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 requires careful monitoring due to potential blood pressure effects, and the most recent evidence suggests using lower doses, such as 15-30mg intramuscularly, to minimize risks 2. The standard intramuscular dose is 30-60mg initially, followed by 15-30mg every 6 hours as needed, not exceeding 120mg daily or 5 days of total therapy.
- Hypertensive patients should start at the lower end of the dosing range.
- Ketorolac, like other NSAIDs, can increase blood pressure by inhibiting prostaglandin synthesis, which affects renal sodium excretion and vascular tone.
- This medication may also reduce the effectiveness of some antihypertensive medications, particularly ACE inhibitors, ARBs, and diuretics. Some key points to consider when using ketorolac in patients with hypertension include:
- Blood pressure should be monitored closely after administration, especially in patients with poorly controlled hypertension.
- Alternative analgesics like acetaminophen should be considered for patients with severe or uncontrolled hypertension, heart failure, or renal impairment.
- Ketorolac is contraindicated in patients with severe renal impairment or risk for renal failure, and should be used with extreme caution in elderly hypertensive patients who have higher risk of adverse effects, as reported in earlier studies 3, 4, 5. However, the most recent study 2 suggests that lower doses of ketorolac may be effective and safer in elderly patients, which is in line with the goal of minimizing morbidity, mortality, and improving quality of life. Additionally, it's essential to consider the potential interactions between ketorolac and other medications, such as antihypertensive drugs, and to monitor patients closely for any adverse effects, as highlighted in a review of hypertension treatment 6.