Ketorol (Ketorolac Trometamol)

Ketorolac trometamol is an NSAID that reduces pain and inflammation by inhibiting cyclooxygenase enzymes.

• Post‑operative pain: provides rapid analgesia to facilitate postoperative recovery.
• Acute musculoskeletal pain: relieves pain from injuries, strains or sprains.
• Dental pain: controls severe pain following dental procedures.
• Renal colic: offers short‑term relief of intense flank pain caused by kidney stones.

• Ketorolac trometamol non‑selectively inhibits cyclooxygenase‑1 (COX‑1) and cyclooxygenase‑2 (COX‑2) enzymes, blocking the conversion of arachidonic acid to prostaglandins. The resulting decrease in prostaglandin synthesis diminishes peripheral sensitisation, inflammation, and nociceptive signalling, producing analgesic and anti‑inflammatory effects throughout the body.

Ketorolac may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Dyspepsia: indigestion or heartburn.
• Headache: transient cranial discomfort.
• Dizziness: occasional light‑headedness.
• Renal function changes: slight increase in serum creatinine.

Serious or Rare Side Effects

• Gastrointestinal bleeding or ulcer perforation.
• Severe skin reactions such as Stevens‑Johnson syndrome.
• Anaphylaxis: life‑threatening allergic response.
• Acute renal failure in susceptible individuals.
• Cardiovascular events including myocardial infarction or stroke.

When prescribing Ketorolac, clinicians should consider several safety measures.

• Assess renal function: evaluate baseline creatinine and avoid use in severe renal impairment.
• Monitor gastrointestinal risk: avoid in patients with active ulcers or a history of GI bleeding.
• Check for hypersensitivity: contraindicated in individuals with known NSAID allergy.
• Use lowest effective dose: limit duration to the shortest period necessary, typically not exceeding 5 days.
• Pregnancy and lactation: use only if benefits outweigh potential risks and after professional consultation.
• Store at ambient temperature: keep in original container, protect from moisture and light.

Ketorolac can interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Anticoagulants (e.g., warfarin): increased risk of serious bleeding.
• Concurrent NSAIDs or COX‑2 inhibitors: additive gastrointestinal toxicity.
• SSRIs or SNRIs: heightened bleeding tendency.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: may reduce renal perfusion, especially in dehydrated patients.
• Diuretics: combined use can impair kidney function.
• Lithium: NSAIDs can raise lithium serum concentrations.
• Methotrexate: reduced clearance leading to toxicity.