Ketorolac is a powerful anti-inflammatory painkiller used for short-term management of moderately severe pain. Unlike most over-the-counter pain relievers in the same drug class, ketorolac is strong enough to serve as an alternative to opioids in many situations, which is why it’s typically given in hospitals or prescribed for just a few days after surgery, injury, or a painful procedure. It’s available as an injection, oral tablet, nasal spray, and eye drops.
How Ketorolac Works
Ketorolac belongs to the NSAID family, the same class as ibuprofen and naproxen. It works by blocking the production of prostaglandins, chemicals your body releases in response to injury that cause pain, swelling, and inflammation. What sets ketorolac apart from other NSAIDs is its potency. Its pain-relieving effect is significantly stronger than what you’d get from standard over-the-counter options, which is why it requires a prescription and has strict limits on how long you can take it.
Primary Uses for Pain
Ketorolac is most commonly used for acute pain that would otherwise require an opioid. The key word is “acute,” meaning short-term pain with a known cause, not chronic conditions like arthritis or back pain. Typical scenarios include:
- Post-surgical pain: One of the most common settings. It’s frequently given after abdominal, orthopedic, and gynecologic surgeries to reduce the amount of opioid medication a patient needs.
- Kidney stones: Ketorolac injections are a go-to treatment in emergency departments for the intense pain of passing a stone.
- Fractures and acute injuries: When over-the-counter pain relievers aren’t enough but doctors want to minimize opioid use.
- Severe headaches and migraines: Often given as an injection in urgent care or ER settings when other treatments haven’t worked.
- Dental pain: Sometimes prescribed after extractions or oral surgery.
In a clinical trial comparing ketorolac to acetaminophen (both given intravenously alongside opioid pain pumps after gynecologic surgery), patients who received ketorolac used significantly less opioid medication and regained bowel function faster, returning to normal gut activity in 2.7 days compared to 3.4 days. Pain scores between the two groups were similar, but ketorolac’s ability to reduce opioid dependence is a major reason it’s favored in surgical recovery.
Ophthalmic (Eye Drop) Uses
Ketorolac also comes as an eye drop solution, and it’s used for entirely different reasons than the injectable or oral forms. The eye drop version treats itchy eyes caused by seasonal allergies. It’s also prescribed to reduce swelling and redness after cataract surgery. The ophthalmic form acts locally on the eye and doesn’t carry the same systemic risks as the oral or injectable versions.
The 5-Day Limit
Ketorolac is not meant for ongoing use. The FDA restricts the total combined duration of oral and injectable ketorolac to no more than 5 days in adults. This is one of the strictest time limits placed on any NSAID, and it exists because the risk of serious side effects climbs sharply the longer you take it.
The biggest concern is gastrointestinal damage. The incidence and severity of GI complications, including stomach ulcers and bleeding, increase with both higher doses and longer treatment courses. This is true of all NSAIDs, but ketorolac’s higher potency makes the risk more significant in a shorter window. Most patients start with an injection in a clinical setting and may transition to oral tablets for a day or two at home, with the total course capped at 5 days regardless of the combination.
Risks and Side Effects
Because ketorolac is a potent NSAID, it carries amplified versions of the risks common to the entire drug class. The most important ones to be aware of:
- Stomach and intestinal bleeding: The most well-documented risk, and the primary reason for the 5-day limit. This can happen without warning symptoms, even in people with no history of stomach problems.
- Kidney effects: NSAIDs reduce blood flow to the kidneys. Ketorolac can be particularly hard on kidney function, especially if you’re dehydrated or already have reduced kidney function.
- Bleeding risk: Ketorolac affects platelet function, which means your blood doesn’t clot as easily. In the gynecologic surgery trial, patients on ketorolac had a larger drop in hemoglobin (2.6 g vs. 2 g) compared to those on acetaminophen, though actual transfusion rates were similar between the groups.
- Cardiovascular risk: Like other NSAIDs, ketorolac may increase the risk of heart attack or stroke, particularly with longer use.
Ketorolac should not be used alongside other NSAIDs, including ibuprofen or naproxen, as stacking these drugs multiplies the risk of side effects without adding meaningful pain relief.
How It Compares to Opioids
One of ketorolac’s biggest advantages is that it provides opioid-level pain relief without the downsides of opioids: no sedation, no risk of addiction, no respiratory depression, and no constipation. In fact, ketorolac appears to help the gut recover faster after surgery compared to relying solely on opioids and acetaminophen. For many patients, especially those undergoing planned surgeries, ketorolac allows doctors to use far less morphine or similar medications during recovery. This makes it a cornerstone of what’s called “multimodal pain management,” where several non-opioid medications are layered together to control pain while keeping opioid use to a minimum.
Who Should Avoid It
Ketorolac isn’t appropriate for everyone. It’s generally not used in people with active stomach ulcers, significant kidney disease, or bleeding disorders. It’s also avoided in patients who are on blood-thinning medications, since it further impairs clotting. People who have had allergic reactions to aspirin or other NSAIDs (including asthma triggered by these drugs) should not take ketorolac. It’s not approved for use in labor and delivery, and it’s not intended for minor aches and pains that respond to standard over-the-counter options. The drug is reserved for pain severe enough to justify its risks within a very short treatment window.