- Generic name: Ketorolac Tromethamine
- Trade names: Toradol, Acular, Sprix (Intranasal)
- Pharmacologic category: Nonsteroidal Anti-inflammatory
- FDA approved: December 20, 1991
- Habit forming? No
- Pregnancy risk factor: C
Ketorolac is a quite potent non-steroidal anti-inflammatory drug
which is licensed for short term use in the management of moderate
to severe postoperative pain. It is one of the newest NSAIDs.
Ketorolac analgesic potency resembles that of the centrally acting analgesics, with 15 to 30 mg of ketorolac producing analgesia equivalent to a 12-mg dose of morphine. It is an accepted alternative to narcotic analgesics.
- Onset of action: Intramuscular ~10 minutes, maximum
effect within 2 hours.
Oral ~30-60 minutes. Peak analgesia after Intramuscular injection lags behind peak plasma levels by 45 to 90 minutes.
- Duration of action: 6-8 hours
- Metabolism: Hepatic
- Elimination half-life: 2-6 hours; prolonged 30% to
50% in elderly; up to 19 hours in renal impairment
- Excretion: Urine (92%, 61% as unchanged drug)
- Injectable formulation. Available in injectable form
which can be used in situations where oral NSAIDs are excluded
(eg. acute post-operative pain).
- Less nausea and sedation than narcotic analgesics.
Risks & Disadvantages
- Expensive. One of the most expensive NSAIDs.
- Weak anti-inflammatory action. In comparison to the
other NSAIDs, ketorolac has poor anti-inflammatory activity.
- Severe gastrointestinal complications. Ketorolac is
reported to have the highest rate of serious gastrointestinal
complications of all non-steroidal anti-inflammatory drugs.
Ketorolac can cause peptic ulcers, gastrointestinal bleeding
and perforation of the stomach or intestines, which can be fatal.
Results of a case control study2
comparing the GI toxicity of different NSAIDs suggest that ketorolac
was approximately five times more likely to cause upper GI bleeding
than other NSAIDs.
- Ketorolac may cause kidney failure.
- Severe migraine headache
- Pain after surgery in children
Mode of action
Ketorolac is a pyrrolizine carboxylic acid derivative. It has analgesic, antipyretic and
anti-inflammatory activity. The primary mechanism of action is
the inhibition of prostaglandin synthesis by competitive blocking
of the enzyme cyclooxygenase (COX).
- 1. U.S. FDA.
Ketorolac (Toradol) Prescribing Information.
- 2. Garcia Rodriguez LA, Cattaruzzi C, Troncon
M, Agostinis L. Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac,
other anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs.
Arch Intern Med. 1998;158(1):33-9.
Last modified: October, 2013