Ketorolac

Ketorolac
Clinical data
Trade namesToradol, Acular, Sprix, others
Other namesKetorolac tromethamine
AHFS/Drugs.comMonograph
MedlinePlusa693001
License data
Pregnancy
category
  • AU: C
Routes of
administration		By mouth, under the tongue, intramuscular, intravenous, eye drops, nasal spray
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability80–100% (oral) 100% IV/IM
MetabolismLiver
Elimination half-life3.5 h to 9.2 h, young adults;
4.7 h to 8.6 h, elderly (mean age 72)
ExcretionKidney: 91.4% (mean)
Biliary: 6.1% (mean)
Identifiers
  • (±)-5-benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
PDB ligand
CompTox Dashboard (EPA)
ECHA InfoCard100.110.314 Edit this at Wikidata
Chemical and physical data
FormulaC15H13NO3
Molar mass255.273 g·mol−1
3D model (JSmol)
ChiralityRacemic mixture
  • O=C(c1ccc2n1CCC2C(=O)O)c3ccccc3
  • InChI=1S/C15H13NO3/c17-14(10-4-2-1-3-5-10)13-7-6-12-11(15(18)19)8-9-16(12)13/h1-7,11H,8-9H2,(H,18,19) checkY
  • Key:OZWKMVRBQXNZKK-UHFFFAOYSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Ketorolac, sold under the brand name Toradol among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain.[3][4] Specifically it is recommended for moderate to severe pain.[5] Recommended duration of treatment is less than six days,[4] and in Switzerland not more than seven days (parenterally two days).[6] It is used by mouth, by nose, by injection into a vein or muscle, and as eye drops.[4][5] Effects begin within an hour and last for up to eight hours.[4] Ketorolac also has antipyretic (fever-reducing) properties.[7][8]

Common side effects include sleepiness, dizziness, abdominal pain, swelling, and nausea.[4] Serious side effects may include stomach bleeding, kidney failure, heart attacks, bronchospasm, heart failure, and anaphylaxis.[4] Use is not recommended during the last part of pregnancy or during breastfeeding.[4] Ketorolac works by blocking cyclooxygenase 1 and 2 (COX1 and COX2), thereby decreasing production of prostaglandins.[4][9]

Ketorolac was patented in 1976 and approved for medical use in 1989.[10][4] It is available as a generic medication.[5] In 2021, it was the 210th most commonly prescribed medication in the United States, with more than 2 million prescriptions.[11][12]

Due to a series of deaths due to gastrointestinal bleeding and kidney failure, ketorolac as a pain medication was removed from the German market in 1993.[13] When ketorolac was introduced into Germany, it was often used as an opioid replacement in pain therapy because its side effects were perceived as much less severe, it did not produce any dependence, and a dose was effective for 7–8 hours compared to morphine with 3–4 hours. As a very potent prostaglandin inhibitor, ketorolac diminishes the kidney's own defenses against vasoconstriction-related effects, e.g. during blood loss or high endogenous catecholamine levels.[14]

  1. ^ "Ketorolac Trometamol 30 mg/ml solution for injection - Summary of Product Characteristics (SmPC) - (emc)". www.medicines.org.uk. Retrieved 26 October 2024.
  2. ^ "Prescription medicines: registration of new generic medicines and biosimilar medicines, 2017". Therapeutic Goods Administration (TGA). 21 June 2022. Archived from the original on 6 July 2023. Retrieved 30 March 2024.
  3. ^ Mallinson T (2017). "A review of ketorolac as a prehospital analgesic". Journal of Paramedic Practice. 9 (12): 522–526. doi:10.12968/jpar.2017.9.12.522. Archived from the original on 5 June 2018. Retrieved 2 June 2018.
  4. ^ a b c d e f g h i "Ketorolac Tromethamine Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Archived from the original on 8 April 2019. Retrieved 13 April 2019.
  5. ^ a b c British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. pp. 1144, 1302–1303. ISBN 9780857113382.
  6. ^ "TORA-DOL Inj Lös 30 mg/ml". Kompendium (in German). 1 March 2022. Archived from the original on 7 June 2023. Retrieved 24 March 2023. Die Behandlung mit Ampullen ist bei akuten und schweren Schmerzzuständen angezeigt und sollte nicht länger als 2 Tage dauern.
  7. ^ Gillis JC, Brogden RN (January 1997). "Ketorolac. A reappraisal of its pharmacodynamic and pharmacokinetic properties and therapeutic use in pain management". Drugs. 53 (1): 139–88. doi:10.2165/00003495-199753010-00012. PMID 9010653.
  8. ^ Mehmood KT, Al-Baldawi S, Zúñiga Salazar G, Zúñiga D, Balasubramanian S (January 2024). "Antipyretic Use in Noncritically Ill Patients With Fever: A Review". Cureus. 16 (1): e51943. doi:10.7759/cureus.51943. PMC 10851038. PMID 38333494.
  9. ^ "DailyMed - ketorolac tromethamine tablet, film coated". dailymed.nlm.nih.gov. Archived from the original on 13 August 2020. Retrieved 14 April 2019.
  10. ^ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 521. ISBN 9783527607495.
  11. ^ "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
  12. ^ "Ketorolac - Drug Usage Statistics". ClinCalc. Archived from the original on 29 February 2024. Retrieved 14 January 2024.
  13. ^ "Abverkauf von Ketorolac (TORATEX) gestoppt" [Sale of Ketorolac (TORATEX) stopped]. 1993. Archived from the original on 3 October 2023. Retrieved 24 March 2023.
  14. ^ "Warnhinweis: Wie lange noch Analgetikum Ketorolac (Toratex)?" [Warning notice: How long anymore analgesic Ketorolac (Toratex)?] (in German). Arznei-Telegramm. 1993. Archived from the original on 24 March 2023. Retrieved 24 March 2023.