Frequently Asked Questions

ketorolac spray

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Nonsteroidal anti-inflammatory agents


Ketorolac spray is only intended for short-term (up to 5 days) treatment of moderate to moderately severe pain. It should not be used to treat minor or long-term pain. Do not use more of ketorolac spray than prescribed. Do not use ketorolac spray to treat children.

Ketorolac spray is a nonsteroidal anti-inflammatory drug (NSAID). It may cause an increased risk of serious, and sometimes fatal, heart and blood vessel problems (eg, a heart attack, a stroke). The risk may be greater if you already have heart problems or if you take ketorolac spray for a long time. Do not use ketorolac spray right before or after coronary artery bypass graft (CABG) surgery.

Ketorolac spray may cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding. Elderly patients may be at greater risk. This may occur without warning signs.

Do not use ketorolac spray if:

  • you are allergic to ketorolac spray, aspirin, or any other NSAIDs (eg, ibuprofen, celecoxib)
  • you are taking another NSAID (eg, ibuprofen, celecoxib)
  • you are in the last 3 months of pregnancy or are in labor
  • you have recently had or will be having CABG surgery
  • you have a stomach ulcer or a history of ulcers or certain severe stomach or bowel problems (eg, bleeding, perforation)
  • you have severe kidney problems or are at risk of kidney failure (eg, low blood volume, dehydrated)
  • you have bleeding in the brain (eg, a stroke, an aneurysm) or bleeding problems (eg, platelet disorder, hemophilia), or you are at risk of bleeding

Do not use ketorolac spray to prevent pain before any major surgery.

Ketorolac spray is used for:

The short-term (up to 5 days) treatment of moderate to moderately severe pain.

Ketorolac spray is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes these symptoms.

Do NOT use ketorolac spray if:

  • you are allergic to any ingredient in ketorolac spray
  • you have had an asthma attack, hives, or another severe allergic reaction (eg, severe rash, breathing difficulties, dizziness) to aspirin or to an NSAID (eg, ibuprofen, naproxen, celecoxib)
  • you have had a severe allergic reaction to ethylenediamine tetraacetic acid (EDTA)
  • you are in the last 3 months of pregnancy or are in labor
  • you have recently had or will be having coronary artery bypass graft (CABG) surgery
  • you have a stomach ulcer, or a history of ulcers or certain severe stomach problems (eg, bleeding, perforation)
  • you have severe kidney problems or are at risk of kidney failure (eg, low blood volume, dehydrated)
  • you have bleeding in the brain (eg, a stroke, an aneurysm), bleeding or clotting problems (eg, a platelet disorder, hemophilia), or you are at risk of bleeding
  • you need to prevent pain before any major surgery
  • you are taking pentoxifylline, probenecid, another formulation of ketorolac spray (eg, tablets, injection), or another NSAID (eg, ibuprofen, celecoxib)

Contact your doctor or health care provider right away if any of these apply to you.

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Before using ketorolac spray:

Some medical conditions may interact with ketorolac spray. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have a history of kidney or liver problems, diabetes, stomach or bowel problems (eg, bleeding, perforation, ulcers, ulcerative colitis, Crohn disease), or frequent heartburn
  • if you have a history of swelling or fluid buildup, asthma, growths in the nose (nasal polyps), or mouth inflammation
  • if you have high blood pressure, blood disorders (eg, anemia, porphyria), bleeding or clotting problems, heart problems (eg, heart failure), or blood vessel disease, or you are at risk of any of these diseases
  • if you have poor health, dehydration or low fluid volume, or low blood sodium levels or if you smoke, drink alcohol, or have a history of alcohol abuse
  • if you take corticosteroids (eg, prednisone) or anticoagulants (eg, warfarin)
  • if you weigh less than 110 lbs (50 kg)
  • if you have recently taken other formulations of ketorolac spray (eg, tablets, injection)

