ketorolac intranasal (Rx)

Brand and Other Names:Sprix
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intranasal

  • 15.75mg per 100 microL spray; 8 sprays/1.7g bottle

Pain

Indicated for short-term (up to 5 days) management of moderate to moderately severe pain

<65 years: 31.5 mg (ie, 1 spray in each nostril) q6-8h; not to exceed 126 mg/day

<50 kg or ≥65 years: 15.75 mg (ie, 1 spray in only 1 nostril) q6-8h; not to exceed 63 mg/day

Also see Administration

Dosage Modifications

Renal impairment

  • 1 spray (15.75 mg) in 1 nostril
  • Total dose: 15.75 mg intranasal q6-8hr; not to exceed 4 doses (63 mg/day)

Hepatic Impairment

  • Use caution; may cause elevation of liver enzymes; discontinued if symptoms of liver toxicity develop

Safety and efficacy not established

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Interactions

Interaction Checker

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              Serious - Use Alternative (45)

              • aceclofenac

                aceclofenac, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • acemetacin

                acemetacin, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • aminolevulinic acid oral

                aminolevulinic acid oral, ketorolac intranasal. 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 intranasal, 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.

              • aspirin

                aspirin, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • benazepril

                ketorolac intranasal, 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 intranasal, 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 intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • diclofenac

                diclofenac, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • diflunisal

                diflunisal, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • enalapril

                ketorolac intranasal, 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.

              • etodolac

                etodolac, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • fenoprofen

                fenoprofen, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • flurbiprofen

                flurbiprofen, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • fosinopril

                ketorolac intranasal, 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 intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • ibuprofen IV

                ibuprofen IV, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • indomethacin

                indomethacin, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • ketoprofen

                ketoprofen, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • lisinopril

                ketorolac intranasal, 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 intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • meclofenamate

                meclofenamate, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • mefenamic acid

                mefenamic acid, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • meloxicam

                meloxicam, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • methotrexate

                ketorolac intranasal increases levels of methotrexate by decreasing renal clearance. Avoid or Use Alternate Drug. The relative risk of interaction of different NSAIDs w/methotrexate is not established. Selective COX 2 inhibitors are believed to have minimal interaction. Greater risk in pts. with renal impairment. Greater toxicity with high dose methotrexate (e.g., anti neoplastic regimen).

              • methyl aminolevulinate

                ketorolac intranasal, 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 intranasal, 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 intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • naproxen

                naproxen, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • oxaprozin

                oxaprozin, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • parecoxib

                parecoxib, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • pemetrexed

                ketorolac intranasal increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug. Especially in pts. w/mild moderate renal insufficiency. D/C NSAIDs 2 5 d before and 2 d after pemetrexed administration.

              • perindopril

                ketorolac intranasal, 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 intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • probenecid

                probenecid increases levels of ketorolac intranasal by decreasing renal clearance. Contraindicated.

              • quinapril

                ketorolac intranasal, 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 intranasal, 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 intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • salsalate

                salsalate, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • sulfasalazine

                sulfasalazine, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • sulindac

                sulindac, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • tolfenamic acid

                tolfenamic acid, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • tolmetin

                tolmetin, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

              • trandolapril

                ketorolac intranasal, 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 (213)

              • acebutolol

                acebutolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of acebutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • aceclofenac

                aceclofenac and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                aceclofenac and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • acemetacin

                acemetacin and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                acemetacin and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • agrimony

                ketorolac intranasal and agrimony both increase anticoagulation. Use Caution/Monitor.

              • albuterol

                ketorolac intranasal increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • alfalfa

                ketorolac intranasal and alfalfa both increase anticoagulation. Use Caution/Monitor.

              • alfuzosin

                ketorolac intranasal decreases effects of alfuzosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • aliskiren

                ketorolac intranasal 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 intranasal and alteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

              • American ginseng

                ketorolac intranasal and American ginseng both increase anticoagulation. Use Caution/Monitor.

              • amiloride

                amiloride and ketorolac intranasal both increase serum potassium. Modify Therapy/Monitor Closely.

