ketorolac (Rx)

Brand and Other Names:Toradol
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Dosing & Uses

AdultPediatricGeriatric

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)

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Interactions

Interaction Checker

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              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.

              • clobetasone

                ketorolac, clobetasone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

              • 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.

              • 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

                warfarin and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.

              • 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.

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              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

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              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
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              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.

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              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%)

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              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

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              ketorolac injection
              -
              30 mg/mL (1 mL) vial
              ketorolac injection
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              30 mg/mL (1 mL) vial
              ketorolac injection
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              15 mg/mL vial
              ketorolac injection
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              15 mg/mL vial
              ketorolac injection
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              30 mg/mL (1 mL) vial
              ketorolac injection
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              30 mg/mL (1 mL) vial
              ketorolac injection
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              30 mg/mL vial
              ketorolac injection
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              15 mg/mL vial
              ketorolac injection
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              15 mg/mL vial
              ketorolac injection
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              30 mg/mL (1 mL) vial
              ketorolac injection
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              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
              -
              15 mg/mL vial
              ketorolac injection
              -
              30 mg/mL solution
              ketorolac injection
              -
              30 mg/mL (1 mL) vial
              ketorolac injection
              -
              15 mg/mL vial
              ketorolac injection
              -
              30 mg/mL solution
              ketorolac injection
              -
              30 mg/mL (1 mL) vial
              ketorolac nasal
              -
              15.75 mg/spray liquid
              Sprix nasal
              -
              15.75 mg/spray liquid
              Sprix nasal
              -
              15.75 mg/spray liquid
              ketorolac intramuscular
              -
              60 mg/2 mL vial
              ketorolac intramuscular
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              60 mg/2 mL vial
              ketorolac intramuscular
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              60 mg/2 mL vial
              ketorolac intramuscular
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              60 mg/2 mL vial
              ketorolac intramuscular
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              60 mg/2 mL vial
              ketorolac intramuscular
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              60 mg/2 mL vial
              ketorolac intramuscular
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              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 solution
              Acular ophthalmic (eye)
              -
              0.5 % drops
              Acular LS ophthalmic (eye)
              -
              0.4 % drops
              ketorolac oral
              -
              10 mg tablet
              ketorolac oral
              -
              10 mg tablet
              ketorolac ophthalmic (eye)
              -
              0.4 % drops
              ketorolac ophthalmic (eye)
              -
              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops
              ketorolac ophthalmic (eye)
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              0.5 % drops

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              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 seek immediate medical attention if you notice any of the following rare but serious side effects: bloody or black/tarry stools, persistent stomach/abdominal pain, 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 frequently, 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 persist or worsen, 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: fainting, fast/pounding heartbeat, hearing changes (such as ringing in the ears), mental/mood changes (such as confusion, depression), persistent/severe headache, stomach pain, vision changes (such as blurred vision), easy bruising/bleeding, signs of kidney problems (such as change in the amount of urine), signs of infection (such as fever, chills, persistent sore throat), 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: dark urine, stomach/abdominal pain, persistent nausea/vomiting, 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.Keep all regular medical and laboratory appointments. Laboratory and/or medical tests (including blood pressure, kidney function tests) may be performed to check for side effects. 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 August 2021. Copyright(c) 2021 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.

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              Formulary

              FormularyPatient Discounts

              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.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.