Ketorolac Trometamol

How it works

It non-selectively inhibits cyclo-oxygenase, reducing prostaglandin synthesis to produce marked analgesic and anti-inflammatory effects.

Prescribing in practice

• Restrict to the shortest possible course because ketorolac carries a high risk of serious gastrointestinal bleeding and ulceration, acute kidney injury and platelet inhibition — avoid in renal impairment, hypovolaemia, bleeding risk and active peptic ulceration.
• It is for short-term use only and the maximum combined parenteral-plus-oral duration is strictly limited; reduce exposure further in older and lower-weight patients.
• Do not use where there is high surgical bleeding risk, and ensure adequate hydration; co-prescribe gastroprotection where indicated.

Monitoring

Monitor renal function, fluid balance, blood pressure and for any gastrointestinal or surgical-site bleeding throughout the brief course.

Counselling the patient

• Explain this is a strong anti-inflammatory injection used only for a short time to control pain after surgery.
• Report stomach pain, black stools, unusual bleeding or reduced urine output.

Evidence & guidelines

Ketorolac is an established short-term parenteral analgesic; the SPC and MHRA advice stress strict duration limits and contraindications owing to its gastrointestinal, renal and bleeding risks.