              • antithrombin alfa

                antithrombin alfa and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • antithrombin III

                antithrombin III and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • arformoterol

                ketorolac intranasal increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • argatroban

                argatroban and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • asenapine

                ketorolac intranasal decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • aspirin

                aspirin and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                aspirin and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                aspirin/citric acid/sodium bicarbonate and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • atenolol

                atenolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of atenolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • bemiparin

                bemiparin and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • benazepril

                benazepril, ketorolac intranasal. 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 intranasal increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • betaxolol

                betaxolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of betaxolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • betrixaban

                ketorolac intranasal, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

              • bimatoprost

                bimatoprost, ketorolac intranasal. 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 intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of bisoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • bivalirudin

                bivalirudin and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • budesonide

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

              • bumetanide

                ketorolac intranasal increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

                ketorolac intranasal decreases effects of bumetanide by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • candesartan

                candesartan and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal 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 intranasal. 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 intranasal. 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 intranasal increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • carvedilol

                carvedilol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • celecoxib

                celecoxib and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                celecoxib and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • celiprolol

                celiprolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of celiprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • chlorothiazide

                ketorolac intranasal increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • chlorpropamide

                ketorolac intranasal increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • chlorthalidone

                ketorolac intranasal increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • cinnamon

                ketorolac intranasal and cinnamon both increase anticoagulation. Use Caution/Monitor.

              • citalopram

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

              • clomipramine

                clomipramine, ketorolac intranasal. 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 intranasal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.

              • cordyceps

                ketorolac intranasal and cordyceps both increase anticoagulation. Use Caution/Monitor.

              • cortisone

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

              • cyclopenthiazide

                ketorolac intranasal increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • dabigatran

                dabigatran and ketorolac intranasal 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 intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • defibrotide

                defibrotide increases effects of ketorolac intranasal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Defibrotide may enhance effects of platelet inhibitors.

              • deflazacort

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

              • dexamethasone

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

              • diclofenac

                diclofenac and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                diclofenac and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • diflunisal

                diflunisal and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                diflunisal and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • digoxin

                ketorolac intranasal and digoxin both increase serum potassium. Use Caution/Monitor.

              • dobutamine

                ketorolac intranasal increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • dong quai

                ketorolac intranasal and dong quai both increase anticoagulation. Use Caution/Monitor.

              • dopexamine

                ketorolac intranasal increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • doxazosin

                ketorolac intranasal decreases effects of doxazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • drospirenone

                drospirenone and ketorolac intranasal both increase serum potassium. Modify Therapy/Monitor Closely.

              • duloxetine

                duloxetine, ketorolac intranasal. 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 intranasal. 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 intranasal by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF, ketorolac intranasal. 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.

              • enalapril

                enalapril, ketorolac intranasal. 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 intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • ephedrine

                ketorolac intranasal increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • epinephrine

                ketorolac intranasal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • epinephrine racemic

                ketorolac intranasal increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • epoprostenol

                ketorolac intranasal and epoprostenol both increase anticoagulation. Use Caution/Monitor.

              • eprosartan

                eprosartan and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal 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 intranasal. 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 intranasal. 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 intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ethacrynic acid

                ketorolac intranasal increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • etodolac

                etodolac and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                etodolac and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • fennel

                ketorolac intranasal and fennel both increase anticoagulation. Use Caution/Monitor.

              • fenoprofen

                fenoprofen and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                fenoprofen and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • feverfew

                ketorolac intranasal and feverfew both increase anticoagulation. Use Caution/Monitor.

              • fish oil triglycerides

                fish oil triglycerides will increase the level or effect of ketorolac intranasal 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.

              • flucloxacillin

                flucloxacillin, ketorolac intranasal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                flucloxacillin, ketorolac intranasal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • fludrocortisone

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

              • fluoxetine

                fluoxetine, ketorolac intranasal. 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 intranasal both increase anticoagulation. Use Caution/Monitor.

                flurbiprofen and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • fluvoxamine

                fluvoxamine, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding; SSRIs inhib. srotonin uptake by platelets.

              • fondaparinux

                fondaparinux and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • formoterol

                ketorolac intranasal increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • forskolin

                ketorolac intranasal and forskolin both increase anticoagulation. Use Caution/Monitor.

              • fosinopril

                fosinopril, ketorolac intranasal. 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 intranasal increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • garlic

                ketorolac intranasal and garlic both increase anticoagulation. Use Caution/Monitor.

