What is the effect of a single intramuscular (IM) injection of ketorolac on a patient with Crohn's disease?

From the Guidelines

A single intramuscular (IM) injection of ketorolac should be avoided in patients with Crohn's disease due to the significant risk of triggering disease flares, worsening intestinal inflammation, and causing serious gastrointestinal complications. The use of ketorolac, a potent non-steroidal anti-inflammatory drug (NSAID), can lead to serious adverse effects in patients with Crohn's disease, including bleeding, perforation, and worsening of existing intestinal ulcers 1. The standard dose of ketorolac IM is 30-60mg, but even a single dose can be problematic for these patients, as it inhibits cyclooxygenase enzymes and reduces prostaglandin synthesis, which not only provides pain relief but also reduces the protective mechanisms in the gastrointestinal mucosa. Alternative pain management strategies that would be safer include acetaminophen (up to 3000mg daily in divided doses), certain opioids if necessary for severe pain, or consultation with a gastroenterologist regarding disease-specific treatments to address the underlying inflammation causing pain 1. Key considerations for managing pain in patients with Crohn's disease include:

• Avoiding NSAIDs, including ketorolac, due to the risk of gastrointestinal complications
• Using acetaminophen as a first-line option for pain management
• Considering consultation with a gastroenterologist for disease-specific treatments
• Carefully evaluating the risks and benefits of opioid use in patients with severe pain. In terms of the effect of a single IM injection of ketorolac on a patient with Crohn's disease, the potential risks and complications associated with its use outweigh any potential benefits, and alternative pain management strategies should be prioritized.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Pharmacodynamics Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic activity in animal models. The effect of a single intramuscular (IM) injection of ketorolac on a patient with Crohn's disease is not directly addressed in the provided drug labels.

• The labels discuss the pharmacokinetics and pharmacodynamics of ketorolac, but do not provide information on its specific effects in patients with Crohn's disease.
• Caution should be exercised when using NSAIDs in patients with Crohn's disease, as they may exacerbate the condition.
• The labels do recommend using the lowest effective dose for the shortest duration consistent with individual patient treatment goals 2. However, without direct information on the effect of ketorolac in patients with Crohn's disease, no conclusion can be drawn.

From the Research

Effect of Ketorolac on Crohn's Disease

• The effect of a single intramuscular (IM) injection of ketorolac on a patient with Crohn's disease is not directly addressed in the provided studies.
• However, a study on ketorolac after colectomy for ulcerative colitis in children found that administration of ketorolac was not associated with an increase in postoperative complications, including disease-related flares 3.
• Another study compared the effectiveness of IV acetaminophen and parenteral ketorolac for analgesia in the prehospital setting, but did not specifically address Crohn's disease 4.
• Studies on Crohn's disease have investigated various treatments, including aminosalicylates, antibiotics, azathioprine/mercaptopurine, and corticosteroids, but not specifically the effect of ketorolac 5, 6.
• A study on the effects of physical exercise on patients with Crohn's disease found that sedentary patients with inactive or mildly active Crohn's disease can tolerate low-intensity exercise without an exacerbation of symptoms, but this is not related to ketorolac 7.

Key Findings

• Ketorolac may be safe to use in patients with inflammatory bowel disease (IBD) without increasing the risk of postoperative complications or disease flares 3.
• More research is needed to understand the effects of ketorolac on patients with Crohn's disease, particularly in terms of its safety and efficacy in this population.
• The current evidence does not provide a clear answer to the question of the effect of a single IM injection of ketorolac on a patient with Crohn's disease.