Ketorolac, Oral/Injection

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KEY POINTS

• This medicine is used for up to 5 days to relieve pain, usually after surgery or dental procedures. Treatment is usually started by injections (shots) and continued with tablets taken by mouth. Take it exactly as directed.
• NSAIDs may increase the chance of a heart attack or stroke that can lead to death. This medicine may cause ulcers and bleeding in the stomach and intestines at any time during treatment. This medicine should not be used right before or after a heart surgery called coronary artery bypass graft (CABG).
• This medicine may also cause other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: nonsteroidal anti-inflammatory drug (NSAID); analgesic (pain medicine)

Generic and brand names: ketorolac, injection; ketorolac, oral

What is this medicine used for?

This medicine is used for up to 5 days to relieve pain, usually after surgery or dental procedures. Treatment is usually started by injections (shots) and continued with tablets taken by mouth.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• A blockage in the intestines, Crohn's disease, or ulcerative colitis
• A stroke or transient ischemic attack (TIA)
• Asthma
• Bleeding problems or blood disorders
• Heart disease
• High blood pressure
• Kidney or liver disease
• Trouble urinating
• Ulcers or intestinal bleeding

Tell your healthcare provider if you smoke or drink alcohol. Alcohol and smoking may increase the risk of ulcers or stomach bleeding. Also tell your provider if you are taking one aspirin a day for heart disease or stroke, or if you take other medicine that reduces the chance of blood clots forming such as warfarin (Coumadin).

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. Do not take this medicine during the 6th to 9th months of pregnancy because it can harm the baby. Do not breast-feed while you are taking or receiving injections of this medicine.

How do I use it?

The shots are given by your healthcare provider after surgery or an injury, usually while you are in a hospital, surgical clinic, or emergency room.

If your healthcare provider has prescribed tablets to be taken by mouth after the shots, be sure to follow the directions exactly. Take this medicine with food. Do not take more tablets than your healthcare provider prescribes. Do not take double doses, and do not take the tablets if you do not have any pain.

This is a strong medicine that can cause ulcers and other intestinal or stomach problems. Therefore, follow your healthcare provider's directions carefully. If you are not sure of the dosage or other directions, ask your healthcare provider or pharmacist to explain.

Check with your healthcare provider before using this medicine in children under age 17.

To prevent severe side effects, treatment with this medicine should not last longer than 5 days. If you need pain relief after 5 days, your healthcare provider will prescribe another pain reliever.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: nausea, vomiting, stomach pain, drowsiness, black or bloody bowel movements, coughing blood, decreased urination, shallow breathing, fainting, coma.

What should I watch out for?

Warning: This medicine may cause ulcers and bleeding in the stomach and intestines at any time during treatment. This may happen without warning symptoms. If you have stomach pain, or bloody or black tarry bowel movements, stop taking this medicine and contact your healthcare provider right away.

NSAIDs may increase the chance of a heart attack or stroke that can lead to death. This chance increases if you:

• Use NSAIDs for a long time
• Have heart disease

Talk with your healthcare provider about this.

Adults over the age of 65 and people with liver or kidney disease require lower dosages of this medicine. Follow your healthcare provider's directions carefully.

This medicine may cause an allergic reaction in people who have asthma or who have had an allergic reaction to aspirin or other Nonsteroidal anti-inflammatory medicines (NSAIDs). If you develop hives, itching, a rash, tightness in your chest, or trouble breathing, stop taking this medicine and contact your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.

Do not take other pain medicines or drink alcohol while you are taking this medicine without your healthcare provider's approval.

This medicine may make you drowsy or dizzy. Do not drive or operate machinery until you are fully alert.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives, itching, rash, swelling of your face or throat, tightness in your chest, trouble breathing).

Serious (Report these to your healthcare provider right away.): Severe drowsiness; severe nausea or vomiting; stomach pain; tarry or bloody bowel movements; swelling of hands, feet, ankles, or legs, or any unexplained swelling; unusual tiredness or weakness; yellowing of the skin or eyes; severe skin rash or blisters; unusual bruising or bleeding; blood in the urine or trouble urinating.

Other: Pain where the injection was given, indigestion, nausea, vomiting, gas, constipation, diarrhea, headache, dizziness, sweating, nervousness, depression.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), quinapril (Accupril), and ramipril (Altace)
• Aliskiren (Tekturna) and aliskiren/hydrochlorothiazide (Tekturna HCT)
• Alprazolam (Xanax)
• Angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• Antibiotics such as ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), and ofloxacin
• Antidepressants such as amitriptyline, citalopram (Celexa), clomipramine, desipramine (Norpramin), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), nefazodone, nortriptyline (Pamelor), sertraline (Zoloft), trazodone, and venlafaxine (Effexor)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol) and phenytoin (Dilantin, Phenytek)
• Aspirin and other salicylates
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), pindolol, and sotalol (Betapace, Sorine)
• Bile acid sequestrants such as cholestyramine (Prevalite), colesevelam (Welchol), and colestipol (Colestid)
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Cancer medicines such as capecitabine (Xeloda), dasatinib (Sprycel), floxuridine, fluorouracil (Adrucil, Carac, Efudex, Fluoroplex), ibritumomab (Zevalin), ibrutinib (Imbruvica), obinutuzumab (Gazyva), pemetrexed (Alimta), and pralatrexate (Folotyn)
• Corticosteroids such as cortisone, dexamethasone, hydrocortisone (A-Hydrocort, Cortef), methylprednisolone (Medrol, Solu-Medrol), prednisolone (Omnipred, Orapred, Prelone), prednisone (Prednisone Intensol), and triamcinolone (Aristospan, Kenalog)
• Desmopressin (DDAVP)
• Digoxin (Lanoxin)
• Diuretics (water pills) such as amiloride, bumetanide, chlorothiazide (Diuril), chlorthalidone, eplerenone (Inspra), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (Microzide), spironolactone (Aldactone), torsemide (Demadex), and triamterene (Dyrenium)
• Doxepin (Silenor)
• Haloperidol (Haldol)
• Hydralazine
• Immunosuppressants such as cyclosporine (Gengraf, Neoral, Sandimmune) and tacrolimus (Astagraf, Prograf, Protopic)
• Lithium (Lithobid)
• Medicines to treat bone loss such as alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel, Atelvia), and zoledronic acid (Reclast, Zometa)
• Medicines to treat or prevent blood clots such as abciximab (ReoPro), apixaban (Eliquis), argatroban, bivalirudin (Angiomax), clopidogrel (Plavix), dabigatran (Pradaxa), dipyridamole (Persantine), edoxaban (Savaysa), lepirudin (Refludan), prasugrel (Effient), rivaroxaban (Xarelto), tirofiban (Aggrastat), and warfarin (Coumadin)
• Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
• Milnacipran (Savella)
• Natural remedies such as alfalfa, anise, bilberry, cat’s claw, celery, chamomile, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo biloba, ginseng, glucosamine, green tea, horse chestnut seed, licorice, red clover, SAMe, and sweet clover
• Other medicines that contain nonsteroidal anti-inflammatory medicines (NSAIDs) such as other pain or fever medicines, or allergy, cold, or cough medicines
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Pentoxifylline
• Probenecid
• Propranolol (Hemangeol, Inderal, InnoPran)
• Thiothixene (Navane)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicines in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.