Will intravenous (IV) ketorolac cause a hypertensive crisis?

From the Guidelines

IV ketorolac is not typically associated with causing hypertensive crisis or cough, and its use is not directly linked to these conditions. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used for short-term management of moderate to severe pain, working by inhibiting cyclooxygenase enzymes that produce prostaglandins involved in pain and inflammation 1. While ketorolac can cause some side effects, including potential increases in blood pressure in some patients, it does not typically cause hypertensive crisis. The medication also does not commonly cause cough as a side effect.

Key Considerations

• The standard IV dose of ketorolac is 30mg initially, followed by 15-30mg every 6 hours as needed, with a maximum daily dose of 120mg and a maximum duration of 5 days total therapy (including all routes of administration) 1.
• Patients with renal impairment, elderly patients, or those weighing less than 50kg should receive reduced doses.
• Common side effects include gastrointestinal issues, headache, and dizziness rather than cough or severe hypertension.
• The management of hypertensive emergencies involves the use of intravenous blood pressure-lowering agents to reach the recommended BP target in a designated time-frame, but this does not directly relate to the administration of IV ketorolac 1.

Clinical Implications

• IV ketorolac can be used for pain management in patients with hypertension, but careful monitoring of blood pressure is recommended.
• The primary concern with IV ketorolac is not its potential to cause hypertensive crisis or cough, but rather its potential to exacerbate existing hypertension or cause other side effects such as gastrointestinal issues.
• Clinicians should be aware of the potential interactions between IV ketorolac and other medications, as well as its potential effects on renal function and blood pressure.

From the FDA Drug Label

NSAIDs, including ketorolac tromethamine, can lead to onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events. The FDA drug label does not answer the question about hypertensive cough. However, hypertension is a possible effect of IV ketorolac, and it is recommended to monitor blood pressure closely during treatment.

• Key points:
  • IV ketorolac may cause new hypertension or worsening of pre-existing hypertension.
  • Blood pressure monitoring is recommended during treatment.
  • There is no information about hypertensive cough in the provided drug labels 2 2.

From the Research

Hypertensive Crisis and IV Ketorolac

• There is no direct evidence in the provided studies to suggest that IV ketorolac causes a hypertensive cough or is associated with hypertensive crisis 3, 4, 5, 6, 7.
• Hypertensive crisis is a severe elevation in blood pressure that can present as hypertensive urgency or emergency, with or without target organ damage 3, 4, 5, 6, 7.
• The risk factors for hypertensive crisis include comorbid cardiovascular conditions, such as chronic kidney disease, coronary artery disease, and stroke 6.
• The management of hypertensive crisis involves the prompt recognition of the condition, appropriate diagnostic tests, and triage, as well as the use of specific agents based on knowledge of any comorbid disease state 3, 4, 5.

IV Ketorolac and Blood Pressure

• There is no mention of IV ketorolac in the provided studies as a cause of hypertensive crisis or cough 3, 4, 5, 6, 7.
• The studies focus on the management and risk factors of hypertensive crisis, rather than the effects of specific medications like IV ketorolac on blood pressure 3, 4, 5, 6, 7.

Conclusion Not Available

• As per the instructions, no conclusion can be drawn, and the response is limited to the information provided in the studies 3, 4, 5, 6, 7.