipril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- moxifloxacin
moxifloxacin, ketorolac. Other (see comment). Modify Therapy/Monitor Closely. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.
- moxisylyte
ketorolac decreases effects of moxisylyte by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- mycophenolate
ketorolac will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- nabumetone
ketorolac and nabumetone both increase anticoagulation. Use Caution/Monitor.
ketorolac and nabumetone both increase serum potassium. Use Caution/Monitor. - nadolol
nadolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - naproxen
ketorolac and naproxen both increase anticoagulation. Use Caution/Monitor.
ketorolac and naproxen both increase serum potassium. Use Caution/Monitor. - nebivolol
nebivolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - nefazodone
nefazodone, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- nettle
ketorolac increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- norepinephrine
ketorolac increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olmesartan
olmesartan and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of olmesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
olmesartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - oxaprozin
ketorolac and oxaprozin both increase anticoagulation. Use Caution/Monitor.
ketorolac and oxaprozin both increase serum potassium. Use Caution/Monitor. - panax ginseng
ketorolac and panax ginseng both increase anticoagulation. Use Caution/Monitor.
- parecoxib
ketorolac and parecoxib both increase anticoagulation. Use Caution/Monitor.
ketorolac and parecoxib both increase serum potassium. Use Caution/Monitor. - paroxetine
paroxetine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- pau d'arco
ketorolac and pau d'arco both increase anticoagulation. Use Caution/Monitor.
- pegaspargase
pegaspargase increases effects of ketorolac by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.
- penbutolol
penbutolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - perindopril
perindopril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- phenindione
phenindione and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- phenoxybenzamine
ketorolac decreases effects of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- phentolamine
ketorolac decreases effects of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- phytoestrogens
ketorolac and phytoestrogens both increase anticoagulation. Use Caution/Monitor.
- pindolol
pindolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of pindolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - pirbuterol
ketorolac increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- piroxicam
ketorolac and piroxicam both increase anticoagulation. Use Caution/Monitor.
ketorolac and piroxicam both increase serum potassium. Use Caution/Monitor. - pivmecillinam
pivmecillinam, ketorolac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
pivmecillinam, ketorolac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - potassium acid phosphate
ketorolac and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium chloride
ketorolac and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium citrate
ketorolac and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium iodide
potassium iodide and ketorolac both increase serum potassium. Use Caution/Monitor.
- pralatrexate
ketorolac increases levels of pralatrexate by decreasing renal clearance. Use Caution/Monitor. NSAIDs may delay pralatrexate clearance, increasing drug exposure. Adjust the pralatrexate dose as needed.
- prasugrel
ketorolac, prasugrel. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Chronic use of NSAIDs with prasugrel may increase bleeding risk.
- prazosin
ketorolac decreases effects of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- prednisolone
ketorolac, prednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- prednisone
ketorolac, prednisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- probenecid
ketorolac will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- propranolol
propranolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - protamine
protamine and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.
- quinapril
quinapril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ramipril
ramipril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- reishi
ketorolac and reishi both increase anticoagulation. Use Caution/Monitor.
- reteplase
ketorolac and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- rivaroxaban
rivaroxaban, ketorolac. Other (see comment). Use Caution/Monitor. Comment: NSAIDs are known to increase bleeding. Bleeding risk may be increased when NSAIDs are used concomitantly with rivaroxaban. Monitor for signs/symptoms of blood loss.
- rivastigmine
rivastigmine increases toxicity of ketorolac by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.
- sacubitril/valsartan
sacubitril/valsartan and ketorolac both increase serum potassium. Use Caution/Monitor.
sacubitril/valsartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
ketorolac decreases effects of sacubitril/valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. - salicylates (non-asa)
ketorolac and salicylates (non-asa) both increase anticoagulation. Use Caution/Monitor.
ketorolac and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor. - salmeterol
ketorolac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salsalate
ketorolac and salsalate both increase anticoagulation. Use Caution/Monitor.
ketorolac and salsalate both increase serum potassium. Use Caution/Monitor. - saw palmetto
saw palmetto increases toxicity of ketorolac by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.
- sertraline
sertraline, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- Siberian ginseng
ketorolac and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.
- silodosin
ketorolac decreases effects of silodosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
ketorolac, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of ketorolac by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of ketorolac by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
ketorolac, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.
