From the Guidelines
Yes, ketorolac is a Non-Steroidal Anti-Inflammatory Drug (NSAID). It belongs to the family of medications that reduce pain, fever, and inflammation by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), which are responsible for producing prostaglandins that cause inflammation and pain. Ketorolac is available in oral, injectable, and ophthalmic formulations, with the injectable form (ketorolac tromethamine) commonly used for short-term management of moderate to severe acute pain. Due to its potent analgesic properties, ketorolac is often used in hospital settings for post-operative pain management. However, it has important usage limitations - treatment should not exceed 5 days total (including all routes of administration combined) due to increased risk of serious gastrointestinal, cardiovascular, and renal adverse effects with prolonged use. Like other NSAIDs, ketorolac carries risks of stomach ulcers, bleeding, kidney problems, and cardiovascular events, particularly in elderly patients or those with pre-existing conditions 1.
Some key points to consider when using ketorolac include:
- It is not associated with common opioid side effects, such as respiratory depression, nausea/vomiting, urinary retention, or sedation 1.
- Ketorolac has a relatively rapid onset of action and a duration of approximately six hours 1.
- The use of ketorolac should be closely monitored because overuse may lead to rebound headaches 1.
- Cardiovascular, gastrointestinal, and renal risks should be taken into account when prescribing NSAIDs, including ketorolac 1.
- Ketorolac is associated with a higher risk of GI toxicity due to its prominent enterohepatic circulation and prolonged half-life 1.
Overall, ketorolac should be used with caution and under close medical supervision, especially in patients with a history of gastrointestinal, cardiovascular, or renal disease, and in elderly patients or those with pre-existing conditions 1.
From the FDA Drug Label
Ketorolac tromethamine is a non-steroidal anti-inflammatory drug (NSAID) that exhibits analgesic activity in animal models. Ketorolac Tromethamine Injection, USP is a member of the pyrrolo-pyrrole group of nonsteroidal anti-inflammatory drugs (NSAIDs).
Ketorolac is a Non-Steroidal Anti-Inflammatory Drug (NSAID), as directly stated in the drug labels 2 and 3. The key points are:
- Classification: Ketorolac is classified as an NSAID.
- Mechanism of action: The mechanism of action of ketorolac is related to prostaglandin synthetase inhibition, which is typical of NSAIDs.
From the Research
Definition of Ketorolac
- Ketorolac is defined as a nonsteroidal anti-inflammatory drug (NSAID) with strong analgesic activity 4, 5, 6, 7.
Characteristics of Ketorolac
- Ketorolac exhibits anti-inflammatory, analgesic, and antipyretic activity 5.
- It is used for the symptomatic relief of moderate to severe postoperative pain, including that associated with abdominal, gynecologic, oral, orthopedic, or urologic surgery 5, 7.
- Ketorolac has been used for the relief of acute renal colic, pain associated with trauma, and visceral pain associated with cancer 5.
Comparison with Other NSAIDs and Opioids
- Ketorolac provides relief from mild to severe pain in the majority of patients and has similar analgesic efficacy to that of standard dosages of morphine and pethidine (meperidine) as well as less frequently used opioids and other NSAIDs 4.
- The analgesic effect of ketorolac may be slightly delayed but often persists for longer than that of opioids 4.
- Combined therapy with ketorolac and an opioid results in a 25 to 50% reduction in opioid requirements, and in some patients this is accompanied by a concomitant decrease in opioid-induced adverse events 4.
Adverse Effects
- The tolerability profile of ketorolac parallels that of other NSAIDs; most clinically important adverse events affect the gastrointestinal tract and/or renal or haematological function 4.
- The incidence of serious or fatal adverse events reported with ketorolac has decreased since revision of dosage guidelines 4.
- Rare but severe reactions like anaphylactic shock have been reported 6.