Is it safe to use ketorolac (Nonsteroidal Anti-Inflammatory Drug) for 14 weeks?

Ketorolac Should Not Be Used for 14 Weeks

Ketorolac treatment should absolutely not exceed 5 days due to significant risks of gastrointestinal, renal, and cardiovascular complications with prolonged use. 1, 2

Safety Limitations of Ketorolac

• Ketorolac is specifically contraindicated for long-term use, with treatment duration strictly limited to a maximum of 5 days according to multiple guidelines 1, 2
• The risk of serious adverse events increases significantly with prolonged therapy beyond 5 days, particularly in vulnerable populations such as the elderly 2
• Ketorolac has been associated with one of the highest risks of gastrointestinal toxicity among NSAIDs, especially with prolonged use 3

Major Risks with Extended Use

Gastrointestinal Complications

• Prolonged ketorolac use dramatically increases risk of GI bleeding and perforation 2
• NSAIDs with prolonged half-lives and significant enterohepatic circulation (like ketorolac) have been linked to greater GI toxicity due to extended mucosal exposure 3
• The risk of GI complications increases with duration of therapy and is especially high in patients over 60 years of age 3

Renal Complications

• Extended ketorolac use significantly increases risk of acute kidney injury 1
• Renal function should be monitored if using ketorolac even for short periods, with discontinuation if BUN or creatinine doubles 1
• NSAIDs impair renal function, with approximately 2% of persons stopping NSAIDs due to renal complications 3

Cardiovascular Risks

• Prolonged NSAID use increases risk of cardiovascular events including myocardial infarction and worsening hypertension 3
• Ketorolac can worsen heart failure and hypertension with extended use 1
• NSAIDs can cause mean blood pressure increases of approximately 5 mm Hg 3

Alternative Approaches for Long-Term Pain Management

• For chronic pain requiring long-term treatment, consider NSAIDs with better safety profiles such as ibuprofen, etodolac, or nabumetone 3
• COX-2 inhibitors like celecoxib may be safer alternatives for patients with high GI risk but without cardiovascular risk 1
• Non-pharmacological interventions should be considered for chronic pain management 1
• If NSAIDs are necessary for extended periods, use the lowest effective dose and consider gastroprotection with proton pump inhibitors 3, 4

Monitoring Requirements for NSAID Use

• If any NSAID must be used (even short-term), monitor blood pressure, BUN, creatinine, liver function tests, and signs of GI bleeding 5
• Baseline tests should be performed before starting therapy and repeated periodically during treatment 5
• Ketorolac should be discontinued immediately if liver function tests increase, if BUN or creatinine doubles, or if hypertension develops or worsens 1

Special Populations and Considerations

• Elderly patients (>60 years) are at substantially higher risk for adverse events from NSAID use 4
• Patients with history of cardiovascular disease, renal impairment, or GI disorders are at particularly high risk for complications 4
• Concurrent use of ketorolac with other NSAIDs, including aspirin, significantly increases risk of adverse events 4

Using ketorolac for 14 weeks would expose patients to unacceptable risks of serious complications with no additional benefit over safer alternatives for long-term pain management.