How Does Ketorolac Work?

Ketorolac is a type of drug called a non-steroidal anti-inflammatory drug (NSAID), works to reduce inflammation by stopping the production of compounds called prostaglandins in the body. These compounds have a number of effects in the body, including to cause inflammation.

Brand Names and Doses

Ketorolac is the generic name of the drug, which is the name of the active component that has an effect on your body. You may also know it better by the brand names, Toradol or Ketoral, which are the names given to the medication made by each pharmaceutical company for marketing purposes. 

Toradol is available as an oral tablet in a dose of 10 mg, or as an injection for hospital use. Ketoral is only available as an injection.

What type of drug is it?

Ketorolac is a type of drug known as a non-steroidal anti-inflammatory drug (NSAID), which is a group of drugs that all work in a similar way. Other examples of NSAIDs include:

• Aspirin

• Celecoxib

• Diclofenac

• Etoricoxib

• Ibuprofen

• Indomethacin

• Ketoprofen

• Mefenamic acid

• Meloxicam

• Naproxen

• Parecoxib

• Piroxicam

• Sulindac

• Tiaprofenic acid

Ketorolac is a nonselective NSAID, which means that it blocks both COX-1 and COX-2 to stop the production of more types of prostaglandins than some other NSAIDs. This means that it is more likely to cause side effects due to the action of the other prostaglandins that is reduced.

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Additionally, you body is very efficient at eliminating ketorolac from the body, so you need to take multiple doses throughout the day in order for it to have a continuous effect. In fact, you would need to take 4 doses per day to provide continuous relief of pain and inflammation and this is why alternative drugs that work in a similar way are usually recommended instead - it’s easier to take 1 tablet a day than 4.

What is Ketorolac used for?

Ketorolac is usually used to help relieve symptoms of mild to moderate pain and inflammation after surgery.

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Unlike other NSAID medications, it is not often used to reduce pain and inflammation of chronic health conditions such as rheumatoid arthritis because it has inconvenient dosing. You are more likely to accidentally forget a dose if you need to take 4 tablets each day.

How does it work?

Ketorolac works by inhibiting COX-1 and COX-2, which are needed to produce the different prostaglandins in your body. You have many different types of prostaglandins in your body, and there are some in almost every tissue of your body. They each have different effects, such as to cause:

• Inflammation in the tissues in your body

• Relaxation and widening of your blood vessels

• Aggregation of the platelets in your blood to form a clot

Ketorolac has a general effect on almost all the prostaglandins because it blocks both COX-1 and COX-2 from producing prostaglandins in your body. This means that it can reduce all of the usual effects prostaglandins. We want it to reduce inflammation because that is why we are using it, but it can also cause hypertension and affect the way the blood forms clots.

Side Effects

There are many different side effects that you may experience if you are taking Ketorolac. These do not affect everyone, but it’s important to know what they are so that you can recognize them if you do notice them.

The side effects of Ketorolac may include:

• Nausea​

• Heartburn (dyspepsia)

• Diarrhea

• Headache

• Dizziness

• Gastrointestinal ulcers

• Gastrointestinal bleeding

• Hypertension

Additionally, for Ketorolac given as an injection, there may be a local reaction on the skin at the site of the injection.

This is not a complete list of side effects, but just some of the most common. Please see the ketorolac information leaflet for more detailed information.

Drug Interactions

Ketorolac can interact with many other medications when they are used in together, including:

• ACE Inhibitors

• Aldosterone antagonists

• Alendronate

• Amiloride

• Aspirin

• Beta blockers

• Brimonidine

• Calcineurin inhibitors

• Corticosteroids

• Cyclosporin

• Fluconazole

• Lithium

• Loop diuretics

• Methotrexate

• Phenindione

• Potassium

• Prostaglandin analogues

• Rifampicin

• Sartans

• Tacrolimus

• Thiazide diuretics

• Thiazolidinediones

• Triamterene

• Warfarin

These medications can often be used together, but your doctor should be aware that you are taking both medications so that they can adjust the dose as needed to ensure they are safe and effective.

Cautions

There are some people who may need to avoid using Ketorolac, or use it with caution, because they may be at risk of side effects due to the medication.

Risk of Bleeding:

Ketorolac should not be used for people who have a high risk of bleeding, such as those who:

• Are taking full anticoagulation treatment

• Are at high risk of hemorrhage

• Have suspected intracranial bleeding

• Have a history of GI bleeding

• Have a history of bleeding diathes

Dehydration or Low Sodium Levels:

Ketorolac should not be used for people who are dehydrated or have low levels of sodium in their blood, known as hypovolemia.

Peptic ulcers or GI bleeding:

Ketorolac is not usually used for people who have a history of peptic ulcers. This is because it can increase the risk of peptic ulcers. If it is required, a medication to help prevent gastrointestinal problems, such as esomeprazole or pantoprazole, is usually recommended as well.

Coagulation disorders:

Ketorolac may increase the risk of bleeding or thrombosis because the antiplatelet effect of the prostaglandins may be reduced.

Cardiovascular disease:

Ketorolac may cause retention of sodium and fluid in the body, which can make hypertension and heart failure worse. It should not be used if you have heart failure, angina, peripheral artery disease or cerebrovascular disease.

Asthma:

Ketorolac may increase the risk of bronchospasm and cause symptoms of asthma to worsen. Some people with asthma can use them without any problems, but it is best to use a low dose and watch for signs of worsening asthma if you are using it for the first time.

Inflammatory Bowel Disease (IBD):

Ketorolac may cause symptoms of inflammatory bowel disease to get worse.

Renal Impairment

Ketorolac can cause renal impairment is some people, particularly when used in combination with some other medications. If you already have some renal impairment, an NSAID may not be the best choice for you.

Pregnancy and Breastfeeding

Ketorolac is not usually recommended for women who are pregnant or trying to conceive. This is because it can interfere with fertility and the development of the fetus.

For women planning to become pregnant, it can prevent or delay ovulation, so that the woman is less likely to conceive. Additionally, using ketorolac during pregnancy, particularly at the time of conception, is linked to a higher risk of miscarriage. It may also cause other problems later on in the pregnancy and should be avoided.

For women who are breastfeeding, ketorolac is considered safe to use.

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