Ketorolac

Ketorolac, sold under the brand name Toradol among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain.[1] Specifically it is recommended for moderate to severe pain.[2] Recommended duration of treatment is less than six days.[1] It is used by mouth, by injection into a vein or muscle, and as eye drops.[1][2] Effects begin within an hour and last for up to eight hours.[1]

Common side effects include sleepiness, dizziness, abdominal pain, swelling, and nausea.[1] Serious side effects may include stomach bleedingkidney failureheart attacksbronchospasmheart failure, and anaphylaxis.[1] Use is not recommended during the last part of pregnancy or during breastfeeding.[1] Ketorolac works by blocking cyclooxygenase 1 and 2 (COX1 and COX2), thereby decreasing production of prostaglandins.[1][3]

Ketorolac was patented in 1976 and approved for medical use in 1989.[4][1] It is available as a generic medication.[2] In the United Kingdom it costs the NHS less than £1 per injectable dose as of 2019.[2] In the United States the wholesale cost of this amount is about US$1.50.[5] In 2016 it was the 296th most prescribed medication in the United States with more than a million prescriptions.[6]

Medical uses[edit]

Ketorolac package from Russia

Ketorolac is used for short-term management of moderate to severe pain.[7] It is usually not prescribed for longer than five days,[8][9][10][11] due to its potential to cause kidney damage.[12]

Ketorolac is effective when administered with paracetamol to control pain in newborns because it does not depress respiration as do opioids.[13] Ketorolac is also an adjuvant to opioid medications and improves pain relief. It is also used to treat dysmenorrhea.[11] Ketorolac is used to treat idiopathic pericarditis, where it reduces inflammation.[14]

For systemic use, ketorolac can be administered orallyunder the tongue, by intramuscular injection, intravenously, and by nasal spray.[8] Usually, it is initially administered by intramuscular injection or intravenously,[7] with oral therapy used as a continuation after the initial IM or IV dose.[8][13]

Ketorolac is also used as an eye drop. It can be given during eye surgery to help with pain,[15] and is effective in treating ocular itching.[16] The eye drops are associated with decreased development of macular edema after cataract surgery, and is more effective alone than as an opioid/ketorolac combination treatment.[17][18] Ketorolac eye drops have also been used to manage pain from corneal abrasions.[19]

During treatment with ketorolac, clinicians monitor for the manifestation of adverse effects. Lab tests, such as liver function tests, bleeding time, BUNserum creatinine and electrolyte levels are often used and help to identify potential complications.[8][9]

Contraindications[edit]

Ketorolac is contraindicated in those with hypersensitivity, allergies to the medication, cross-sensitivity to other NSAIDs, prior to surgery, history of peptic ulcer disease, gastrointestinal bleeding, alcohol intolerance, renal impairment, cerebrovascular bleeding, nasal polypsangioedema, and asthma.[8][9] Recommendations exist for cautious use of ketorolac in those who have experienced cardiovascular disease, myocardial infarction, stroke, heart failurecoagulation disorders, renal impairment, and hepatic impairment.[8][9]