              • gemifloxacin

                gemifloxacin, ketorolac intranasal. Other (see comment). Modify Therapy/Monitor Closely. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

              • gentamicin

                ketorolac intranasal increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • ginger

                ketorolac intranasal and ginger both increase anticoagulation. Use Caution/Monitor.

              • ginkgo biloba

                ketorolac intranasal and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

              • glimepiride

                ketorolac intranasal increases effects of glimepiride by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • glipizide

                ketorolac intranasal increases effects of glipizide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • glyburide

                ketorolac intranasal increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • heparin

                heparin and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • horse chestnut seed

                ketorolac intranasal and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.

              • hydralazine

                ketorolac intranasal decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • hydrochlorothiazide

                ketorolac intranasal increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • hydrocortisone

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

              • ibuprofen

                ibuprofen and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                ibuprofen and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • ibuprofen IV

                ibuprofen IV and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                ibuprofen IV and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • indapamide

                ketorolac intranasal increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • indomethacin

                indomethacin and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                indomethacin and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • irbesartan

                irbesartan and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal 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 intranasal. 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 intranasal increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • ketoprofen

                ketoprofen and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.

                ketoprofen and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • labetalol

                labetalol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of labetalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • latanoprost

                latanoprost, ketorolac intranasal. 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 intranasal. 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 intranasal increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • levofloxacin

                levofloxacin, ketorolac intranasal. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • levomilnacipran

                levomilnacipran, ketorolac intranasal. 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 intranasal. 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 intranasal increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • lornoxicam

                ketorolac intranasal and lornoxicam both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and lornoxicam both increase serum potassium. Use Caution/Monitor.

              • losartan

                losartan and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal 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 intranasal. 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 intranasal both increase anticoagulation. Use Caution/Monitor.

                meclofenamate and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • mefenamic acid

                ketorolac intranasal and mefenamic acid both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and mefenamic acid both increase serum potassium. Use Caution/Monitor.

              • meloxicam

                ketorolac intranasal and meloxicam both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and meloxicam both increase serum potassium. Use Caution/Monitor.

              • mesalamine

                mesalamine, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive nephrotoxicity.

              • metaproterenol

                ketorolac intranasal increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • methotrexate

                ketorolac intranasal will increase the level or effect of methotrexate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • methylprednisolone

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

              • metolazone

                ketorolac intranasal increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • metoprolol

                metoprolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of metoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • milnacipran

                milnacipran, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

              • mistletoe

                ketorolac intranasal increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • moexipril

                moexipril, ketorolac intranasal. 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 intranasal. Other (see comment). Modify Therapy/Monitor Closely. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

              • moxisylyte

                ketorolac intranasal decreases effects of moxisylyte by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • mycophenolate

                ketorolac intranasal will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • nabumetone

                ketorolac intranasal and nabumetone both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and nabumetone both increase serum potassium. Use Caution/Monitor.

              • nadolol

                nadolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • naproxen

                ketorolac intranasal and naproxen both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and naproxen both increase serum potassium. Use Caution/Monitor.

              • nebivolol

                nebivolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • nefazodone

                nefazodone, ketorolac intranasal. 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 intranasal increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • norepinephrine

                ketorolac intranasal increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • olmesartan

                olmesartan and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal 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 intranasal. 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 intranasal and oxaprozin both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and oxaprozin both increase serum potassium. Use Caution/Monitor.

              • panax ginseng

                ketorolac intranasal and panax ginseng both increase anticoagulation. Use Caution/Monitor.

              • parecoxib

                ketorolac intranasal and parecoxib both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and parecoxib both increase serum potassium. Use Caution/Monitor.

              • paroxetine

                paroxetine, ketorolac intranasal. 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 intranasal and pau d'arco both increase anticoagulation. Use Caution/Monitor.

              • penbutolol

                penbutolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • perindopril

                perindopril, ketorolac intranasal. 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 intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • phenoxybenzamine

                ketorolac intranasal decreases effects of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • phentolamine

                ketorolac intranasal decreases effects of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • phytoestrogens

                ketorolac intranasal and phytoestrogens both increase anticoagulation. Use Caution/Monitor.

              • pindolol

                pindolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of pindolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • pirbuterol

                ketorolac intranasal increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • piroxicam

                ketorolac intranasal and piroxicam both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and piroxicam both increase serum potassium. Use Caution/Monitor.

