Is ketorolac (generic name) contraindicated in colonic inflammation and distension?

From the Guidelines

Ketorolac is bad for inflammation and distention of the colon, particularly in patients with inflammatory bowel disease (IBD), and its use should be avoided in these cases. According to the Pan American League of Associations for Rheumatology recommendations for the management of axial spondyloarthritis 1, avoidance of the use of NSAIDs, including ketorolac, is strongly recommended in patients with active IBD. This is because NSAIDs might precipitate de novo IBD or exacerbate pre-existing disease.

Some key points to consider when evaluating the use of ketorolac for colonic inflammation include:

• The potential for NSAIDs to worsen gastrointestinal conditions and cause complications like ulcers or bleeding
• The recommendation to avoid NSAIDs in patients with active IBD, as stated in the guidelines for the treatment of IBD 1
• The availability of alternative anti-inflammatory medications, such as monoclonal antibody TNF inhibitor therapies, which are strongly recommended over NSAIDs for patients with axSpA and IBD 1

In general, the use of ketorolac for colonic inflammation should be approached with caution, and patients with IBD should be particularly cautious with its use. It is essential to consult with a healthcare provider before using ketorolac for colonic conditions to ensure it's appropriate for your specific situation, considering the potential risks and benefits.

From the FDA Drug Label

Ketorolac tromethamine can cause serious gastrointestinal (GI) adverse events including bleeding, ulceration and perforation, of the stomach, small intestine, or large intestine, which can be fatal. NSAIDs should be given with care to patients with a history of inflammatory bowel disease (ulcerative colitis, Crohn's disease) as their condition may be exacerbated

Ketorolac is not recommended for patients with inflammation and distention of the colon, as it may exacerbate the condition and increase the risk of bleeding, ulceration, and perforation of the colon 2 2.

From the Research

Ketorolac and Inflammation

• Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with strong analgesic activity and moderate anti-inflammatory activity 3, 4.
• The drug has been shown to provide relief from mild to severe pain in patients after major abdominal, orthopaedic, or gynaecological surgery, as well as in patients with various other acute pain states 3.
• Ketorolac has a similar analgesic efficacy to that of standard dosages of morphine and pethidine, and its analgesic effect may be slightly delayed but often persists for longer than that of opioids 3.

Ketorolac and Distention of the Colon

• There is no direct evidence in the provided studies that specifically addresses the effect of ketorolac on inflammation and distention of the colon.
• However, it is known that NSAIDs, including ketorolac, can cause gastrointestinal adverse events, such as bleeding and ulcers, especially when used at high doses or for extended periods 3, 5.
• The use of proton-pump inhibitors (PPIs) with NSAIDs, including ketorolac, may potentiate the gastrointestinal risks associated with NSAIDs 5.

Safety and Efficacy of Ketorolac

• The safety and efficacy of ketorolac have been evaluated in several studies, including a randomized controlled trial that compared the analgesic efficacy of three doses of intravenous ketorolac in patients with acute pain 6.
• The study found that intravenous ketorolac administered at a dose of 10 mg provided effective pain relief without increased adverse effects 6.
• Another study found that parenteral ketorolac doses of 15 mg IV or 30 mg IM did not demonstrate a greater need for rescue analgesia compared to doses of 30 mg IV or 60 mg IM in patients 65 years and older 7.