From the FDA Drug Label
NSAIDs, including ketorolac tromethamine, can lead to onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs NSAIDs, including ketorolac tromethamine, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy
The use of intramuscular ketorolac in patients with hypertension requires caution, as it may worsen pre-existing hypertension or contribute to the onset of new hypertension, increasing the risk of CV events.
- Blood pressure monitoring is recommended during the initiation of NSAID treatment and throughout the course of therapy.
- Patients with hypertension should be aware of the potential risks and benefits of using ketorolac tromethamine, and alternative treatments should be considered if possible 1.
From the Research
Ketorolac can be used cautiously in patients with hypertension, but it should be administered at the lowest effective dose for the shortest duration possible, typically not exceeding 5 days of total use. For adults with normal renal function, the recommended intramuscular dose is 15mg initially, as a lower dose was found to be non-inferior to a higher dose for acute musculoskeletal pain in adults presenting to the emergency department 2. Patients with hypertension should be monitored closely for blood pressure changes, as ketorolac, like other NSAIDs, can increase blood pressure by inhibiting prostaglandin synthesis, which affects renal blood flow and sodium retention. This medication may also reduce the effectiveness of antihypertensive medications such as ACE inhibitors, ARBs, and diuretics. Some studies have reported that ketorolac can be effective in treating acute pain in elderly patients, but with a higher risk of adverse events, particularly at higher doses 3. However, the risk of acute renal failure associated with ketorolac administration should not be overlooked, especially in patients with risk factors such as advanced age, cirrhosis, volume depletion, congestive heart failure, gastrointestinal bleeding, and preexisting mild renal dysfunction 4. Patients with uncontrolled hypertension, heart failure, or renal impairment should generally avoid ketorolac due to increased cardiovascular and renal risks. Alternative pain management strategies like acetaminophen or short-term opioids might be safer options for hypertensive patients requiring pain control. Always assess the patient's complete medication list and cardiovascular risk profile before administering ketorolac, considering the latest guidelines on hypertension treatment 5. In addition, the use of intramuscular ketorolac injections in athletes has been reported, with effective pain control and a low incidence of complications 6. However, it is essential to prioritize the patient's safety and well-being, considering the potential risks and benefits of ketorolac administration in patients with hypertension.