              • pivmecillinam

                pivmecillinam, ketorolac intranasal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                pivmecillinam, ketorolac intranasal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • potassium acid phosphate

                ketorolac intranasal and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

              • potassium chloride

                ketorolac intranasal and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

              • potassium iodide

                potassium iodide and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              • pralatrexate

                ketorolac intranasal increases levels of pralatrexate by decreasing renal clearance. Use Caution/Monitor.

              • prasugrel

                ketorolac intranasal, prasugrel. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Chronic use of NSAIDs with prasugrel may increase bleeding risk.

              • prazosin

                ketorolac intranasal decreases effects of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • prednisolone

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

              • prednisone

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

              • probenecid

                ketorolac intranasal will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • propranolol

                propranolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • protamine

                protamine and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

              • quinapril

                quinapril, ketorolac intranasal. 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 intranasal. 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 intranasal and reishi both increase anticoagulation. Use Caution/Monitor.

              • reteplase

                ketorolac intranasal and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

              • sacubitril/valsartan

                sacubitril/valsartan and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                sacubitril/valsartan, ketorolac intranasal. 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 intranasal 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 intranasal and salicylates (non-asa) both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

              • salmeterol

                ketorolac intranasal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • salsalate

                ketorolac intranasal and salsalate both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and salsalate both increase serum potassium. Use Caution/Monitor.

              • sertraline

                sertraline, ketorolac intranasal. 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 intranasal and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.

              • silodosin

                ketorolac intranasal decreases effects of silodosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                ketorolac intranasal, 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 intranasal 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 intranasal 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.

              • sotalol

                sotalol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • spironolactone

                spironolactone and ketorolac intranasal both increase serum potassium. Modify Therapy/Monitor Closely.

              • succinylcholine

                ketorolac intranasal and succinylcholine both increase serum potassium. Use Caution/Monitor.

              • sulfasalazine

                ketorolac intranasal and sulfasalazine both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and sulfasalazine both increase serum potassium. Use Caution/Monitor.

              • sulindac

                ketorolac intranasal and sulindac both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and sulindac both increase serum potassium. Use Caution/Monitor.

              • tafluprost

                tafluprost, ketorolac intranasal. 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 intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal 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 intranasal. 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 intranasal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                temocillin, ketorolac intranasal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • tenecteplase

                ketorolac intranasal and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

              • terazosin

                ketorolac intranasal decreases effects of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              • terbutaline

                ketorolac intranasal increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • ticarcillin

                ticarcillin, ketorolac intranasal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                ticarcillin, ketorolac intranasal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • timolol

                timolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tolazamide

                ketorolac intranasal increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • tolbutamide

                ketorolac intranasal increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • tolfenamic acid

                ketorolac intranasal and tolfenamic acid both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and tolfenamic acid both increase serum potassium. Use Caution/Monitor.

              • tolmetin

                ketorolac intranasal and tolmetin both increase anticoagulation. Use Caution/Monitor.

                ketorolac intranasal and tolmetin both increase serum potassium. Use Caution/Monitor.

              • tolvaptan

                ketorolac intranasal and tolvaptan both increase serum potassium. Use Caution/Monitor.

              • torsemide

                ketorolac intranasal increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • trandolapril

                trandolapril, ketorolac intranasal. 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 intranasal. 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 intranasal. 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 intranasal, 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 intranasal both increase serum potassium. Modify Therapy/Monitor Closely.

              • valsartan

                valsartan and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal 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 intranasal. 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 intranasal. 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 intranasal increases and vitamin K1 (phytonadione) decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • voclosporin

                voclosporin, ketorolac intranasal. 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.

              • vortioxetine

                ketorolac intranasal, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

              • warfarin

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

              • zanubrutinib

                ketorolac intranasal, 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 intranasal decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

              Minor (73)

              • aceclofenac

                aceclofenac will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • acemetacin

                acemetacin will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • acyclovir

                ketorolac intranasal will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • alendronate

                ketorolac intranasal, alendronate. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI ulceration.

              • amikacin

                ketorolac intranasal increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • aminohippurate sodium

                ketorolac intranasal will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • anamu

                ketorolac intranasal and anamu both increase anticoagulation. Minor/Significance Unknown.

