Ketorolac
Pronunciation: kee-toe-ROLE-ak.
- Generic name
- ketorolac tromethamine
- Brand names
- TORADOL (oral, Australia), KETOROLAC KABI (injection, Australia), KETOBREL (eye drops, Australia)
- Drug class
- Nonsteroidal anti-inflammatory drug (NSAID)
- Form
- Injection, tablet, or ophthalmic solution -- these are separate products with different indications and are not interchangeable.
- Route
- Injection (intravenous or intramuscular), oral tablet, or ophthalmic (eye drop), depending on the exact product
- Legal status
- Prescription-only medicine.
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
Boxed warning: Serious risks; strict duration limit
Ketorolac carries the NSAID class boxed warning for serious cardiovascular thrombotic events and serious gastrointestinal bleeding, ulceration, and perforation, which can be fatal and can occur without warning. Systemic ketorolac (injection, and in the US, oral tablets as continuation therapy only) is limited to a combined total of no more than 5 days of use, due to increasing risk of serious adverse events with longer use. (1)
What ketorolac tromethamine is and how it works
Ketorolac is an NSAID used by injection, and sometimes orally as continuation treatment, for short-term relief of moderately severe acute pain. A separate ophthalmic (eye drop) product treats a different, eye-specific condition. (1)
Systemic ketorolac is not for routine or long-term pain and has a strict 5-day combined maximum duration across all systemic use. It is not a first-choice oral pain medicine; in the United States, oral ketorolac is only used to continue treatment that started with an injection.
Mechanism of action: how ketorolac tromethamine works
Ketorolac is a potent NSAID that inhibits prostaglandin synthesis via cyclo-oxygenase inhibition, providing analgesia comparable to opioid-level pain relief for short-term acute pain, with the gastrointestinal, renal, cardiovascular, and bleeding risks typical of the NSAID class, often more pronounced given its potency. (1)
What ketorolac tromethamine is used for
Short-term management of moderately severe acute pain (injection)
Ketorolac injection (intravenous or intramuscular) is used for short-term management of moderately severe acute pain that requires analgesia at the opioid level, typically in a hospital or clinical setting. (1)
Oral continuation therapy (United States)
In the United States, oral ketorolac tablets are indicated only as continuation therapy after initial treatment with injectable ketorolac, not as an initial or standalone treatment. The combined duration of injectable plus oral treatment must not exceed 5 days. (1)
Oral tablets (Australia)
An oral ketorolac tablet product (TORADOL) is separately registered in Australia; confirm the exact current Australian indication and duration limits against the local product information. (2)
Ophthalmic use (eye drops)
A separate ketorolac eye-drop product exists for an eye-specific condition. This is not the same product as systemic ketorolac and has its own, different indication, dosing, and safety profile. (4)
Before taking ketorolac tromethamine
Do not take / not appropriate for
- Do not use ketorolac if you have active peptic ulcer disease, recent gastrointestinal bleeding or perforation, advanced kidney disease, or a bleeding disorder. (systemic products) (1)
- Do not use ketorolac if you have had asthma, hives, or another allergic-type reaction after aspirin or another NSAID. (systemic products) (1)
- Do not use ketorolac for pain immediately before or during surgery, or while in labour, and do not use it around coronary artery bypass graft (CABG) surgery. (systemic products) (1)
- Do not combine systemic ketorolac with aspirin or another NSAID, including a different ketorolac product. (systemic products) (1)
Tell your clinician about
- Any heart disease, stroke, high blood pressure, or cardiovascular risk factors.
- Any history of stomach ulcer, gastrointestinal bleeding, or bleeding disorder.
- Kidney or liver disease.
- Pregnancy, plans for pregnancy, or breastfeeding.
- Whether you have already received ketorolac by injection, since this affects how many more days of oral treatment, if any, are appropriate.
- Every other medicine you take, especially aspirin, other NSAIDs, anticoagulants, or lithium.
How to take ketorolac tromethamine
- Ketorolac injection is given by a healthcare professional in a clinical setting.
- If prescribed oral tablets, take exactly as directed; in the United States, these are used only to continue treatment already started with the injection, never as the first treatment.
- The combined total duration of injectable and oral ketorolac must not exceed 5 days.
- Do not combine with aspirin or another NSAID.
- Do not change your dose or extend treatment beyond what your prescriber has directed.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
Ketorolac is used for a short, defined course, often in a clinical setting. If you are taking oral tablets at home and miss a dose, ask your prescriber or pharmacist rather than adjusting the schedule yourself, since the treatment window is strictly limited.
Overdose
Contact your prescriber, pharmacist, or a poison-control/emergency service if an overdose is suspected. (1)
Side effects
Ketorolac carries the same serious gastrointestinal and cardiovascular risks as other NSAIDs, at a meaningful level given its potency and typical use in acute pain.
Stomach upset, nausea, or indigestion
What to notice: Digestive symptoms are commonly reported.
What to do: Tell your care team if severe; do not ignore black stools or vomiting blood. (1)
Drowsiness, dizziness, or headache
What to notice: Commonly reported effects.
What to do: Avoid driving or hazardous tasks if affected. (1)
Nausea and vomiting
Incidence: Common
Headache
Incidence: Common
Possible kidney problem
What to notice: Reduced urination, swelling, or unusual tiredness.
What to do: Contact a clinician promptly. (1)
Serious warnings
Heart attack or stroke risk — emergency
Symptoms: Chest pain, shortness of breath, sudden weakness on one side, slurred speech, or sudden severe headache.
