Section 02 · Monograph
Ketorolac
Reviewed Nov 2026FDA label
Toradol / SprixNSAID · parenteral
- Forms
- Inj: 15, 30mg/mL | Tab: 10mg | NS: 15.75mg/spray (Sprix)
- Dose
- IV/IM 15-30mg single dose (ED migraine); max 5 days total therapy | Sprix: 31.5mg (one spray each nostril) q6-8h, max 126mg/day
- MOA
- Potent COX inhibition
Black Box Warning
- Increased risk of serious GI bleeding, ulceration and perforation; cardiovascular thrombotic events; renal risk and risk of bleeding; contraindicated in labor and delivery, nursing mothers, and before major surgery; total therapy must not exceed 5 days; anaphylactoid reactions possible
Indications
- Short-term (up to 5 days) management of moderately severe acute pain requiring opioid-level analgesia (injection, tablets, nasal spray)FDA-labeled
Off-Label Uses
- Acute migraine in the emergency department (IV/IM)Off-label
Mechanism of Action
- Potent non-selective COX inhibitor with analgesic efficacy comparable to some opioids for acute pain
Full Dosing
Adult / usual
- Multiple doses: 30mg every 6 hours (max 120mg/day); 15mg every 6 hours (max 60mg/day) in older or renally impaired patients; maximum 5 days
- Sprix nasal spray: 31.5mg (one spray in each nostril) every 6-8 hours, max 126mg/day, up to 5 days
Renal
- IV/IM single dose: 30mg (age under 65) or 15mg (age 65 or older, under 50kg, or renal impairment)
Contraindications
- Active peptic ulcer disease or recent GI bleeding or perforation
- Suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis
- Advanced renal impairment or risk of renal failure from volume depletion
- Concomitant aspirin, other NSAIDs or probenecid/pentoxifylline
- Perioperative CABG pain; labor and delivery; hypersensitivity to NSAIDs
Drug Interactions
- Aspirin and other NSAIDs: contraindicated
- Anticoagulants and antiplatelets: bleeding risk
- ACE inhibitors/diuretics increase renal risk; raises lithium and methotrexate levels
Adverse Effects
- GI bleeding and ulceration
- Acute kidney injury
- Bleeding including intracranial
- Anaphylactoid reactions
- Cardiovascular thrombotic events
Monitoring Parameters
- Renal function and volume status
- Signs of GI bleeding
- Total duration of therapy (maximum 5 days)
Pregnancy & Lactation
- Contraindicated in labor and delivery; avoid at 20 weeks gestation and later
- Contraindicated in nursing mothers per label