Toradol, Acular, Acular LS
Classifications: analgesic, nonsteroidal antiinflammatory drug (nsaid); antipyretic; Therapeutic:nsaid, analgesic; antipyretic
Pregnancy Category: B
10 mg tablets; 15 mg/mL, 30 mg/mL injection; 0.4%, 0.5% ophthalmic solution
It inhibits synthesis of prostaglandins by inhibiting both COX-1 and COX-2 enzymes. Is a peripherally acting analgesic.
Exhibits analgesic, antiinflammatory, and antipyretic activity. Effective in controlling acute post-operative pain.
Short-term management of pain; ocular itching due to seasonal allergic conjunctivitis, reduction of post-operative pain and photophobia
after refractive surgery.
Hypersensitivity to ketorolac; individuals with complete or partial syndrome of nasal polyps, angioedema, and bronchospastic
reaction to aspirin or other NSAIDs; during labor and delivery; patients with severe renal impairment or at risk for renal failure due to volume depletion;
patients with risk of bleeding; active peptic ulcer disease; pre- or intraoperatively; intrathecal or epidural administration;
in combination with other NSAIDs.
History of peptic ulcers; impaired renal or hepatic function; older adults; debilitated patients; diabetes mellitus; SLE;
CHF; pregnancy (category B); children under 2 years; children under 3 years with ophthalmic solution.
Route & Dosage
Adult: IV Loading Dose 30 mg (15 mg <50 kg) IM 3060 mg loading dose, then 1530 mg q6h [max: 150 mg/d on first day, then 120 mg subsequent days (30 mg load,
then 15 mg q6h if <50 kg)] PO 10 mg q6h prn (max: 40 mg/d) max duration all routes 5 d
Geriatric: IV Loading Dose 15 mg IM 30 mg loading dose, then 15 mg q6h PO 510 mg q6h prn (max: 40 mg/d) max duration all routes 5 d
Pain after Refractive Surgery
Adult: Ophthalmic Acular LS only 1 drop in operative eye q.i.d. up to 4 d
Adult: Ophthalmic 1 drop 0.5% solution q.i.d.
WARNING: Do not administer IV, IM, or PO ketorolac longer than 5 d.
- Give with food to reduce GI effects.
- Do not touch container to the eye when applying ophthalmic drops.
- Inject IM drug slowly and deeply into a large muscle.
- Rotate injection sites to avoid injection site pain in patients receiving multiple doses.
PREPARE: Direct: Give undiluted.
ADMINISTER: Direct: Give IV bolus dose over at least 15 sec. Preferred method is to give through a Y-tube in a free-flowing IV.
INCOMPATIBILITIES Solution/additive: Haloperidol, hydroxyzine, meperidine, morphine, prochlorperazine, promethazine. Y-site: Azithromycin, fenoldopam.
- Store all forms at 15°30° C (59°86° F).
Adverse Effects (≥1%)CNS: Drowsiness,
dizziness, headache. GI: Nausea,
dyspepsia, GI pain, hemorrhage. Other:
Edema, sweating, pain at injection site.
May increase methotrexate
levels and toxicity; may increase lithium
levels and toxicity. Herbal: Feverfew, garlic, ginger, ginkgo
increased bleeding potential.
4560 min. Distribution:
Into breast milk. Metabolism:
In liver. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Correct hypovolemia prior to administration of ketorolac.
- Lab tests: Periodic serum electrolytes and liver functions; urinalysis (for hematuria and proteinuria) with long-term use.
- Monitor urine output in older adults and patients with a history of cardiac decompensation, renal impairment, heart failure,
or liver dysfunction as well as those taking diuretics. Discontinuation of drug will return urine output to pretreatment
- Monitor for S&S of GI distress or bleeding including nausea, GI pain, diarrhea, melena, or hematemesis. GI ulceration with
perforation can occur anytime during treatment. Drug decreases platelet aggregation and thus may prolong bleeding time.
- Monitor for fluid retention and edema in patients with a history of CHF.
Patient & Family Education
- Watch for S&S of GI ulceration and bleeding (e.g., bloody emesis, black tarry stools) during long-term therapy.
- Note: Possible CNS adverse effects (e.g., light-headedness, dizziness, drowsiness).
- Do not drive or engage in potentially hazardous activities until response to drug is known.
- Do not use other NSAIDs while taking this drug.