Non-steroidal anti-inflammatory drugs (NSAIDs)
ATC code: M01AB15 (Ketorolac)
Non-selective COX-1 and COX-2 inhibitor with predominantly analgesic (rather than anti-inflammatory) effect. Analgesic potency is comparable to morphine for certain pain syndromes. Rapid onset: 30-60 minutes orally, 10-15 minutes intramuscularly. One of the most potent non-opioid analgesics.
First line
First-line for acute moderate-to-severe pain when rapid non-opioid analgesia is needed. Oral dose is 10 mg every 4-6 hours, maximum 40 mg daily. Course is strictly limited to 5 days. Beyond 5 days, the risk of GI bleeding and renal injury rises sharply. Not indicated for chronic pain.
First line
Widely used in the early postoperative period. Reduces opioid requirements by 25-45%. Intramuscularly or intravenously – 30 mg loading dose, then 15-30 mg every 6 hours. In patients over 65, weighing under 50 kg, or with renal impairment – maximum 60 mg daily. Total parenteral and oral course duration must not exceed 5 days.
Boxed warning
Ketorolac is contraindicated for chronic pain management. Total treatment duration must not exceed 5 days. Increased risk of serious GI adverse events – bleeding, ulceration, perforation. Increased risk of cardiovascular thrombotic events.
FDA category C in the first and second trimesters. Contraindicated in the third trimester (category D) – causes premature ductus arteriosus closure and oligohydramnios. Avoid after 20 weeks.
ketorolac is evaluated for the following indications with varying evidence strength: Acute moderate-to-severe pain (evidence tier A), Postoperative pain (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of ketorolac (≥ 1 in 100): Dyspepsia, nausea, abdominal pain, Headache, dizziness, Drowsiness, Edema. See the Safety section for uncommon and serious reactions.
FDA category C. FDA category C in the first and second trimesters. Contraindicated in the third trimester (category D) – causes premature ductus arteriosus closure and oligohydramnios. Avoid after 20 weeks.
Passes into breast milk in small amounts. Short-term use (1-2 days) is acceptable during breastfeeding per LactMed.
ketorolac is contraindicated in: Active peptic ulcer or history of GI bleeding; Severe renal impairment or risk of renal failure (hypovolemia, dehydration); Perioperative setting in CABG surgery; Hemostatic disorders or concurrent anticoagulant use; Third trimester of pregnancy. Full list in the Safety section.
Passes into breast milk in small amounts. Short-term use (1-2 days) is acceptable during breastfeeding per LactMed.
Ketorolac is contraindicated for chronic pain management. Total treatment duration must not exceed 5 days. Increased risk of serious GI adverse events – bleeding, ulceration, perforation. Increased risk of cardiovascular thrombotic events.