From the Guidelines
Ketorolac can potentially cause delirium, particularly in elderly patients or those with certain risk factors, as evidenced by clinical practice guidelines and studies on delirium management 1.
Delirium Risk Factors
The risk of delirium associated with ketorolac is higher in vulnerable populations, including:
- Elderly patients
- Those with kidney impairment
- Dehydrated patients
- Patients with pre-existing cognitive issues The mechanism likely involves the drug's effects on prostaglandin synthesis in the brain or possibly through indirect effects related to changes in renal function.
Clinical Practice Guidelines
According to clinical practice guidelines for delirium management in adult cancer patients, medications such as antipsychotics and benzodiazepines can be used to manage delirium symptoms, but their use should be limited to patients with distressing delirium symptoms or safety concerns 1.
Alternative Pain Management Strategies
Healthcare providers should use caution when prescribing ketorolac to high-risk patients and consider alternative pain management strategies when appropriate, such as nefopam, which has been suggested as a safe and effective alternative or adjunctive analgesic for ICU patients 1.
Monitoring and Discontinuation
If a patient develops confusion, disorientation, altered consciousness, or other signs of delirium while taking ketorolac, the medication should be discontinued and medical attention sought immediately. Regular monitoring of patients taking ketorolac is essential to promptly identify any signs of delirium and take appropriate action to prevent further complications.
From the Research
Ketoralac and Delirium
- There is no direct evidence in the provided studies that ketoralac causes delirium 2, 3.
- However, one study suggests that non-psychoactive drugs such as NSAIDs (nonsteroidal anti-inflammatory agent) may cause acute or chronic cognitive impairment, which can include delirium 4.
- Another study found that the use of medications with cognitive side effects, including NSAIDs, has increased among older adults and is associated with cognitive impairment 5.
- It is also noted that elderly people are more likely to develop cognitive impairments associated with medication use, including delirium, due to factors such as impaired renal and liver functions 6, 4.
- The overall risk of adverse events associated with ketorolac therapy is only slightly higher than with opioids, but the risk increases with high doses, prolonged therapy, or in vulnerable patients, such as the elderly 2, 3.