Ketorolac

Provider Level

RN/Paramedic

Class

Nonsteroidal anti-inflammatory drug (NSAID)

Mechanism of Action

Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and COX-2) enzymes, leading to decreased synthesis of prostaglandins, providing analgesic and anti-inflammatory effects.

Indications

Short-term management of moderate to severe acute pain.

Contraindications

Hypersensitivity to ketorolac, aspirin, or other NSAIDs. Active or history of peptic ulcer disease or GI bleeding. Advanced renal impairment or volume depletion. Suspected or confirmed cerebrovascular bleeding. Bleeding diatheses. Prophylactic analgesic before major surgery. Pregnancy (third trimester) and labor or delivery.

Routes

IM, IV

Onset / Duration

Onset: 10 to 30 minutes. Peak effect: 1 to 2 hours. Duration: 4 to 6 hours.

Adverse Effects

Nausea, dyspepsia, GI bleeding, edema, hypertension, dizziness, headache, drowsiness, prolonged bleeding time, acute renal failure, anaphylaxis.

Precautions & Interactions

Use with caution in elderly patients, patients with hepatic impairment, heart failure, or history of cardiovascular disease. Ensure adequate hydration to minimize renal risk. Concomitant use of anticoagulants increases bleeding risk.

Special Considerations

Authorized for RN/Paramedic use. Maximum duration of therapy (including all routes) should not exceed 5 days in a clinical setting due to increased risk of serious GI and renal adverse events.