Is Ketorolac (Toradol) an Anti-Inflammatory Medication?
Yes, ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits both analgesic and anti-inflammatory properties through inhibition of prostaglandin synthesis. 1
Mechanism of Action
Ketorolac functions as a potent NSAID by inhibiting cyclooxygenase (COX) enzymes, which blocks prostaglandin synthesis—the primary mechanism underlying both its analgesic and anti-inflammatory effects 1, 2. The drug is administered as a racemic mixture, with the S-enantiomer providing the therapeutic analgesic activity 1. Unlike opioids, ketorolac directly interacts with inflammatory pathways to treat pain symptoms rather than acting on central nervous system opioid receptors 3.
Clinical Classification and Use
Ketorolac is explicitly classified as a nonsteroidal anti-inflammatory drug in multiple authoritative guidelines, including those from the American Academy of Family Physicians, the National Comprehensive Cancer Network, and FDA labeling 3, 1.
The drug is categorized alongside other NSAIDs such as ibuprofen, naproxen, and diclofenac in pain management protocols 3.
In pediatric guidelines, ketorolac is described as an "intravenous nonsteroidal antiinflammatory agent" used to reduce postoperative opioid requirements 3.
Anti-Inflammatory Properties in Practice
Ketorolac's anti-inflammatory action provides specific clinical advantages:
It reduces inflammation-mediated pain by decreasing hypersensitization of tissue nociceptors that occurs with surgery 4.
The drug has demonstrated particular benefit in pain resulting from inflammatory conditions, including bone metastases in cancer patients 2.
In critical care settings, ketorolac is recommended specifically because it "interacts with inflammation pathways to directly treat many pain symptoms" 3.
A randomized trial in 620 older patients undergoing total joint arthroplasty showed that scheduled parecoxib (a selective COX-2 inhibitor NSAID) significantly reduced postoperative delirium, suggesting that anti-inflammatory effects may prevent neuroinflammation 3.
Analgesic Potency
While ketorolac possesses anti-inflammatory properties, its primary clinical utility is as a potent analgesic:
Single-dose ketorolac provides analgesic efficacy comparable to standard doses of morphine and meperidine for moderate to severe postoperative pain 2, 5, 6.
The peak analgesic effect occurs within 2–3 hours, with duration of analgesia being the main difference between dosing levels 1.
In pediatric patients, ketorolac reduces postoperative opioid consumption by 25–50% compared with opioid-only regimens 7, 2, 4.
Important Clinical Distinction
A common pitfall is assuming all NSAIDs have equivalent anti-inflammatory potency in clinical practice. Ketorolac is formulated and dosed primarily for its analgesic effects rather than for treating chronic inflammatory conditions like rheumatoid arthritis 2, 5. The drug's anti-inflammatory mechanism underlies its pain relief, but it is not typically used as a disease-modifying anti-inflammatory agent for chronic inflammatory diseases.
Safety Considerations Related to NSAID Class
Because ketorolac is an NSAID, it carries the class-related risks of gastrointestinal bleeding, renal toxicity, and cardiovascular events 3, 8. These adverse effects are directly related to prostaglandin inhibition—the same mechanism that provides anti-inflammatory benefit 1. Duration should be limited to ≤5 days to minimize cumulative toxicity 8.