              • aspirin

                aspirin will increase the level or effect of ketorolac intranasal 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 intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • balsalazide

                ketorolac intranasal 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 intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cefadroxil

                cefadroxil will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cefamandole

                cefamandole will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cefazolin

                cefazolin will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cefpirome

                cefpirome will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ceftibuten

                ceftibuten will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • celecoxib

                celecoxib will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cephalexin

                cephalexin will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • chlorothiazide

                chlorothiazide will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • chlorpropamide

                ketorolac intranasal 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 intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • creatine

                creatine, ketorolac intranasal. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.

              • cyclopenthiazide

                cyclopenthiazide will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • danshen

                ketorolac intranasal and danshen both increase anticoagulation. Minor/Significance Unknown.

              • devil's claw

                ketorolac intranasal and devil's claw both increase anticoagulation. Minor/Significance Unknown.

              • diclofenac

                diclofenac will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • diclofenac topical

                diclofenac topical, ketorolac intranasal. 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 intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • eplerenone

                ketorolac intranasal decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

              • etodolac

                etodolac will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • fenoprofen

                fenoprofen will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • feverfew

                ketorolac intranasal decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.

              • flurbiprofen

                flurbiprofen will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • furosemide

                ketorolac intranasal decreases effects of furosemide by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

              • ganciclovir

                ketorolac intranasal will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • gentamicin

                ketorolac intranasal 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 intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ibuprofen

                ibuprofen will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ibuprofen IV

                ibuprofen IV will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • imidapril

                ketorolac intranasal decreases effects of imidapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

              • indapamide

                indapamide will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • indomethacin

                indomethacin will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ketoprofen

                ketoprofen will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • lornoxicam

                ketorolac intranasal 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 intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • mefenamic acid

                ketorolac intranasal will increase the level or effect of mefenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • meloxicam

                ketorolac intranasal will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • mesalamine

                ketorolac intranasal will increase the level or effect of mesalamine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • metolazone

                metolazone will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • nabumetone

                ketorolac intranasal will increase the level or effect of nabumetone by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • naproxen

                ketorolac intranasal will increase the level or effect of naproxen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • neomycin PO

                ketorolac intranasal increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • noni juice

                ketorolac intranasal and noni juice both increase serum potassium. Minor/Significance Unknown.

              • ofloxacin

                ofloxacin, ketorolac intranasal. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • oxaprozin

                ketorolac intranasal will increase the level or effect of oxaprozin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • parecoxib

                ketorolac intranasal will increase the level or effect of parecoxib by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • paromomycin

                ketorolac intranasal increases levels of paromomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • pegaspargase

                pegaspargase increases effects of ketorolac intranasal by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of bleeding events.

              • piroxicam

                ketorolac intranasal will increase the level or effect of piroxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • rivastigmine

                rivastigmine increases toxicity of ketorolac intranasal by pharmacodynamic synergism. Minor/Significance Unknown. Increased GI symptoms.

              • rose hips

                rose hips will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • salicylates (non-asa)

                ketorolac intranasal will increase the level or effect of salicylates (non-asa) by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • salsalate

                ketorolac intranasal will increase the level or effect of salsalate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • streptomycin

                ketorolac intranasal increases levels of streptomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • sulfasalazine

                ketorolac intranasal will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • sulindac

                ketorolac intranasal will increase the level or effect of sulindac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • tobramycin

                ketorolac intranasal increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • tolfenamic acid

                ketorolac intranasal will increase the level or effect of tolfenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • tolmetin

                ketorolac intranasal will increase the level or effect of tolmetin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • triamterene

                triamterene, ketorolac intranasal. Other (see comment). Minor/Significance Unknown. Comment: Risk of acute renal failure. Mechanism: NSAIDs decrease prostaglandin synthesis, which normally protect against nephrotoxicity.

                ketorolac intranasal increases toxicity of triamterene by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis, increasing the risk of nephrotoxicity.

              • valganciclovir

                ketorolac intranasal will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • vancomycin

                ketorolac intranasal increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.

