Ketorolac

Introduction

Written by Alex Brewer, PharmD, MBA
Medically reviewed by Patricia Weiser, PharmD
Updated on July 29, 2023

Ketorolac (KEE toe role ak) is a generic medication prescribed for short-term pain and certain eye conditions. Ketorolac belongs to a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs).

The Food and Drug Administration (FDA) has approved ketorolac for:

• short-term (up to 5 days) treatment of moderate or severe pain, such as following surgery
• inflammation in the eye following cataract surgery
• short-term relief of itching in the eyes caused by seasonal allergies

These approved uses differ based on the form of ketorolac your doctor prescribes.

Boxed warnings

Certain forms of ketorolac have boxed warnings, which are the most serious warnings from the Food and Drug Administration (FDA).

With ketorolac oral tablet and ketorolac injection,* these boxed warnings include:

• risk of serious digestive problems
• risk of serious heart and blood vessel problems, such as a heart attack
• risk of kidney failure
• risk of bleeding
• risk of serious effects with use during labor and delivery
• risk of serious effects when used with NSAIDs
• risk of serious effects in certain adults

Ketorolac injection also has a boxed warning for the following:

• risk of serious effects with injections into the spine area

For details, see the “Interactions and warnings for ketorolac” section.

* Ketorolac injection is given into your muscle or vein.

Side effects of ketorolac

Ketorolac may cause mild or serious side effects. More common mild side effects of ketorolac and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about ketorolac’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for ketorolac listed in the “Resources” section.

Mild side effects

More common mild side effects reported with some forms of ketorolac are listed below. These side effects may differ based on your form of ketorolac treatment.

This article doesn’t include all possible mild side effects of the drug. To learn more about ketorolac’s side effects based on the form, refer to the prescribing information for ketorolac listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. But if the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Mild side effects of ketorolac eye drops include:

• burning or stinging in the eyes after applying a drop
• eye irritation
• eye infection
• swelling in your eye
• mild allergic reaction*

Mild side effects of ketorolac oral tablet include:

• abdominal pain
• indigestion
• nausea or vomiting
• headache
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for ketorolac” section.

Serious side effects

Serious side effects of ketorolac are listed below. These side effects may differ based on your form of ketorolac treatment.

This article doesn’t include all possible serious side effects of the drug. To learn more about ketorolac’s side effects based on the form, refer to the prescribing information for ketorolac listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, ketorolac’s serious side effects include:

• anemia (low red blood cell level)
• liver problems, including liver damage and liver failure
• boxed warnings:* risk of:
  • serious digestive problems
  • serious heart and blood vessel problems
  • kidney failure
  • bleeding
  • serious effects with use during labor and delivery
  • serious effects when used with nonsteroidal anti-inflammatory drugs (NSAIDs)
  • serious effects in certain adults
  • serious effects with injections into the spine area
• severe allergic reaction*

For ketorolac eye drops, the following serious side effects may also occur:

• ulcer (open sore) on your cornea (the clear layer at the front of your eye)
• inflammation in the cornea, which may lead to vision loss

* For details about this side effect, see the “Interactions and warnings for ketorolac” section.

Uses of ketorolac

The Food and Drug Administration (FDA) approves prescription drugs such as ketorolac for certain conditions. Approved uses for ketorolac are described below. These uses differ based on the form of ketorolac prescribed.

Use for pain and inflammation

Doctors may prescribe ketorolac oral tablet and ketorolac injection for treating moderate or severe pain and inflammation. Ketorolac is used for this purpose in adults. It’s usually prescribed as a short-term treatment. Ketorolac injection is given into your muscle or vein.

Doctors may prescribe ketorolac eye drops for treating inflammation in the eye following cataract surgery. They may also prescribe this form for short-term treatment of itching in the eyes caused by seasonal allergies. Ketorolac eye drops may be used for these purposes in adults and children ages 2 years and older. It’s typically prescribed as a short-term treatment.

Inflammation is created by your immune system in response to infection or injury. Symptoms of inflammation include pain, swelling, and skin redness or discoloration.

Note: Ketorolac oral tablets are only prescribed to continue treatment that begins with ketorolac injections. Doctors typically restrict treatment to a total of 5 consecutive days with either of these two drug forms.

Common questions about ketorolac

Below you’ll find answers to a few commonly asked questions about ketorolac.

Can I take another pain reliever along with ketorolac?

Yes, you can take another pain reliever with ketorolac if your doctor tells you it’s safe to do so. Doctors typically won’t prescribe ketorolac for people taking another nonsteroidal anti-inflammatory drug (NSAID). (Ketorolac is an NSAID.)

Combining ketorolac with another NSAID raises your risk of serious side effects with ketorolac. This includes many of the drug’s boxed warnings* as discussed in the “Interactions and warnings for ketorolac” section.

