From the Research
A single intramuscular (IM) injection of ketorolac is generally not significantly irritating to the gastric mucosa in patients with ulcerative colitis, making it a reasonable short-term pain management option, as supported by the most recent study 1. The standard IM dose is 30-60 mg initially, followed by 15-30 mg every 6 hours as needed, not exceeding 120 mg in 24 hours or 5 days of total use. While ketorolac is an NSAID that can potentially irritate the GI tract, the advantage of a single IM dose is that it bypasses direct contact with the gastric mucosa, reducing local irritation compared to oral administration. However, caution is still warranted as ketorolac can systemically inhibit prostaglandin synthesis, which may theoretically exacerbate ulcerative colitis symptoms in some patients. For patients with active severe ulcerative colitis or a history of NSAID-induced colitis flares, alternative analgesics like acetaminophen or short-term opioids might be safer options. If ketorolac is used, monitoring for increased abdominal pain, bloody stools, or other signs of colitis exacerbation is recommended, and the medication should be discontinued if symptoms worsen. Some studies have reported gastrointestinal complications associated with the use of intramuscular ketorolac tromethamine therapy in elderly patients 2, 3, but these findings may not be directly applicable to patients with ulcerative colitis. Additionally, a study on ketogal, a derivative of ketorolac, showed reduced ulcerogenicity and renal toxicity compared to ketorolac 4, but this does not directly inform the use of ketorolac in patients with ulcerative colitis. Another study found an elevated risk of gastroduodenal lesions associated with ketorolac use 5, but this study was not specific to patients with ulcerative colitis. Overall, the most recent and relevant study 1 suggests that ketorolac can be a safe and effective option for short-term pain management in patients with ulcerative colitis, when used judiciously and with appropriate monitoring. Key considerations include:
- Monitoring for signs of colitis exacerbation
- Using the lowest effective dose and shortest duration necessary
- Considering alternative analgesics for patients with active severe ulcerative colitis or a history of NSAID-induced colitis flares.