              • willow bark

                ketorolac intranasal 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%

              Nasal discomfort (15%)

              Rhinalgia (13%)

              1-10%

              Increased lacrimation (5%)

              Throat irritation (4%)

              Oliguria (3%)

              Rash (3%)

              Bradycardia (2%)

              Decreased urine output (2%)

              Increased ALT and/or AST (2%)

              Hypertension (2%)

              Rhinitis (2%)

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              Warnings

              Black Box Warnings

              Limitations of use

              • Total duration of use of intranasal alone or sequentially with and other ketorolac formulations should not exceed 5 days

              Cardiovascular risk

              • 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 risk factors for or existing cardiovascular disease may be at greater risk; contraindicated for perioperative pain in the setting of CABG surgery (increased risk of MI and stroke)

              Gastrointestinal risk

              • NSAIDs increase risk of serious GI adverse events including bleeding, ulceration, and perforation of the stomach or intestines, 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

              Bleeding risk

              • Inhibits platelet function and is contraindicated with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or high risk of bleeding

              Renal risk

              • Contraindicated with advanced renal impairment and patients at risk for renal failure due to volume depletion

              Contraindications

              Hypersensitivity to ketorolac, other NSAID, aspirin, ethylenediamine tetraacetic acid (EDTA)

              Active peptic ulcer disease, recent GI bleeding or perforation, or history of peptic ulcer disease or GI bleeding

              History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs

              Prophylactic analgesic before any major surgery; during the perioperative period in the setting of coronary artery bypass graft (CABG) surgery; advanced renal disease or patients at risk for renal failure due to volume depletion

              Labor and delivery

              Breastfeeding women

              Suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or those for whom hemostasis is critical

              Coadministration with probenecid or pentoxifylline

              Cautions

              May lead to onset of new hypertension or exacerbate existing hypertension

              NSAIDs may cause serious skin reactions (eg, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis)

              Common local adverse effects include mild and transient nasal discomfort and irritation

              Long-term administration of NSAIDs may result in renal papillary necrosis and other renal injury; patients at greatest risk include the elderly, or those with impaired renal function, hypovolemia, heart failure, liver dysfunction, salt depletion, and individuals taking diuretics, ACE inhibitors, or ARBs

              Drug reaction with eosinophilia and systemic symptoms (DRESS)

              • Drug Reaction reported in patients taking NSAIDs; some of these events have been fatal or life-threatening; DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy, and/or facial swelling
              • Other clinical manifestations may include hepatitis, nephritis, hematological abnormalities, myocarditis, or myositis; sometimes symptoms of DRESS may resemble an acute viral infection
              • Eosinophilia is often present; because this disorder is variable in its presentation, other organ systems not noted here may be involved
              • Early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not evident; if such signs or symptoms are present, discontinue therapy and evaluate the patient immediately
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              Pregnancy & Lactation

              Pregnancy

              Use of NSAIDs can cause premature closure of fetal ductus arteriosus and fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment

              Because of these risks, limit dose and duration of use between about 20 and 30 weeks of gestation, and avoid use at about 30 weeks of gestation and later in pregnancy

              Use of NSAIDs at about 30 weeks gestation or later in pregnancy increases risk of premature closure of fetal ductus arteriosus

              Avoid use of NSAIDs in women at about 30 weeks gestation and later in pregnancy, because NSAIDs can cause premature closure of fetal ductus arteriosus

              Use of NSAIDs at about 20 weeks gestation or later in pregnancy has been associated with cases of fetal renal dysfunction leading to oligohydramnios, and in some cases, neonatal renal impairment

              If an NSAID is necessary at about 20 weeks gestation or later in pregnancy, limit the use to the lowest effective dose and shortest duration possible; if treatment extends beyond 48 hours, consider monitoring with ultrasound for oligohydramnios; if oligohydramnios occurs, discontinue therapy and follow up according to clinical practice

              Data from observational studies regarding other potential embryofetal risks of NSAID use in women in first or second trimesters of pregnancy are inconclusive

              In animal studies, administration of prostaglandin synthesis inhibitors resulted in increased pre-and post-implantation loss

              Prostaglandins also have been shown to have an important role in fetal kidney development; in published animal studies, prostaglandin synthesis inhibitors have been reported to impair kidney development when administered at clinically relevant doses

              Lactation

              Excreted in human milk

              Limited data from one published study involving ten nursing mothers 2-6 days postpartum showed low levels of ketorolac in breast milk

              Exercise caution when administering drug to a nursing woman; available information has not shown any specific adverse events in nursing infants; however, instruct patients to contact their infant’s health care provider if they note any adverse events

              The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

              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 cyclooxygenase isoenzymes, cyclooxygenase-1 (COX-1) and -2 (COX-2)

