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Generic Ketorolac
Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug (NSAID) indicated for the short-term management of moderate to severe acute pain, including post-operative pain. It works by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, reducing the synthesis of prostaglandins that mediate pain, inflammation, and fever. Ketorolac has potent analgesic activity comparable to opioids in some settings but without opioid-related side effects such as respiratory depression or dependence. Because of its significant risk of serious gastrointestinal, renal, and cardiovascular adverse events, ketorolac is reserved for short-term use (maximum 5 days) and is not indicated for minor or chronic pain. It is available as oral tablets, injectable solution, and nasal spray.
Usual adult dose: For oral therapy, the recommended dose is 10 mg taken every 4 to 6 hours as needed, with a maximum total daily dose of 40 mg. The 10 mg oral tablet is typically used as a continuation of therapy after an initial intramuscular or intravenous dose (e.g., 30 mg to 60 mg IM or 30 mg IV). The total combined duration of parenteral and oral ketorolac must not exceed 5 days. In patients 65 years of age and older, in those with renal impairment, or in patients weighing less than 50 kg, the maximum total daily dose should not exceed 60 mg for parenteral therapy, and oral doses should be reduced accordingly; in these populations, a 10 mg tablet is the preferred oral dose. Ketorolac should be taken with food or milk to minimize gastrointestinal upset. It is contraindicated in patients with active peptic ulcer disease, recent gastrointestinal bleeding, severe renal impairment, or a history of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs.
Dosage form: Film-coated tablets: 10 mg (white to off-white, round, biconvex, debossed with "KETO 10" or similar marking). Available in blister packs or bottles of 20 tablets. Ketorolac is also available as an injectable solution (15 mg/mL or 30 mg/mL) for intramuscular or intravenous use, and as a nasal spray (15.75 mg per actuation). The oral tablet is used only after initial parenteral dosing in most acute pain protocols.
Onset of action: Analgesia begins within 30 to 60 minutes after oral administration, with peak plasma concentrations reached at approximately 30 to 60 minutes. The onset is slower than intravenous administration (which is within minutes) but adequate for continuation therapy in the acute pain setting. Maximum analgesic effect may take 1 to 2 hours.
Duration of action: The analgesic effect lasts approximately 4 to 6 hours, supporting dosing every 4 to 6 hours. The elimination half-life of ketorolac is approximately 5 to 6 hours in patients with normal renal function but may be prolonged in the elderly or those with renal impairment. The total duration of therapy must not exceed 5 days because of the increased risk of adverse events with longer use.
Alcohol recommendation: Alcohol must be avoided during treatment with ketorolac. The combination significantly increases the risk of serious gastrointestinal bleeding, ulceration, and perforation, which can be fatal. Alcohol may also potentiate the nephrotoxic effects of ketorolac and increase the risk of liver injury, dizziness, and drowsiness. Patients should be counselled to abstain from alcohol for the entire treatment period and for at least 24 hours after the last dose.
Most common side effects: Nausea, dyspepsia, abdominal pain, diarrhea, dizziness, headache, and drowsiness. Gastrointestinal side effects are common; taking the medication with food may reduce them. More serious adverse events include gastrointestinal bleeding, perforation, and ulceration; renal impairment including acute renal failure; cardiovascular thrombotic events (myocardial infarction and stroke); and hypersensitivity reactions. Ketorolac is contraindicated in patients with active or recent gastrointestinal bleeding, peptic ulcer disease, severe renal impairment (creatinine clearance less than 30 mL/min), hemorrhagic diathesis, and in the setting of coronary artery bypass graft surgery. It should not be used in patients with a history of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs. Ketorolac is also contraindicated during labour and delivery, and in breastfeeding women. Patients should seek immediate medical attention for signs of gastrointestinal bleeding (black stools, vomiting blood), chest pain, shortness of breath, or sudden weakness. Ketorolac is available only by prescription in Canada and must be prescribed and supervised by a healthcare professional.
Would you like to try Ketorolac without a prescription?
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