- sotalol
sotalol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - sparsentan
ketorolac and sparsentan both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Coadministration of NSAIDS, including selective COX-2 inhibitors, may result in deterioration of kidney function (eg, possible kidney failure). Monitor for signs of worsening renal function with concomitant use with NSAIDs.
- spironolactone
spironolactone and ketorolac both increase serum potassium. Modify Therapy/Monitor Closely.
- succinylcholine
ketorolac and succinylcholine both increase serum potassium. Use Caution/Monitor.
- sulfasalazine
ketorolac and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
ketorolac and sulfasalazine both increase serum potassium. Use Caution/Monitor. - sulindac
ketorolac and sulindac both increase anticoagulation. Use Caution/Monitor.
ketorolac and sulindac both increase serum potassium. Use Caution/Monitor. - tafluprost
tafluprost, ketorolac. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- telmisartan
telmisartan and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of telmisartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
telmisartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - temocillin
temocillin, ketorolac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
temocillin, ketorolac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - tenecteplase
ketorolac and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- tenofovir DF
tenofovir DF, ketorolac. Either increases levels of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of tenofovir DF with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.
- terazosin
ketorolac decreases effects of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- terbutaline
ketorolac increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ticagrelor
ticagrelor, ketorolac. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding with use of ticagrelor and chronic NSAID use. .
- ticarcillin
ticarcillin, ketorolac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, ketorolac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - timolol
timolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tobramycin inhaled
tobramycin inhaled and ketorolac both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity
- tolazamide
ketorolac increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- tolbutamide
ketorolac increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- tolfenamic acid
ketorolac and tolfenamic acid both increase anticoagulation. Use Caution/Monitor.
ketorolac and tolfenamic acid both increase serum potassium. Use Caution/Monitor. - tolmetin
ketorolac and tolmetin both increase anticoagulation. Use Caution/Monitor.
ketorolac and tolmetin both increase serum potassium. Use Caution/Monitor. - tolvaptan
ketorolac and tolvaptan both increase serum potassium. Use Caution/Monitor.
- torsemide
ketorolac increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trandolapril
trandolapril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- travoprost ophthalmic
travoprost ophthalmic, ketorolac. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- trazodone
trazodone, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- triamcinolone acetonide injectable suspension
ketorolac, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .
- triamterene
triamterene and ketorolac both increase serum potassium. Modify Therapy/Monitor Closely.
- valsartan
valsartan and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
valsartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - venlafaxine
venlafaxine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- vitamin K1 (phytonadione)
ketorolac increases and vitamin K1 (phytonadione) decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- voclosporin
voclosporin, ketorolac. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
- vorapaxar
ketorolac, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur.
- vortioxetine
ketorolac, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.
- warfarin
ketorolac, warfarin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Drugs with antiplatelet properties may increase anticoagulation effect of warfarin.
- zanubrutinib
ketorolac, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.
- zotepine
ketorolac decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
Minor (72)
- aceclofenac
aceclofenac will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acemetacin
acemetacin will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acyclovir
ketorolac will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- alendronate
ketorolac, alendronate. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI ulceration.
- amikacin
ketorolac increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- aminohippurate sodium
ketorolac will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- anamu
ketorolac and anamu both increase anticoagulation. Minor/Significance Unknown.
- aspirin
aspirin will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin rectal
aspirin rectal will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- balsalazide
ketorolac will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- bendroflumethiazide
bendroflumethiazide will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefadroxil
cefadroxil will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefamandole
cefamandole will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefpirome
cefpirome will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ceftibuten
ceftibuten will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- celecoxib
celecoxib will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cephalexin
cephalexin will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorothiazide
chlorothiazide will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorpropamide
ketorolac will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorthalidone
chlorthalidone will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- choline magnesium trisalicylate
ketorolac will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- creatine
creatine, ketorolac. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.
- cyclopenthiazide
cyclopenthiazide will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- danshen
ketorolac and danshen both increase anticoagulation. Minor/Significance Unknown.
- devil's claw
ketorolac and devil's claw both increase anticoagulation. Minor/Significance Unknown.
- diclofenac
diclofenac will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- diclofenac topical
diclofenac topical, ketorolac. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Although low, there is systemic exposure to diclofenac topical; theoretically, concomitant administration with systemic NSAIDS or aspirin may result in increased NSAID adverse effects.
