Ketorolac

About Ketorolac

Ketorolac is a nonsteroidal anti-inflammatory drug for pain that needs opioid-level relief. The tablet label covers up to five days of moderately severe acute pain in adults and allows the tablets only to continue treatment started with intravenous or intramuscular ketorolac: the oral form is never the first dose. Adults aged 17 to 64 take 20 mg once, then 10 mg every four to six hours as needed; people aged 65 or older, under 50 kg, or with reduced kidney function start with 10 mg. The maximum is 40 mg a day, and the tablets are not approved under age 17. Sprix nasal spray, for adults only, is one spray in each nostril every six to eight hours (one nostril for those same groups). Acular 0.5 percent eye drops and their generics treat allergic eye itching and inflammation after cataract surgery; Acular LS 0.4 percent treats pain after corneal refractive surgery.

The tablet label carries a boxed warning with four parts: stomach and intestinal ulcers, bleeding and perforation, which can be fatal and occur without warning; a higher risk of heart attack and stroke, so it is not used around coronary artery bypass surgery; bleeding, because ketorolac blocks platelets; and kidney failure with advanced kidney disease or dehydration. The Sprix label carries the boxed warning shared by NSAIDs, covering the heart attack, stroke and stomach bleeding risks, with the bleeding and kidney warnings outside the box. It must not be taken with aspirin or any other NSAID, with probenecid or pentoxifylline, before major surgery, or during labor and delivery, and it is not for minor or long-term pain. People who have reacted to aspirin or other NSAIDs with asthma or hives must not take it. Common side effects are headache, abdominal pain, indigestion, nausea, dizziness and drowsiness.

The five-day limit counts injection, tablets and spray together. Brand Toradol tablets are no longer on the market. Each single-day Sprix bottle is discarded 24 hours after the first dose. In pregnancy the label says to avoid ketorolac from about 30 weeks and to limit dose and duration between about 20 and 30 weeks.

Taking Ketorolac

How to take it

Take the tablets every four to six hours, never closer together or more than four a day, and stop on the fifth day after your first ketorolac injection. Do not inhale while using Sprix. Take out contact lenses before the eye drops.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip it. Do not take a double dose.

Storage

Tablets at room temperature in a tight, light-resistant container, out of reach of children. Unopened Sprix in the refrigerator, an opened bottle at room temperature; eye drops at room temperature, protected from light.

Interactions to know about

Aspirin and other NSAIDs, probenecid and pentoxifylline are contraindicated with ketorolac. Blood thinners, oral steroids, SSRIs and SNRIs add to the bleeding risk; ACE inhibitors, angiotensin receptor blockers and diuretics add to the kidney risk; ketorolac can raise lithium and methotrexate levels.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Ketorolac differs from pharmacy to pharmacy

Ketorolac tablets are an old generic that costs pharmacies little, and a course is a few days at most. A prescription for a handful of tablets is mostly dispensing fee, so the quote depends less on the drug than on what each pharmacy charges to fill anything at all.

Sprix is priced as a brand, is refrigerated before opening, and comes in cartons of one or five single-day bottles, so fewer pharmacies keep it. The 0.5 percent eye drops have several generic makers; Acular LS 0.4 percent is a separate brand product and cannot be swapped for them at the counter.

Ways to pay less for Ketorolac without insurance

• Ask for generic substitution, and ask the prescriber to write only the tablets you need for the days left in your five-day course.
• Compare more than one pharmacy, since a small tablet count is mostly dispensing fee.
• For Sprix, ask the maker whether its savings or patient assistance program applies to someone paying cash.
• For eye drops, ask the prescriber whether generic ketorolac 0.5 percent suits you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Ketorolac

1. 1.My course started with an injection; on which day must I stop my tablets?
2. 2.Can I keep taking my daily aspirin, ibuprofen or naproxen while I am on ketorolac?
3. 3.Does my age, weight or kidney function mean I should be on the lower dose?
4. 4.How do I store my Sprix bottles, and when do I throw each one away?

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