              May inhibit chemotaxis, may alter lymphocyte activity, decrease proinflammatory cytokine activity, and may inhibit neutrophil aggregation. These effects may contribute to its anti-inflammatory activity

              Pharmacokinetics

              Bioavailability: 60% (compared with 30 mg IM)

              Peak plasma time: 0.75 hr

              Peak plasma concentration: 1805.8 ng/mL

              Protein bound: 99% (5% to albumin)

              Vd: 13 L

              Metabolism: By liver via hydroxylation and conjugation

              Half-life: 5.24 hr; 6-19 hr with renal impairment

              Excretion: 92% urine (~40% as metabolites); 6% feces

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              Administration

              Intranasal Administration

              Is not an inhaled product; do not inhale when administering this product

              Do not use concomitantly with other formulations of ketorolac or other NSAIDs

              Activate pump

              • Activate the pump before using the bottle for the FIRST time, activate the pump
              • To activate the pump, hold the bottle at arm’s length away from the body with index finger and middle finger resting on the top of the finger flange and thumb supporting the base
              • Press down evenly and release the pump 5 times; patient may not see a spray the first few times it is pressed down
              • No need to activate the pump again if more doses are used from the bottle

              Patient instructions

              • Step 1
                • Blow nose gently to clear nostrils
                • Sit up straight or stand; tilt head slightly forward
                • Insert the tip of the container into your right nostril
                • Point the container away from the center of your nose
                • Hold your breath and spray once into your right nostril, pressing down evenly on both sides
                • Immediately after administration, resume breathing through mouth to reduce expelling the product
                • Also pinch the nose to help retain the spray if it starts to drip
                • If only one spray per dose is prescribed, administration is complete; skip to Step 3 below
              • Step 2
                • If a dose of 2 sprays is prescribed, repeat the process in Step 1 for the left nostril
                • Again, be sure to point the spray away from the center of nose
                • Spray once into the left nostril
              • Step 3
                • Replace the clear plastic cover and place the bottle in a cool, dry location out of direct sunlight
                • Keep out of reach of children
                • Discard bottle within 24 hr after first priming, even if bottle still contains medication (will not deliver intended dose after 24 hr)

              Storage

              Protect from light and freezing

              Refrigerate unopened bottle at 2-8°C (36-46°F)

              Store at controlled room temperature during use, between 15-30°C (59-86°F), out of direct sunlight

              Discard within 24 hr of priming

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              Images

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

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              ketorolac oral

              KETOROLAC - ORAL

              (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 taking this drug but is more likely if you take 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 taking 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 taking 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 take 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 in adults. 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 taking ketorolac and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth, usually every 4 to 6 hours with a full glass of water (8 ounces or 240 milliliters), or as directed by your doctor. Do not lie down for at least 10 minutes after taking this drug. If stomach upset occurs while taking this medication, take it with food, milk, or an antacid.Dosage is based on your medical condition and response to treatment. To reduce your risk of stomach bleeding and other side effects, take this medication at the lowest effective dose for the shortest possible time. Do not increase your dose, take it more frequently, or take it for longer than 5 days. If you still have pain after 5 days, talk with your doctor about other medications you may use. Do not take more than 40 milligrams in a 24-hour period.If you are taking this drug "as needed" (not on a regular schedule), remember that pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medicine may not work as well.Tell your doctor if your condition worsens or if your pain is not relieved.

              SIDE EFFECTS: See also Warning section.Upset stomach, nausea, vomiting, constipation, diarrhea, gas, dizziness, or drowsiness 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 any of these unlikely but serious side effects occur: 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), symptoms of heart failure (such as swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).Tell your doctor right away if any of these rare but serious side effects occur: 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).This drug may rarely cause serious (possibly fatal) liver disease. Seek immediate medical attention 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, seek immediate medical attention 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 taking 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 taking 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 more sensitive to the effects of the drug, especially bleeding in the stomach/intestines, kidney problems, heart attack, and stroke. Using high doses for a long time may increase this risk.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 medication 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 losartan, valsartan), lithium, methotrexate, probenecid, corticosteroids (such as prednisone), other medications that may affect the kidneys (including cidofovir, "water pills"/diuretics such as furosemide).This medication may increase the risk of bleeding when taken 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.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.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: If you are taking this medication on a regular schedule (not just "as needed") and you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines 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 for more details about how to safely discard your product.

              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.