- diflunisal
diflunisal will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- eplerenone
ketorolac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- etodolac
etodolac will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- fenoprofen
fenoprofen will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- feverfew
ketorolac decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.
- flurbiprofen
flurbiprofen will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- furosemide
ketorolac decreases effects of furosemide by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- ganciclovir
ketorolac will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- gentamicin
ketorolac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- hydrochlorothiazide
hydrochlorothiazide will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ibuprofen
ibuprofen will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- imidapril
ketorolac decreases effects of imidapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- indapamide
indapamide will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- indomethacin
indomethacin will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ketoprofen
ketoprofen will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- lornoxicam
ketorolac will increase the level or effect of lornoxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- meclofenamate
meclofenamate will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- mefenamic acid
ketorolac will increase the level or effect of mefenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- meloxicam
ketorolac will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- mesalamine
ketorolac will increase the level or effect of mesalamine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- methyclothiazide
methyclothiazide will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- metolazone
metolazone will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- nabumetone
ketorolac will increase the level or effect of nabumetone by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- naproxen
ketorolac will increase the level or effect of naproxen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- neomycin PO
ketorolac increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- noni juice
ketorolac and noni juice both increase serum potassium. Minor/Significance Unknown.
- ofloxacin
ofloxacin, ketorolac. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.
- oxaprozin
ketorolac will increase the level or effect of oxaprozin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- parecoxib
ketorolac will increase the level or effect of parecoxib by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- paromomycin
ketorolac increases levels of paromomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- piroxicam
ketorolac will increase the level or effect of piroxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- rose hips
rose hips will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- salicylates (non-asa)
ketorolac will increase the level or effect of salicylates (non-asa) by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- salsalate
ketorolac will increase the level or effect of salsalate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- streptomycin
ketorolac increases levels of streptomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- sulfasalazine
ketorolac will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- sulindac
ketorolac will increase the level or effect of sulindac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- tobramycin
ketorolac increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- tolfenamic acid
ketorolac will increase the level or effect of tolfenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- tolmetin
ketorolac will increase the level or effect of tolmetin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- triamterene
triamterene, ketorolac. Other (see comment). Minor/Significance Unknown. Comment: Risk of acute renal failure. Mechanism: NSAIDs decrease prostaglandin synthesis, which normally protect against nephrotoxicity.
ketorolac increases toxicity of triamterene by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis, increasing the risk of nephrotoxicity. - valganciclovir
ketorolac will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- vancomycin
ketorolac increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- willow bark
ketorolac will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
Adverse Effects
>10%
Headache (17%)
Somnolence (3-14%)
Dyspepsia (12-13%)
GI pain (12-13%)
Nausea (12-13%)
1-10%
Diarrhea (3-9%)
Dizziness (3-9%)
Pruritus (3-9%)
Edema (1-3%)
Increased blood urea nitrogen (BUN) (3%)
Constipation (<3%)
Purpura (<3%)
Increased serum creatinine (2%)
Drowsiness (6%)
Hypertension (4%)
<1%
Abnormal thinking
Anaphylaxis
Blurred vision
Bronchospasm
Cholestatic jaundice
Depression
Difficulty in concentration
Dysgeusia
Euphoria
Hemolytic-uremic syndrome
Hepatitis
Hyperkalemia
Hyponatremia
Hypotension
Increased liver function test values
Insomnia
Laryngeal/lingual edema
Liver failure
Melena
Nervousness
Oliguria
Pallor
Peptic ulcer
Rash
Rectal bleeding
Stomatitis
Urinary frequency
Urinary retention
Vasodilation
Warnings
Black Box Warnings
Cardiovascular risk
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), and stroke, which can be fatal
- Risk may increase with duration of use
- Patients with existing cardiovascular disease or risk factors for such disease may be at greater risk
- NSAIDs are contraindicated for perioperative pain in setting of coronary artery bypass graft (CABG) surgery
- Patients treated with NSAIDs following heart attack reported to be more likely to die in first yearof heart attack compared to patients not treated with NSAIDs after first heart attack
Gastrointestinal risk
- NSAIDs increase risk of serious GI adverse events, including bleeding, ulceration, and gastric or intestinal perforation, which can be fatal
- GI adverse events may occur at any time during use and without warning symptoms
- Elderly patients are at greater risk for serious GI events
Additional Warnings
- Major surgery: Contraindicated for prophylactic analgesic
- CABG: Contraindicated for treatment of perioperative pain in the setting of CABG surgery
- Labor and delivery: Contraindicated because it may adversely affect fetal circulation and inhibit uterine contractions
- Breastfeeding women: Contraindicated because of potential adverse effects of prostaglandin-inhibiting drugs on neonates
- Use with other NSAIDs: Contraindicated in patients currently receiving aspirin or other NSAIDs, because of a cumulative risk of inducing serious NSAID-related adverse effects
- Renal risk: Contraindicated with advanced renal impairment and in patients at risk for renal failure due to volume depletion
- Gastrointestinal: Contraindicated with active peptic ulcer disease, recent GI bleeding or perforation, or history of peptic ulcer disease or GI bleeding
- Bleeding risk: Inhibits platelet function; contraindicated with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, and high risk of bleeding
- Demonstrated hypersensitivity: Contraindicated with previously demonstrated hypersensitivity to ketorolac or allergic manifestations to aspirin or other NSAIDs
- Injectable: Contraindicated for intrathecal or epidural administration, due to its alcohol content.
