WARNING

Ketorolac injection is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term pain management, usually after surgery. While effective, it’s associated with several risks:

• Gastrointestinal Effects: Ketorolac can cause stomach ulcers, bleeding, or perforation, particularly with prolonged use or in individuals with a history of gastrointestinal issues.
• Renal Effects: NSAIDs like ketorolac can impair kidney function, leading to fluid retention, decreased urine output, and potentially acute kidney injury, especially in those with preexisting kidney conditions.
• Cardiovascular Risks: There’s a potential for increased risk of cardiovascular events such as heart attack or stroke, especially in those with underlying cardiovascular disease or risk factors.
• Bleeding: Ketorolac can inhibit platelet function, which may lead to increased bleeding risk, particularly in patients undergoing surgery or those with bleeding disorders.
• Allergic Reactions: Some individuals may experience allergic reactions ranging from mild skin rashes to severe anaphylaxis.
• Central Nervous System Effects: Ketorolac may cause dizziness, drowsiness, or headaches, which can impair the ability to perform tasks requiring mental alertness.
• Liver Toxicity: Rarely, ketorolac can cause liver damage, particularly with prolonged or high-dose use.
• Pregnancy and Lactation: Ketorolac is generally not recommended during pregnancy, especially in the third trimester, as it may harm the fetus. It’s also not recommended during lactation due to potential risks to the infant.
• Other: Other potential side effects include hypertension, fluid retention, and exacerbation of asthma.

It’s crucial to use ketorolac injection under the supervision of a healthcare professional, at the lowest effective dose for the shortest duration possible, and to monitor for adverse effects regularly. Patients should discuss their medical history and any concerns with their healthcare provider before starting ketorolac or any NSAID therapy.

Why is this medication prescribed?

Ketorolac injection is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve moderate to severe pain, typically following surgery or injury. It is also sometimes used to manage pain in conditions like kidney stones or severe migraine headaches. It works by reducing inflammation and blocking the production of certain chemicals in the body that cause pain, fever, and inflammation.

How should this medicine be used?

Here’s how ketorolac injection is typically used:

• Dosage: The dosage of ketorolac injection varies depending on the severity of pain, patient’s age, weight, and medical condition. It’s usually administered as a single injection.
• Administration: Ketorolac injection is given intramuscularly (into a muscle) or intravenously (into a vein). Intramuscular injections are typically administered into the upper outer quadrant of the buttocks (dorsogluteal site) or the middle third of the thigh (vastus lateralis site).
• Frequency: The injection is typically given every 6 hours as needed for pain relief, but the frequency may be adjusted based on individual response and physician recommendations.
• Duration: Ketorolac injection is usually prescribed for short-term use only, generally for up to 5 days. Prolonged use can increase the risk of adverse effects, particularly gastrointestinal complications.
• Precautions: Patients should not exceed the recommended dosage or duration of treatment without consulting their healthcare provider. It’s essential to use the lowest effective dose for the shortest duration necessary to minimize the risk of side effects.
• Monitoring: Patients receiving ketorolac injection should be closely monitored for signs of adverse effects, including gastrointestinal bleeding, renal dysfunction, and cardiovascular events.
• Contraindications: Ketorolac injection is contraindicated in patients with active peptic ulcer disease, a history of gastrointestinal bleeding or perforation, severe renal impairment, or a history of allergic reactions to NSAIDs.

It’s crucial to follow the instructions provided by the healthcare provider and to discuss any concerns or questions about ketorolac injection with them. Additionally, patients should inform their healthcare provider about their medical history, current medications, and any allergies before starting ketorolac therapy.

Other uses for this medicine

As for other uses of ketorolac injection, it’s important to note that its primary use is for pain relief, especially postoperative pain management. However, it’s sometimes used off-label for other types of pain, such as migraines or renal colic, although this usage is less common and typically not recommended due to the risk of adverse effects.

What special precautions should I follow?

Regarding special precautions for ketorolac injection use, here are some important points to consider:

• Gastrointestinal Risk: Ketorolac can increase the risk of gastrointestinal ulcers, bleeding, and perforation. Patients with a history of peptic ulcer disease, gastrointestinal bleeding, or other gastrointestinal disorders should use ketorolac with caution.
• Renal Function: Ketorolac can cause kidney injury, particularly in patients with preexisting renal impairment, dehydration, heart failure, or liver cirrhosis. It should be avoided or used with extreme caution in these patients.
• Cardiovascular Risk: NSAIDs, including ketorolac, may increase the risk of cardiovascular events such as heart attack or stroke, especially with long-term use or in patients with existing cardiovascular disease.
• Hypersensitivity Reactions: Patients with a history of hypersensitivity reactions to NSAIDs, including aspirin, may be at increased risk of allergic reactions with ketorolac use.
• Use in Elderly Patients: Elderly patients are more susceptible to the adverse effects of ketorolac, including gastrointestinal bleeding and renal impairment. Lower doses and careful monitoring are recommended in this population.
• Pregnancy and Lactation: Ketorolac is generally contraindicated during the third trimester of pregnancy due to the risk of fetal harm. It should be avoided during lactation as well, as it can be excreted in breast milk.
• Drug Interactions: Ketorolac may interact with other medications, including anticoagulants, antiplatelet drugs, ACE inhibitors, and diuretics. Patients should inform their healthcare provider about all medications, supplements, and herbal products they are taking.

