Ketorolac (Toradol)

• Type of Drug: Nonsteroidal anti-inflammatory drug (NSAID).
• Prescribed for: Short-term treatment of moderately severe pain that has required narcotic pain relievers. Ketorolac tablets should only be taken by people who have first been treated with Ketorolac injection. Total treatment with injectable and oral Ketorolac should not exceed 5 days. Ketorolac eyedrops are prescribed for eye redness and inflammation caused by seasonal allergies.

Ketorolac General Information

Ketorolac is one of 16 NSAIDs used to relieve pain and inflammation. Unlike the others in this group, Ketorolac is a potent drug with many risks (see Cautions and Warnings) that can be serious in some people. Taking more than is prescribed only increases risk; it does not offer the possibility of better results. NSAID eyedrops may be used during eye surgery to prevent movement of the eye muscles. Other NSAID eyedrops (including Diclofenac, Flurbiprofen, and Suprofen) are also prescribed during eye surgery, for inflammation following cataract extraction, and for itching and redness caused by seasonal allergies.

We do not know exactly how NSAIDs work, but part of their action may be due to an ability to inhibit the body’s production of a hormone called prostaglandin and to inhibit the action of other body chemicals, including cyclo-oxygenase, lipoxygenase, leukotrienes, lysosomal enzymes, and a host of other factors. Ketorolac is absorbed into the bloodstream fairly quickly. Pain relief comes within an hour after taking the first dose.

Ketorolac Cautions and Warnings

People who are allergic to Ketorolac (or any other NSAID) and those with a history of asthma attacks brought on by another NSAID, Iodides, or Aspirin should not take Ketorolac.

Ketorolac can cause gastrointestinal (GI) bleeding, ulcers, and stomach perforation. This can occur at any time, with or without warning, in people who take chronic Ketorolac treatment. People with a history of active GI bleeding should be cautious about taking any NSAID. Minor stomach upset, distress, or gas is common during the first few days of treatment with Ketorolac. People who develop bleeding or ulcers and continue treatment should be aware of the possibility of developing more serious drug toxicity.

Ketorolac can affect platelets and blood clotting at high doses, and should be avoided by people with clotting problems and by those taking Warfarin.

People with heart problems who use Ketorolac may experience swelling in their arms, legs, or feet.
Ketorolac may actually cause headaches. If this happens, you may have to stop taking this medicine or switch to another NSAID.

Ketorolac can cause severe toxic effects to the kidney. Report any unusual side effects to your doctor, who may need to periodically test your kidney function.

Ketorolac can make you unusually sensitive to the effects of the sun (photosensitivity).
People taking this drug on a regular basis should have their liver function checked periodically.

Ketorolac Possible Side Effects

• Most common: diarrhea, nausea, vomiting, constipation, stomach gas, stomach upset or irritation, and loss of appetite (injectable and oral); temporary burning, stinging, or other minor eye irritation (eyedrops).
• Less common: stomach ulcers, GI bleeding, hepatitis, gallbladder attacks, painful urination, poor kidney function, kidney inflammation, blood and protein in the urine, dizziness, fainting, nervousness, depression, hallucinations, confusion, disorientation, tingling in the hands or feet, light-headedness, itching, increased sweating, dry nose and mouth, heart palpitations, chest pain, difficulty breathing, and muscle cramps (injectable and oral); nausea, vomiting, viral infections, and eye reactions (longer-lasting eye redness, burning, itching, or tearing) (eye-drops).
• Rare: severe allergic reactions, including closing of the throat, fever and chills, changes in liver function, jaundice (yellowing of the skin or eyes), and kidney failure. People who experience such effects must be promptly treated in a hospital emergency room or doctor’s office.
  NSAIDs have caused severe skin reactions; if this happens to you, see your doctor immediately.
  The risk of developing bleeding problems of other body-wide side effects with Ketorolac eyedrops is small because only a small amount of this drug is absorbed into the blood.

Drug Interactions

• Ketorolac can increase the effects of oral anticoagulant (blood-thinning) medicines, such as Warfarin. You may take this combination; however, your doctor may have to reduce your anticoagulant dose.
• Taking Ketorolac with Cyclosporine may increase the toxic kidney effects of both drugs. Methotrexate toxicity may be increased in people also taking Ketorolac.
• Ketorolac may reduce the blood-pressure-lowering effect of beta blockers and loop diuretics.
• Ketorolac may increase blood levels of Phenytoin, leading to increased Phenytoin side effects. Blood-Lithium levels may be increased in people taking Ketorolac.
• Ketorolac blood levels may be affected by Cimetidine because of that drug’s effect on the liver.
• Probenecid may interfere with the body’s elimination of Ketorolac, increasing the chances for Ketorolac toxic reactions.
• Aspirin and other salicylates may decrease the amount of Ketorolac in your blood. These medicines should never be taken at the same time.
• No drug interactions have been reported with Ketorolac eyedrops.

Food Interactions

Take Ketorolac with food or a magnesium/aluminum antacid if it upsets your stomach.

Usual Dose

Tablets
Up to 40 mg per day for no more than 5 days in a row.

Eyedrops
1 drop 4 times per day for itching and irritation caused by seasonal allergies.

Ketorolac Overdosage

People have died from NSAID overdoses. The most common signs of overdosage are drowsiness, nausea, vomiting, diarrhea, abdominal pain, rapid breathing, rapid heartbeat, increased sweating, ringing or buzzing in the ears, confusion, disorientation, stupor, and coma, fake the victim to a hospital emergency room at once. ALWAYS bring the medicine bottle with you.

Ketorolac Special Information

Ketorolac can make you drowsy and/or tired: Be careful when driving or operating hazardous equipment Take each dose with a full glass of water, and don’t lie down for 15 to 30 minutes after you take the medicine. Do not take any nonprescription products with Acetaminophen or Aspirin while taking this drug; also, avoid alcoholic beverages.

Contact your doctor if you develop skin rash or itching, visual disturbances, weight gain, breathing difficulty, fluid retention, hallucinations, black or tarry stools, persistent headache, or any unusual or intolerable side effects.

If you forget to take a dose of Ketorolac tablets, take it as soon as you remember. If you take several doses a day and it is within 4 hours of your next dose, skip the one you forgot and continue with your regular schedule. If you take your medicine once a day and it is within 8 hours of your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose.

To self-administer the eyedrops, lie down or tilt your head back. Hold the dropper above your eye and drop the medicine inside your lower lid while looking up. To prevent possible infection, don’t allow the dropper to touch your fingers, eyelids, or any surface. Release the lower lid and keep your eye open. Don’t blink for about 30 seconds. Press gently on the bridge of your nose at the inside corner of your eye for about a minute to help circulate the medicine around your eye. Wait at least 5 minutes before using any other eyedrops.

If you forget a dose of Ketorolac eyedrops, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose.

Special Populations

Pregnancy/Breast-feeding
Ketorolac should not be taken by women who are pregnant because the drug can affect blood circulation in the fetus and prevent normal labor.

There is a possibility that a nursing mother taking Ketorolac could affect her baby’s heart or Cardiovascular system. If you must take Ketorolac, bottle-feed your baby.

Seniors
Older adults may be more susceptible to Ketorolac side effects, especially ulcer disease.