But it may be safe to take ketorolac and acetaminophen (Tylenol) together if your doctor approves. Acetaminophen is a pain reliever, but it’s not an NSAID.

Before taking another pain reliever during ketorolac treatment, talk with your doctor or pharmacist. They can check for interactions with ketorolac and determine whether the pain reliever is safe to use.

* A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Is ketorolac similar to ibuprofen?

Yes, ketorolac is similar to ibuprofen (Advil, Motrin IB, others). Both ketorolac and ibuprofen are nonsteroidal anti-inflammatory drugs (NSAIDs). Both drugs are used to treat pain and inflammation. However, ketorolac is reserved for moderate to severe pain, and ibuprofen is for mild or moderate pain. Doctors may prescribe ibuprofen for conditions that ketorolac isn’t approved for, including rheumatoid arthritis.

Ketorolac and ibuprofen also have different lengths of treatment. Generally, treatment with ketorolac oral tablet or ketorolac injection* for more than 5 days is not recommended.† This is due to the risk of serious side effects. But it’s usually safe to take ibuprofen for more than 5 days in a row if your doctor approves.

Ask your pharmacist or doctor if you have additional questions about how ketorolac and ibuprofen compare.

* Ketorolac injection is given into your muscle or vein.
† To learn more about ketorolac treatment by drug form, see the “Uses of ketorolac” section.

How does ketorolac work? And how long does it take to start working?

Ketorolac belongs to a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). They work by blocking certain responses from your immune system that cause inflammation. Blocking these responses reduces inflammation, which can also relieve pain.

Ketorolac begins working with your first dose. You should notice some symptom relief within a few hours after you start treatment.

If you’d like to know more about how ketorolac works, talk with your doctor or pharmacist.

Interactions and warnings for ketorolac

Below, you’ll find information about ketorolac’s possible interactions and warnings.

Interactions of ketorolac

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you start ketorolac treatment, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for ketorolac” section just below.

Warnings for ketorolac

Some people should not use ketorolac, and others should use it cautiously.

Boxed warnings

Certain forms of ketorolac have boxed warnings about the following risks. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

These risks are based on studies of ketorolac oral tablet and ketorolac injection into your muscle or vein. They do not apply to ketorolac eye drops.

Note: Due to these risks, doctors typically limit treatment with ketorolac oral tablet and ketorolac injection to no more than 5 days in a row. To learn more about these warnings, read below. You can also talk with your doctor or pharmacist.

Risk of serious digestive problems. Serious digestive problems reported in studies of ketorolac include bleeding in your stomach, holes in your stomach or intestines, and ulcers. These side effects were rarely reported in studies of ketorolac.

Symptoms may include vomiting blood, blood in your stool, and abdominal pain.

Older adults (ages 65 years or above) have an increased risk of serious digestive problems from treatment with ketorolac. Consuming alcohol while taking ketorolac oral tablet also increases this risk.

If you experience digestive problems or any of the symptoms above, tell your doctor right away. They’ll likely recommend stopping ketorolac. If your symptoms feel severe or life threatening, call 911 or a local emergency number.

Due to this risk, doctors typically won’t prescribe ketorolac if you’ve previously had a peptic ulcer or gastrointestinal bleeding.

Risk of serious heart and blood vessel problems. Treatment with ketorolac raises your risk of serious heart and blood vessel problems. These problems include heart attack and stroke. Heart and blood vessel problems were rarely reported in studies of the drug.

Symptoms of a heart attack may include discomfort or pain in your chest and difficulty breathing. Chest pain may spread to your shoulder, arm, or back. Symptoms of a stroke include difficulty speaking and numbness or paralysis, particularly on one side of your body.

Heart and blood vessel problems that ketorolac may cause are serious and require immediate medical treatment. If your symptoms feel life threatening, call 911 or a local emergency number.

Due to this risk, doctors typically avoid prescribing ketorolac if you’ve recently had a heart attack. They’ll also avoid prescribing the drug if you’re about to have or have recently had heart bypass surgery. (This type of heart surgery improves blood flow to your heart.)

Your doctor will likely have you stop ketorolac treatment if you experience a heart or blood vessel problem.

Risk of kidney failure. People with kidney problems have an increased risk of sudden kidney failure from treatment with ketorolac. In rare cases, ketorolac can cause kidney injury (including sudden kidney failure) in people with or without existing kidney problems.

Symptoms may include swelling in your legs or ankles, shortness of breath, and passing less urine than usual.

If you experience the symptoms above, tell your doctor right away. They’ll likely recommend stopping ketorolac. If your symptoms feel severe or life threatening, call 911 or a local emergency number.

Due to this risk, doctors typically won’t prescribe ketorolac if you have severe kidney problems. And they’re cautious about prescribing it for people with mild or moderate kidney problems.