- Hypersensitivity reactions, ranging from bronchospasm to anaphylactic shock, have occurred, and appropriate counteractive measures must be available when administering the first dose of ketorolac injection
Contraindications
Duration of therapy >5 days
Not for chronic or minor pain
Demonstrated hypersensitivity to ketorolac or allergic manifestations to aspirin or other NSAIDs; appropriate counteractive measures must be available when first ketorolac injection is given
Major surgery: Contraindicated for prophylactic analgesia; contraindicated for treatment of perioperative pain in setting of CABG surgery
OB/GYN: Contraindicated during labor and delivery because it may adversely affect fetal circulation and inhibit uterine contractions; contraindicated in breastfeeding women because of potential adverse effects of prostaglandin-inhibiting drugs on neonates
Renal: Contraindicated with advanced renal impairment and in patients at risk for renal failure due to volume depletion
GI: Contraindicated with previous or currently active peptic ulcer disease, previous or current GI bleeding or perforation
Bleeding risk: Because of inhibition of platelet function; contraindicated with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, and high risk of bleeding
Use with other NSAIDs: Contraindicated in patients currently receiving aspirin or other NSAIDs, because of a cumulative risk of inducing serious NSAID-related adverse effects
Contraindicated for intrathecal or epidural administration because of alcohol content
Cautions
Use with caution in perioperative setting, tonsillectomy in children (may interfere with hemostasis), gastric perforation, hepatic/renal impairment, history of hepatic/renal disease, concomitant anticoagulant therapy, hypertension (may cause new onset of hypertension or worsening of existing hypertension)
PO therapy should be used only as continuation after initial parenteral therapy
Limited data supporting safe use of multiple-dose parenteral treatment in children
Potential risk of cardiovascular damage
Long-term administration of NSAIDs may result in renal papillary necrosis and other renal injury; patients at greatest risk include elderly individuals; those with impaired renal function, hypovolemia, heart failure, liver dysfunction, or salt depletion; and those taking diuretics, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers
Risk of severe skin reactions
May cause drowsiness, blurred vision, and dizziness; may impair ability to operate heavy machinery
May increase risk of hyperkalemia, especially in renal disease, patients with diabetes, the elderly, and when used concomitantly with other agents capable of inducing hyperkalemia
Not for use in patients with aspirin-sensitive asthma (severe bronchospasm may occur)
Heart Failure(HF) risk
- NSAIDS have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
- NSAIDS should be avoided or withdrawn whenever possible
- AHA/ACC Heart Failure Guidelines; Circulation. 2016; 134
Pregnancy & Lactation
Pregnancy category: C; D in third trimester (may cause premature closure of ductus arteriosus)
Quebec Pregnancy Registry identified 4705 women who had spontaneous abortions by 20 weeks' gestation; each case was matched to 10 control subjects (n=47,050) who had not had spontaneous abortions; exposure to nonaspirin NSAIDs during pregnancy was documented in approximately 7.5% of cases of spontaneous abortions and approximately 2.6% of controls
Lactation: Drug excreted in breast milk with multiple doses; use contraindicated
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclo-oxygenase (COX) isoenzymes, COX-1 and COX-2
May inhibit chemotaxis, alter lymphocyte activity, decrease proinflammatory cytokine activity, and inhibit neutrophil aggregation; these effects may contribute to anti-inflammatory activity
Absorption
Bioavailability: 80-100%
Onset: IM, 10 min; PO, 30-60 min
Duration: 4-6 hr (analgesia)
Peak serum time: 1-3 min (IV); 30-60 min (IM); ~1 hr (PO)
Peak plasma concentration: Varies with dose and route
Distribution
Protein bound: >99%
Vd: ~13 L
Metabolism
Metabolized in liver
Metabolites: p-hydroxyketorolac, unidentified polar metabolites
Elimination
Half-life: 2-6 hr
Dialyzable: Yes, with unknown effect
Excretion: Urine (91%), feces (6%)
