Ketorolac

TORADOL

Open Ketorolac in the interactive console ↗

What it isPotent non-selective COX inhibitor; short-term moderate to severe acute pain.

Why this oneAnalgesia approaching an opioid without respiratory depression or dependence, and it is available IV and IM.

What limits itFive days maximum, total, by any route — GI bleeding and renal injury rise steeply after that. Avoid in renal impairment and around surgery with bleeding risk.

FDA-approved for

acute pain (1989)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING NSAID for short-term (≤5 days) moderately severe acute pain only, as continuation after IV/IM; serious GI, cardiovascular, bleeding, and renal risks; contraindicated in CABG surgery

FDA dosing	Population	Start	Target	Max
Moderately severe acute pain (continuation after IV/IM)	age 17-64	20 mg PO once, then 10 mg q4-6h PRN		40 mg/day
Moderately severe acute pain (continuation after IV/IM)	≥65 yr, renally impaired, or <50 kg	10 mg PO once, then 10 mg q4-6h PRN		40 mg/day

Renal Contraindicated in advanced renal impairment or risk of renal failure from volume depletion; reduced dose (10 mg) in renal impairment

Hepatic Undefined

Combined duration of IV/IM and oral ketorolac not to exceed 5 days in adults

Instructions

Use lowest effective dose; oral form not for initial dosing—continuation only
Do not shorten the 4-6 hour dosing interval

Contraindications

Active peptic ulcer disease; recent GI bleeding/perforation; history of peptic ulcer or GI bleeding
Asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs
Prophylactic analgesic before major surgery
Coronary artery bypass graft (CABG) surgery
Advanced renal impairment or risk of renal failure due to volume depletion
Labor and delivery

Cautions

GI ulceration, bleeding, perforation
Cardiovascular thrombotic events
Acute renal failure
Anaphylactic/anaphylactoid reactions
Postoperative bleeding
Hepatotoxicity/liver failure

Adverse reactions

Abdominal pain, dyspepsia, nausea
Constipation/diarrhea, flatulence
GI ulcers
Headache
Edema

Pregnancy Avoid at ~30 weeks gestation and later (premature ductus arteriosus closure); contraindicated in labor and delivery; limit use 20-30 weeks

Lactation Undefined

⚠ BOXED WARNINGS

Cardiovascular thrombotic events
Gastrointestinal bleeding, ulceration and perforation
Renal, bleeding and labor risks; short-term use only

Cost, est. cash$20–$1,500/dose or month

Generic entry1997

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent

Defining liabilityGI bleeding, kidney injury, hypertension and fluid retention; many agents increase lithium concentrations.

Mechanism of action: Ketorolac ballicule

Ketorolac ballicule: receptor binding, kinetics and half-life diagram

Open Ketorolac in the interactive console ↗

Memory aids: mascots and interaction avatars

Ketorolac TORADOL mascot mnemonic cartoon — **“Key to tolerate Torrid”**
“The N said... NSAID”

Box: minimal PK interactions

Open Ketorolac in the interactive console ↗