Ketorolac Does Not Relax the Esophagus
Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with potent analgesic properties that works by inhibiting cyclooxygenase enzymes—it has no mechanism of action that would cause esophageal smooth muscle relaxation. 1
Mechanism of Action
- Ketorolac functions as an NSAID by reversibly inhibiting cyclooxygenase, which decreases prostaglandin synthesis and reduces tissue nociceptor hypersensitization 2
- This drug provides analgesia through anti-inflammatory pathways, not through any direct effect on smooth muscle tone or esophageal motility 1
- Unlike medications that affect esophageal sphincter tone (such as calcium channel blockers or nitrates), ketorolac has no documented effect on gastrointestinal smooth muscle relaxation 1
Clinical Implications
- Ketorolac is indicated for short-term management (maximum 5 days) of moderately severe acute pain requiring opioid-level analgesia 3, 4
- The drug's primary gastrointestinal effects are related to mucosal injury and ulceration risk, not smooth muscle relaxation 5, 6
- Ketorolac carries significant risk for gastrointestinal complications including bleeding and perforation, particularly in patients over 60 years, those with peptic ulcer disease history, or when used beyond 5 days 7, 5
Important Safety Considerations
- Absolute contraindications include active or history of peptic ulcer disease, aspirin/NSAID-induced asthma, cerebrovascular bleeding, and significant renal impairment 7
- Treatment duration must not exceed 5 days due to increased risk of serious adverse events with prolonged use 3, 4
- The drug should be avoided in elderly patients (≥60 years) due to markedly increased risk of gastrointestinal and renal complications 7, 5