Administration
IV Incompatibilities
Additive: Hydroxyzine, meperidine, morphine, promethazine
Syringe: Haloperidol, hydroxyzine, nalbuphine, prochlorperazine, promethazine, thiethylperazine
Y-site: Azithromycin, fenoldopam
IV Compatibilities
Solution: D5/NS, D5W, Ringer solution, LR, NS
Syringe: Hydromorphone, sufentanil
Y-site: Cisatracurium, dexmedetomidine, fentanyl, hydromorphone, methadone, morphine sulfate, remifentanil, sufentanil
IV/IM Administration
IM: Inject slowly and deeply into muscle
IV: Inject over ≥15 seconds
60 mg/2 mL preparation for IM administration only
Storage
Store at controlled room temperature
Protect from light
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac injection - | 30 mg/mL vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 15 mg/mL solution |  | |
| ketorolac injection - | 30 mg/mL solution |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac injection - | 30 mg/mL solution |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 30 mg/mL (1 mL) vial |  | |
| ketorolac injection - | 15 mg/mL vial |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.4 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| ketorolac ophthalmic (eye) - | 0.5 % drops |  | |
| Acular LS ophthalmic (eye) - | 0.4 % drops |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL solution |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac intramuscular - | 60 mg/2 mL solution |  | |
| ketorolac intramuscular - | 60 mg/2 mL vial |  | |
| ketorolac nasal - | 15.75 mg/spray liquid |  | |
| Sprix nasal - | 15.75 mg/spray liquid |  | |
| Sprix nasal - | 15.75 mg/spray liquid |  | |
| ketorolac oral - | 10 mg tablet |  | |
| ketorolac oral - | 10 mg tablet |  | |
| ketorolac oral - | 10 mg tablet |  | |
| ketorolac oral - | 10 mg tablet |  | |
| Acular ophthalmic (eye) - | 0.5 % drops |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
ketorolac injection
KETOROLAC - INJECTION
(KEE-toe-ROLE-ak)
COMMON BRAND NAME(S): Toradol
WARNING: It is important that you use this medication properly to help reduce your risk of side effects. Your doctor may adjust your dose if you are older, have low body weight, or have kidney problems.Nonsteroidal anti-inflammatory drugs (including ketorolac) may rarely increase the risk for a heart attack or stroke. This effect can happen at any time while using this drug but is more likely if you use it for a long time. The risk may be greater in older adults or if you have heart disease or increased risk for heart disease (for example, due to smoking, family history of heart disease, or conditions such as high blood pressure or diabetes). Talk to your doctor about the benefits and risks of using this drug.This drug may rarely cause serious (rarely fatal) bleeding from the stomach or intestines. This effect can occur without warning at any time while using this drug. Older adults may be at higher risk for this effect. Do not use this medication if you have stomach/intestinal problems (such as bleeding, ulcers).Stop using ketorolac and get medical help right away if you notice any of the following rare but serious side effects: stomach/abdominal pain that doesn't go away, bloody or black/tarry stools, vomit that looks like coffee grounds, chest/jaw/left arm pain, shortness of breath, unusual sweating, weakness on one side of the body, sudden vision changes, trouble speaking.Do not use this drug right before or after heart bypass surgery (CABG) or before any surgery. It also should not be used during labor/delivery or in people with severe kidney problems or high risk for kidney problems. Do not use ketorolac if you are taking high doses of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). See also Drug Interactions section.
USES: Ketorolac is used for the short-term treatment of moderate to severe pain. It is usually used before or after medical procedures or after surgery. Reducing pain helps you recover more comfortably so that you can return to your normal daily activities. This medication is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body's production of certain natural substances that cause inflammation. This effect helps to decrease swelling, pain, or fever.Ketorolac should not be used for mild or long-term painful conditions (such as arthritis).