Action: Call emergency services immediately. This is a class-wide NSAID risk and can occur early in treatment. (1)
Gastrointestinal bleeding, ulceration, or perforation — emergency
Symptoms: Black or bloody stools, vomiting blood or material like coffee grounds, or severe stomach pain.
Action: Get urgent medical help immediately; this can occur without warning symptoms, and a clinician or emergency service will decide whether ketorolac needs to be stopped. (1)
Serious allergic reaction — emergency
Symptoms: Swelling of the face, lips, or throat, difficulty breathing, or a severe rash.
Action: Seek emergency medical help immediately. (1)
Unusual bleeding — urgent
Symptoms: Unusual bruising, prolonged bleeding, or blood in urine.
Action: Seek prompt medical assessment; ketorolac affects platelet function and can increase bleeding risk. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Aspirin and other NSAIDs | Combining increases the risk of gastrointestinal bleeding and other adverse effects without added benefit. | Never combine ketorolac with aspirin or another NSAID. (1) |
| Anticoagulants | Combined use increases bleeding risk. | Tell your care team about any blood thinners you take. (1) |
| Lithium | Ketorolac can increase lithium blood levels. | Your care team may monitor lithium levels more closely. (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy and labour
Ketorolac is not used late in pregnancy or during labour and delivery. (1)
Kidney impairment
Ketorolac is not suitable for advanced kidney disease, and dose adjustment or avoidance is needed for lesser degrees of kidney impairment; this is a clinician decision. (1)
Older adults
Older adults may need a reduced dose and are at higher risk of gastrointestinal and kidney-related side effects. (1)
Breastfeeding
The US ketorolac injection label reports limited data from one published study of 10 breastfeeding women 2 to 6 days after delivery, in which levels of ketorolac in breast milk were low and were undetectable (below 5 ng/mL) in 4 of them. That label advises caution when ketorolac is given to a nursing woman, states that available information has not shown any specific adverse events in nursing infants, and tells patients to contact their infant's healthcare provider if they notice any. LactMed adds that milk levels are low with the usual oral dosage but have not been measured after the higher injectable doses or with the nasal spray, that ketorolac injection is used short-term after caesarean delivery in some hospital protocols without evidence of harm to breastfed infants, and that because the manufacturer contraindicates ketorolac during breastfeeding an alternative pain medicine is preferred after the first 24 to 72 hours, when larger volumes of milk are produced, especially when nursing a newborn or preterm infant. Product labels differ on this point, so whether ketorolac is used while breastfeeding is a decision for the prescriber. (1)
Monitoring
Before starting
- Confirm cardiovascular, gastrointestinal, kidney, and bleeding history.
- Confirm whether the patient has already received injectable ketorolac, to calculate remaining allowable treatment days.
During treatment
- Track total combined days of systemic ketorolac use to ensure the 5-day maximum is not exceeded.
- Watch for gastrointestinal, cardiovascular, kidney, and bleeding warning signs.
Storage
Store as directed on the product label, out of reach of children.
Professional information
Clinician-facing context only. Use the current local product information for exact dosing; systemic and ophthalmic ketorolac products are entirely separate and must not be cross-applied.
United States
Indication: Moderately severe acute pain (injection, with oral continuation)
Dose summary: No universal dose is displayed. Combined injectable plus oral treatment must not exceed a total of 5 days. Oral tablets are for continuation only, never initial therapy, in the US.
Renal context: Dose reduction or avoidance needed in renal impairment; contraindicated in advanced renal disease. (1)
Hepatic guidance
Use current local product information and clinical judgement.
Overdose note
Manage suspected overdose supportively per local poison-control and emergency guidance. (1)
Frequently asked questions
What is ketorolac tromethamine used for?
ketorolac tromethamine is prescribed for approved indications. Always follow your healthcare provider's guidance.
What are the side effects of ketorolac tromethamine?
Common side effects may include gastrointestinal symptoms and headache. Serious side effects require immediate medical attention.
Can I take ketorolac tromethamine with other medications?
Always inform your healthcare provider about all medications you are taking, including over-the-counter products and supplements.
What is the mechanism of action of ketorolac tromethamine?
Ketorolac is a potent NSAID that inhibits prostaglandin synthesis via cyclo-oxygenase inhibition, providing analgesia comparable to opioid-level pain relief for short-term acute pain, with the gastrointestinal, renal, cardiovascular, and bleeding risks typical of the NSAID class, often more pronounced given its potency. (1)
References
- Ketorolac tromethamine injection — prescription drug labelU.S. National Library of Medicine DailyMed · United States · dated 2026-02-13 · accessed 2026-07-22 · source 1
- TORADOL ketorolac trometamol 10 mg tablet — ARTG 42060Therapeutic Goods Administration · Australia · dated 1998-10-12 · accessed 2026-07-22 · source 2
- KETOROLAC KABI 30 mg/1 mL injection — ARTG 275273Therapeutic Goods Administration · Australia · dated 2017-04-28 · accessed 2026-07-22 · source 3
- KETOBREL eye drops — prescription medicine registrationTherapeutic Goods Administration · Australia · dated 2023-07-18 · accessed 2026-07-22 · source 4
Brand names by country
Single-ingredient ketorolac tromethamine names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Toronova SUIK30 mg/mL · advanced rx of tennessee, llc
- Toronova II SUIK30 mg/mL · advanced rx of tennessee, llc
- Acular5 mg/mL · allergan, inc.
- ACUVAIL4.5 mg/mL · allergan, inc.
- ACULAR LS4 mg/mL · allergan, inc.
- Sprix15.75 mg · zyla life sciences us llc
Canada
- ACULAR
- TORADOL
- TORADOL IM
- ACULAR LS
- ACUVAIL