ketorolac

Brand: Toradol

⚠ BBW Beers Criteria Prototype: ibuprofen

Drug Class: nonsteroidal anti-inflammatory drug (NSAID)

Drug Family: NSAID

Subclass: non-selective COX inhibitor (pyrrolizine carboxylic acid)

Organ Systems: cnsmusculoskeletal

Mechanism of Action

Potent non-selective COX inhibitor with analgesic potency comparable to opioids at recommended doses; available in IV/IM/oral/intranasal formulations. Inhibits prostaglandin synthesis to produce analgesia without direct opioid receptor activity.

COX-1COX-2

Indications

moderate to severe pain (short-term, up to 5 days only)
post-operative pain
renal colic

Contraindications

active peptic ulcer
renal impairment
cerebrovascular bleeding
third trimester pregnancy
pre- or intraoperative use when hemostasis is critical
labor and delivery

Adverse Effects

Common

nausea
dyspepsia
GI pain
drowsiness
injection site pain (IM)

Serious

GI bleeding/ulceration (higher risk than oral NSAIDs due to parenteral route and potency)
AKI
bleeding (impairs platelet function)

Pharmacokinetics (ADME)

Absorption	IV: complete; IM: complete; oral: ~80%; intranasal: ~36%
Distribution	protein binding >99%; Vd ~0.23 L/kg
Metabolism	hepatic glucuronidation and para-hydroxylation
Excretion	renal (92%)
Half-life	5-6 hours
Onset	IV: 10-15 minutes; IM: 30-60 minutes
Peak	IV: 1-2 hours; IM: 45 minutes
Duration	4-6 hours
Protein Binding	>99%
Vd	0.23 L/kg

Drug Interactions

Drug / Agent	Mechanism	Severity
anticoagulants	additive bleeding risk; major concern	major
ACE inhibitors/ARBs	AKI risk; antihypertensive antagonism	major
probenecid	inhibits ketorolac renal clearance; increase in ketorolac levels	major

Nursing Considerations

Maximum treatment duration is 5 days total (IV + IM + oral combined); document start date and calculated end date on the medication administration record.
Parenteral ketorolac provides opioid-comparable analgesia for moderate-severe pain; it is an important opioid-sparing or opioid-alternative analgesic in appropriate patients.
IM injection must be given deep into large muscle mass (ventrogluteal or vastus lateralis); painful injection if given subcutaneously.
Absolute contraindication in third trimester pregnancy and active bleeding; verify pregnancy status and recent labs before administration.

Clinical Pearls

Ketorolac is the only parenteral (IV/IM) NSAID available in the US, occupying a unique niche as a non-opioid parenteral analgesic for moderate-severe pain when opioids are undesirable.
The 5-day treatment limit is not merely a caution — it is a hard FDA requirement based on clinical trial data showing sharply increased GI toxicity beyond 5 days; prescriptions should not exceed this duration.

Safety Profile

Pregnancy contraindicated

Lactation use-with-caution

Renal Adjustment Required

Hepatic Adjustment Required

TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Moderate To Severe Pain (short-term, Up To 5 Days Only) Nonsteroidal Anti-inflammatory Drug (NSAID) Post-operative Pain Renal Colic

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