HOW TO USE: Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start using ketorolac. If you have any questions, ask your doctor or pharmacist.This medication is given by injection into a muscle or vein as directed by your doctor. It may be given as a one-time dose or given on a regular schedule. If given on a regular schedule, it is usually injected every 6 hours as needed, or as directed by your doctor. This drug must not be injected into the spine.Dosage is based on your medical condition and response to treatment. To reduce your risk of stomach bleeding and other side effects, use this medication at the lowest effective dose for the shortest possible time. Do not increase your dose, use it more often, or use it for longer than 5 days. If you still have pain after 5 days, talk with your doctor about other medications you may use.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.If you have "breakthrough" pain while using this medication, ask your doctor about other medications that you can use with this drug. Tell your doctor if your condition worsens or if your pain is not relieved.
SIDE EFFECTS: See also Warning section.Pain at the injection site, dizziness, drowsiness, headache, or upset stomach may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: headache that is severe or doesn't go away, fainting, fast/pounding heartbeat, hearing changes (such as ringing in the ears), mental/mood changes (such as confusion, depression), stomach pain, vision changes (such as blurred vision), easy bruising/bleeding, signs of kidney problems (such as change in the amount of urine), symptoms of meningitis (such as unexplained stiff neck, fever), symptoms of heart failure (such as swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).This drug may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, including: nausea/vomiting that doesn't stop, dark urine, stomach/abdominal pain, yellowing eyes/skin.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using ketorolac, tell your doctor or pharmacist if you are allergic to it; or to aspirin or other nonsteroidal anti-inflammatory drugs-NSAIDs (such as ibuprofen, naproxen, celecoxib); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: asthma (including a history of worsening breathing after taking aspirin or other NSAIDs), bleeding or clotting problems, blood disorders (such as anemia), heart disease (such as previous heart attack), high blood pressure, liver disease, growths in the nose (nasal polyps), throat/stomach/intestinal problems (such as bleeding, heartburn, ulcers), stroke, swelling of the ankles/feet/hands.Kidney problems can sometimes occur with the use of NSAID medications, including ketorolac. Problems are more likely to occur if you are dehydrated, have heart failure or kidney disease, are an older adult, or if you take certain medications (see also Drug Interactions section). Drink plenty of fluids as directed by your doctor to prevent dehydration and tell your doctor right away if you have a change in the amount of urine.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medicine may cause stomach/intestinal bleeding. Daily use of alcohol and tobacco, especially when combined with this medicine, may increase your risk for stomach bleeding. Limit alcohol and stop smoking. Consult your doctor or pharmacist for more information.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be at greater risk for stomach/intestinal bleeding, kidney problems, heart attack, and stroke while using this drug.Before using this medication, women of childbearing age should talk with their doctor(s) about the benefits and risks. Tell your doctor if you are pregnant or if you plan to become pregnant. This medication may harm an unborn baby and cause problems with normal labor/delivery. It is not recommended for use in pregnancy from 20 weeks until delivery. If your doctor decides that you need to use this medication between 20 and 30 weeks of pregnancy, you should use the lowest effective dose for the shortest possible time. You should not use this medication after 30 weeks of pregnancy.This drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: aliskiren, ACE inhibitors (such as captopril, lisinopril), angiotensin II receptor blockers (such as valsartan, losartan), corticosteroids (such as prednisone), methotrexate, probenecid, other medications that may affect the kidneys (including cidofovir), "water pills" (diuretics such as furosemide).This medication may increase the risk of bleeding when used with other drugs that also may cause bleeding. Examples include anti-platelet drugs such as clopidogrel, "blood thinners" such as dabigatran/enoxaparin/warfarin, among others.This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include lithium, pemetrexed, among others.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (aspirin, NSAIDs such as ibuprofen or naproxen). These drugs are similar to ketorolac and may increase your risk of side effects if taken together. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should continue taking the aspirin unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe stomach pain, vomit that looks like coffee grounds, extreme drowsiness, slow/shallow breathing.
NOTES: Do not share this medication with others.Lab and/or medical tests (including blood pressure, kidney function) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.This medication has been prescribed for your current condition only. Do not use it later for another condition unless your doctor directs you to do so. A different medication may be necessary in that case.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you are using this drug on a regular schedule (not "as needed") and you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised May 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
