ketorolac trometamol: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
ketorolac trometamol: clinical details
Prescribing considerations
- Confirm the intended route because injection and ophthalmic products have different indications and risks.
- Injection treatment is restricted to acute postoperative pain initiated in hospital; reassess gastrointestinal, renal, cardiovascular and haemostatic risk.
- Older, dehydrated, low-body-weight or renally impaired patients have greater systemic exposure or adverse-effect risk.
- For eye drops, assess corneal integrity and risk factors including dry eye, diabetes, rheumatoid arthritis, complicated or repeated eye surgery and concurrent topical corticosteroids.
- Ketorolac may impair female fertility through cyclo-oxygenase and prostaglandin inhibition.
Contraindications and cautions
- Injection: hypersensitivity to ketorolac, aspirin or another NSAID; previous NSAID-induced asthma or allergy; active peptic ulcer or any history of gastrointestinal bleeding, ulceration or perforation; moderate or severe renal impairment or risk from volume depletion; severe cardiac, hepatic or renal failure; significant bleeding risk or incomplete haemostasis; concurrent anticoagulants, aspirin, another NSAID, lithium, probenecid or oxpentyfylline; pregnancy, labour, delivery or breastfeeding; age under 16 years.
- Eye drops: hypersensitivity to ketorolac or an excipient, or previous hypersensitivity to aspirin or another NSAID.
Monitoring
- For injection, assess renal function, hydration, bleeding, gastrointestinal symptoms, fluid retention and blood pressure as clinically appropriate.
- Consider additional renal monitoring with medicines affecting renal perfusion or kidney function.
- Stop systemic treatment if gastrointestinal bleeding, significant renal impairment or a serious hypersensitivity or skin reaction occurs.
- With eye drops, monitor promptly for increasing pain, irritation, impaired healing, visual deterioration or corneal epithelial breakdown.
Clinical pharmacology
Ketorolac is a non-selective cyclo-oxygenase inhibitor that reduces prostaglandin synthesis. Systemic ketorolac is highly protein-bound and eliminated mainly through the kidneys; clearance is reduced in renal impairment and older people. Ophthalmic use produces therapeutic ocular concentrations with very low or undetectable plasma concentrations in most studied patients.
Formulation and product differences
- The injection is a systemic formulation for intramuscular or bolus intravenous administration and contains ethanol; it is not suitable for epidural or intrathecal use.
- The eye drops are clear ocular solutions containing benzalkonium chloride, which can irritate the ocular surface and be absorbed by soft contact lenses.
- Selected eye-drop products share the postoperative ocular indication but may differ in manufacturer, pack presentation and excipients.
ketorolac trometamol preparations and strengths
Eye drops
Route: Ophthalmic
Strengths: 0.5% w/v
Injection
Route: Parenteral
Strengths: 30 mg/mL
ketorolac trometamol interactions
Tell the clinical team about prescribed, non-prescription and complementary products. Important interactions mainly concern injected ketorolac.
Aspirin, other NSAIDs or COX-2 inhibitors
Concurrent systemic use is contraindicated because serious NSAID adverse effects may increase.
Warfarin, heparin and other anticoagulants
Concurrent use is contraindicated because ketorolac impairs platelet function and may increase bleeding.
Lithium
Concurrent use is contraindicated because ketorolac can reduce lithium clearance and raise blood concentrations.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.