Ketorolac tromethamine is a potent, non-narcotic, non-steroidal anti-inflammatory drug (NSAID) of the pyrrolo-pyrrole group, used for the short-term management of moderate to severe acute pain requiring opioid-level analgesia. It is a peripherally acting analgesic with significant anti-inflammatory and antipyretic properties. In India, it is a critical tool for post-operative pain, renal colic, and acute musculoskeletal pain, but its use is strictly limited to short-term (up to 5 days) due to high risk of serious adverse events.
Adult: IM/IV (Single Dose): 30mg as a loading dose. IM/IV (Multiple Doses): 15-30mg every 6 hours. Maximum daily dose: 90mg (for patients <65 years and weight >50 kg). ORAL (following parenteral therapy): 10mg every 4-6 hours. Max oral daily dose: 40mg.
Note: IM: Administer deep into the muscle (gluteal or deltoid). IV: Administer as a bolus over no less than 15 seconds. Do not mix with other drugs in syringe. Oral: Take with food or a full glass of water to minimize GI upset. Do not crush/chew tablets. Switch from parenteral to oral only when clinically appropriate; oral dose is lower.
Ketorolac is a non-selective, competitive inhibitor of the cyclooxygenase (COX) enzymes, COX-1 and COX-2. This inhibition prevents the conversion of arachidonic acid to prostaglandin precursors (prostaglandin G2 and H2).
Pregnancy: Category C (1st/2nd trimester): Use only if potential benefit justifies potential fetal risk. Avoid use due to oligohydramnios risk. Category D (3rd trimester): CONTRAINDICATED. Risk of premature closure of ductus arteriosus, delayed labor, and increased maternal bleeding.
Driving: May cause dizziness, drowsiness, or blurred vision. Patients should be cautioned about operating machinery or driving until they know how the drug affects them.
| Warfarin/Acenocoumarol | Increased risk of bleeding due to platelet inhibition and potential displacement from protein binding | Major |
| Aspirin (Salicylates) | Increased risk of GI toxicity (ulcers, bleeding) with no therapeutic benefit | Major |
| Other NSAIDs (e.g., Ibuprofen, Diclofenac) | Additive toxicity, increased risk of GI and renal adverse effects | Major |
| Selective Serotonin Reuptake Inhibitors (SSRIs) e.g., Sertraline | Increased risk of upper GI bleeding | Moderate |
| ACE Inhibitors (e.g., Ramipril) / ARBs (e.g., Telmisartan) | Reduced antihypertensive effect; increased risk of renal impairment | Moderate |
| Diuretics (e.g., Furosemide) | Reduced diuretic and antihypertensive efficacy; risk of renal failure | Moderate |
| Lithium | Decreased renal clearance of lithium, leading to lithium toxicity | Major |
| Methotrexate | Reduced renal clearance of methotrexate, increasing its toxicity | Major |
| Probenecid | Markedly increases ketorolac plasma levels by reducing its clearance | Major |
| Pentoxifylline | Increased risk of bleeding | Moderate |