Risk of bleeding. Ketorolac treatment raises your risk of bleeding. Bleeding of the digestive tract is a common side effect of ketorolac and other nonsteroidal anti-inflammatory drugs (NSAIDs). (Ketorolac is an NSAID.)

Symptoms may include vomiting blood, cuts or wounds that bleed excessively, and blood in your stool.

Other factors can increase your risk of bleeding while taking ketorolac. These include consuming alcohol, being age 65 years or older, and smoking tobacco.

If you experience symptoms of bleeding, tell your doctor right away. They’ll likely recommend stopping ketorolac. If your symptoms feel severe or life threatening, call 911 or a local emergency number.

Due to the risk of bleeding, doctors typically won’t prescribe ketorolac if you:

• have bleeding in your skull or brain
• have certain bleeding disorders
• have an elevated risk of bleeding

Doctors will also usually avoid prescribing ketorolac injection for pain relief before surgery.

Risk of serious effects with use during labor and delivery. For more information, see the “Pregnancy or breastfeeding and ketorolac” section below.

Risk of serious effects when used with NSAIDs. Ketorolac should not be used or taken with other NSAIDs. Doing so raises the risk of serious side effects, including bleeding and kidney failure.

Due to this risk, doctors typically won’t prescribe ketorolac together with other NSAIDs. Be sure to tell your doctor and pharmacist about all medications you take before you start ketorolac treatment.

Risk of serious effects in certain adults. Certain adults have an increased risk of side effects from ketorolac. For information about the drug’s side effects, refer to the “Side effects of ketorolac” section.

Due to this risk, doctors typically prescribe a lower dosage of ketorolac for people who:

• are ages 65 years or older
• weigh less than 110 pounds (lb)
• have certain kidney problems

Risk of serious effects with injections into the spine area. Doctors will not inject ketorolac into the spine area. This is because ketorolac injection contains alcohol.

Other warnings

Ketorolac could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether ketorolac is a safe option for you. These warnings may differ based on the form of your ketorolac treatment.

Ask your doctor about specific warnings for ketorolac, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Ketorolac can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to ketorolac or any of its ingredients, your doctor will likely not prescribe ketorolac. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

Serious, possibly life threatening allergic skin reactions have happened during ketorolac treatment. Specifically, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis were reported for ketorolac oral tablet and ketorolac injection. Symptoms include:

• discolored skin rash that is painful
• rash that causes blisters on your skin, eyes, nose, mouth, or genitals
• broken, raw, or shedding skin
• fever

If you have a mild allergic reaction to ketorolac, call your doctor right away. If you have severe symptoms or feel they’re life threatening, call 911 or a local emergency number. For serious allergic skin reactions such as SJS, you need immediate medical treatment in an emergency room or hospital.

Overdose of ketorolac

If you take ketorolac, you should not take more ketorolac than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much ketorolac, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and ketorolac

Information about ketorolac and pregnancy and breastfeeding is described below.

Ketorolac and pregnancy

Ketorolac oral tablet and ketorolac injection should not be taken or administered after week 30 of pregnancy. Doctors also typically recommend avoiding these forms of the drug between weeks 20 and 30. If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication. Your doctor may suggest birth control options to use during ketorolac treatment.

Risk of serious effects with use during labor and delivery

Ketorolac oral tablet and ketorolac injection have a boxed warning about the risk of serious effects with use during labor and delivery.

Treatment with ketorolac oral tablet or ketorolac injection during labor and delivery can block contractions of the uterus (womb) and impact blood flow. Due to this risk, doctors will not prescribe the drug during labor and delivery.

Ketorolac and breastfeeding

In general, ketorolac is considered safe to take while breastfeeding. That said, ask your doctor whether they feel it’s safe for you.

What to ask your doctor

Let your doctor know if you have questions about ketorolac or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• How does ketorolac compare with other nonsteroidal anti-inflammatory drugs for treating my condition?
• If I’m still experiencing pain or inflammation after 5 days of ketorolac treatment, what are my treatment options?
• Does my health history raise my risk of side effects with ketorolac treatment?
• What drug interactions do I need to avoid during ketorolac treatment?
• Are there foods I should avoid during treatment with ketorolac?

Resources

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Ketorolac tromethamine injection, USP for intravenous/intramuscular use (15 mg and 30 mg); for intramuscular use only (60 mg). (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/1aae6a4d-0909-4672-aa26-e3f2d8c4d413/spl-doc
• Ketorolac tromethamine ophthalmic solution 0.5%. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/01f1c931-c796-4834-89ba-f5971d865de9/spl-doc
• Ketorolac tromethamine tablets USP, 10 mg. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/fe7eb195-48be-753b-e053-6294a90a8500/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.