Patients should always follow their healthcare provider’s instructions regarding the use of ketorolac injection and report any adverse effects or concerns promptly.

What special dietary instructions should I follow?

There are no specific dietary restrictions associated with ketorolac injection. However, since ketorolac can cause gastrointestinal irritation, it may be advisable to take it with food or milk to help reduce the risk of stomach upset. Avoiding alcohol consumption while taking ketorolac is also recommended, as alcohol can increase the risk of gastrointestinal bleeding.

What should I do if I forget a dose?

If you miss a dose of ketorolac injection, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to make up for a missed one. It’s important to follow your healthcare provider’s instructions regarding dosing frequency and not to exceed the recommended dosage. If you have any concerns or questions about missed doses, consult your healthcare provider or pharmacist for guidance.

What side effects can this medication cause?

Ketorolac injection, like other nonsteroidal anti-inflammatory drugs (NSAIDs), can cause a range of side effects. These side effects can vary in severity and may affect different individuals differently. Common side effects of ketorolac injection include:

• Gastrointestinal Effects: This is one of the most common side effects of ketorolac. It can cause stomach upset, nausea, vomiting, indigestion, abdominal pain, and diarrhea. In some cases, it may lead to more serious gastrointestinal complications such as ulcers, bleeding, or perforation.
• Renal Effects: Ketorolac can impair kidney function, leading to decreased urine output, fluid retention, and potentially acute kidney injury, especially in individuals with preexisting kidney conditions or those at risk for renal impairment.
• Cardiovascular Effects: NSAIDs, including ketorolac, may increase the risk of cardiovascular events such as heart attack or stroke, particularly with long-term use or in individuals with existing cardiovascular disease or risk factors.
• Bleeding: Ketorolac can inhibit platelet function, which may lead to increased bleeding risk, particularly in patients undergoing surgery or those with bleeding disorders.
• Hypersensitivity Reactions: Some individuals may experience allergic reactions to ketorolac, ranging from mild skin rashes to severe anaphylaxis. Patients with a history of hypersensitivity reactions to NSAIDs, including aspirin, are at increased risk.
• Central Nervous System Effects: Ketorolac may cause dizziness, drowsiness, headache, or confusion, which can impair the ability to perform tasks requiring mental alertness.
• Hepatic Effects: Rarely, ketorolac can cause liver damage or hepatitis, particularly with prolonged or high-dose use.
• Respiratory Effects: Ketorolac may exacerbate asthma or cause bronchospasm in susceptible individuals.
• Hematologic Effects: Ketorolac can affect blood cell counts, leading to anemia, leukopenia, thrombocytopenia, or other hematologic abnormalities.
• Other Effects: Other potential side effects of ketorolac injection include hypertension, fluid retention, photosensitivity reactions, and exacerbation of inflammatory bowel disease.

It’s essential for patients to be aware of these potential side effects and to report any unusual symptoms or adverse reactions to their healthcare provider promptly. In some cases, the benefits of ketorolac therapy may outweigh the risks, but close monitoring and appropriate management of side effects are crucial to ensure patient safety.

What should I know about storage and disposal of this medication?

Storage and Disposal of ketorolac injection:

Storage:

• Ketorolac injection should be stored at room temperature (approximately 20-25°C or 68-77°F).
• Keep the medication in its original packaging and away from moisture, heat, and light.
• Do not freeze ketorolac injection.
• Keep it out of reach of children and pets.

Disposal:

• Dispose of unused or expired ketorolac injection properly according to local regulations or guidelines.
• Do not flush medications down the toilet or pour them into a drain unless instructed to do so.
• Check with your pharmacist or local waste disposal facility for proper disposal methods, such as using a medication take-back program.

In case of emergency/overdose

• In case of an overdose or emergency situation, such as severe gastrointestinal bleeding, allergic reaction, or signs of kidney failure (e.g., decreased urine output, swelling), seek immediate medical attention or contact a poison control center.
• Be prepared to provide information about the amount of ketorolac injection ingested, any other medications taken, and the person’s medical history.

What other information should I know?

• Inform your healthcare provider about all medications, supplements, and herbal products you are taking, as they may interact with ketorolac injection.
• Avoid alcohol consumption while taking ketorolac, as it may increase the risk of gastrointestinal bleeding.
• Ketorolac injection is not recommended for use in children under 2 years of age.
• Elderly patients, pregnant or breastfeeding women, and individuals with certain medical conditions (e.g., asthma, heart disease, kidney problems) may require special monitoring or dosage adjustments when using ketorolac injection.
• Ketorolac injection may cause drowsiness or dizziness. Avoid driving or operating machinery until you know how it affects you.
• Report any side effects or adverse reactions to your healthcare provider promptly.

It’s essential to follow these guidelines to ensure the safe and effective use of ketorolac injection and to minimize the risk of complications. If you have any questions or concerns about storage, disposal, or emergency situations, consult your healthcare provider or pharmacist for guidance.