Some MEDICINES MAY INTERACT with ketorolac spray. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Anticoagulants (eg, warfarin), antiplatelet medicines (eg, clopidogrel), aspirin, corticosteroids (eg, prednisone), heparin and other blood thinners (eg, dalteparin), pentoxifylline, rivaroxaban, selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine), or other NSAIDs (eg, ibuprofen, celecoxib) because the risk of bleeding may be increased
  • Probenecid because it may increase the risk of ketorolac spray's side effects
  • Alprazolam, cyclosporine, lithium, methotrexate, quinolones (eg, ciprofloxacin), or thiothixene because the risk of their side effects may be increased by ketorolac spray
  • Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), angiotensin receptor blockers (eg, losartan), carbamazepine, diuretics (eg, furosemide, hydrochlorothiazide), or phenytoin because their effectiveness may be decreased by ketorolac spray

This may not be a complete list of all interactions that may occur. Ask your health care provider if ketorolac spray may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use ketorolac spray:

Use ketorolac spray as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Ketorolac spray comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get ketorolac spray refilled.
  • Do not take ketorolac spray by mouth. Use in your nose only.
  • Before you use each bottle for the first time, you must prime it. Remove the clear plastic cover and the blue plastic safety clip. Hold the bottle at arm's length away from you. Using your index and middle fingers on the top of the bottle and your thumb on the bottom of the bottle, press down evenly and release the pump 5 times. The bottle is now ready to use.
  • To use this nose spray, gently blow your nose. Sit up straight or stand and tilt your head forward slightly. Place the tip of the spray container into the nose. Be sure to point the container away from the center of your nose. Breathe gently through the nostril and squeeze the spray container. If your dose requires 2 sprays, repeat the process for your other nostril. Replace the clear plastic cover after each use.
  • Do NOT use ketorolac spray for more than 5 days. Ketorolac spray is not for the treatment of mild to moderate or chronic pain (eg, headache).
  • Avoid contact with the eyes. If you get ketorolac spray in your eyes, rinse it out with water. If eye irritation persists for more than 1 hour, contact your doctor.
  • Each bottle contains 1 day's supply of ketorolac spray. Discard each bottle within 24 hours of opening it, even if it still contains some unused medicine.
  • If you miss a dose of ketorolac spray and you are taking it regularly, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use ketorolac spray.

Important safety information:

  • Serious stomach ulcers or bleeding can occur with the use of ketorolac spray. Taking it in high doses or for a long time, smoking, or drinking alcohol increases the risk of these side effects. Taking ketorolac spray with food will NOT reduce the risk of these effects. Contact your doctor or emergency room at once if you develop severe stomach or back pain; black, tarry stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling.
  • Serious and sometimes fatal skin reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis) may happen with ketorolac spray. Get medical help right away if you develop a rash; red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes.
  • Do NOT take more than the recommended dose, use more often than prescribed, or use for longer than prescribed without checking with your doctor.
  • Tell your doctor or dentist that you take ketorolac spray before you receive any medical or dental care, emergency care, or surgery.
  • If vomiting or diarrhea occurs, you will need to take care not to become dehydrated. Contact your doctor for instructions.
  • Ketorolac spray is an NSAID. Before you start any new medicine, check the label to see if it has an NSAID (eg, ibuprofen) in it too. If it does or if you are not sure, check with your doctor or pharmacist.
  • Do not take aspirin while you are using ketorolac spray unless your doctor tells you to.
  • Check with your doctor or pharmacist before you take acetaminophen while you are taking ketorolac spray. The risk of liver problems may be increased.
  • Lab tests, including kidney or liver function, blood electrolyte levels, complete blood cell counts, or blood pressure, may be performed while you use ketorolac spray. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
  • Use ketorolac spray with caution in the ELDERLY; they may be more sensitive to its effects, especially stomach bleeding and kidney problems.
  • Ketorolac spray should not be used in CHILDREN younger than 17 years old; safety and effectiveness in these children have not been confirmed.
  • PREGNANCY and BREAST-FEEDING: Ketorolac spray may cause harm to the fetus. Do not use it during the last 3 months of pregnancy. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using ketorolac spray while you are pregnant. Ketorolac spray is found in breast milk. If you are or will be breast-feeding while you use ketorolac spray, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of ketorolac spray:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; gas; headache; heartburn; increased tearing; mild nasal discomfort, irritation, or pain; mild stomach pain or upset; nausea; throat irritation; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue, unusual hoarseness); bloody or black, tarry stools; bloody or cloudy urine; change in the amount of urine produced or trouble urinating; chest, jaw, or left arm pain; confusion; dark urine; depression; fainting; fast, slow, or irregular heartbeat; fever, chills, or persistent sore throat; hallucinations; loss of appetite; mental or mood changes; mouth sores; numbness of an arm or leg; one-sided weakness; pale stools; persistent flu-like symptoms; ringing in the ears; seizures; severe headache or dizziness; severe or persistent stomach pain or nausea; severe vomiting or diarrhea; shortness of breath; sudden or unexplained weight gain; swelling of the arms, hands, legs, or feet; unusual bruising or bleeding; unusual joint or muscle pain; unusual tiredness or weakness; vision or speech changes; vomit that looks like coffee grounds; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of ketorolac spray:

Store unopened bottles of ketorolac spray in the refrigerator, between 36 and 46 degrees F (2 and 8 degrees C). Do not freeze. Store opened bottles of ketorolac spray at room temperature, between 59 and 86 degrees F (15 and 30 degrees C), in a tightly closed container out of direct sunlight. Store upright, away from heat, moisture, and light. Discard opened bottles of ketorolac spray within 24 hours of opening. Do not store in the bathroom. Keep ketorolac spray out of the reach of children and away from pets.

General information:

  • If you have any questions about ketorolac spray, please talk with your doctor, pharmacist, or other health care provider.
  • Ketorolac spray is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take ketorolac spray or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about ketorolac spray. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to ketorolac spray. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using ketorolac spray.

Issue Date: February 4, 2015
Database Edition
Copyright © 2015 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

Not all side effects for ketorolac may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to ketorolac: injectable, solution, tablet

Other dosage forms:

  • nasal spray

In addition to its needed effects, some unwanted effects may be caused by ketorolac. In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking ketorolac:

More common
  • Swelling of face, fingers, lower legs, ankles, and/or feet
  • weight gain (unusual)
Less common
  • Bruising (not at place of injection)
  • high blood pressure
  • skin rash or itching
  • small, red spots on skin
  • sores, ulcers, or white spots on lips or in mouth
  • Abdominal or stomach pain, cramping, or burning that is severe
  • bleeding from the rectum or bloody or black, tarry stools
  • bloody or cloudy urine
  • blue lips and fingernails
  • blurred vision of other vision change
  • burning, red, tender, thick, scaly, or peeling skin
  • chest pain
  • convulsions
  • cough or hoarseness
  • dark urine
  • decrease in amount of urine that is sudden
  • fainting
  • fast, irregular, noisy, or troubled breathing
  • fever with severe headache, drowsiness, confusion, and stiff neck or back
  • fever with or without chills or sore throat
  • hallucinations (seeing, hearing, or feeling things that are not there)
  • hearing loss
  • hives
  • increase in amount of urine or urinating often
  • light-colored stools
  • loss of appetite
  • low blood pressure
  • mood changes or unusual behavior
  • muscle cramps or pain
  • nausea, heartburn, or indigestion that is severe and continues
  • nosebleeds
  • pain in lower back and/or side
  • pain, tenderness, or swelling in the upper stomach area
  • painful or difficult urination
  • pale skin
  • puffiness or swelling of the eyelids or eyes
  • ringing or buzzing in ears
  • runny nose
  • severe restlessness
  • shortness of breath
  • swollen or painful glands
  • swollen tongue
  • thirst that continues
  • tightness in the chest with or without wheezing
  • unusual tiredness or weakness
  • vomiting of blood or material that looks like coffee grounds
  • yellow eyes or skin

Some of the side effects that can occur with ketorolac may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Abdominal or stomach pain (mild or moderate)
  • bruising at place of injection
  • diarrhea
  • dizziness
  • drowsiness
  • headache
  • indigestion
  • nausea
Less common or rare
  • Bloating or gas
  • burning or pain at place of injection
  • constipation
  • feeling of fullness in abdominal or stomach area
  • increased sweating
  • vomiting

For Healthcare Professionals

Applies to ketorolac: injectable solution, nasal spray, oral tablet


The most common adverse reactions among patients treated with ketorolac include abdominal pain, nausea, dyspepsia, and headaches. For patients receiving the nasal spray, nasal discomfort, rhinalgia, increased lacrimation, throat irritation, and rhinitis were reported.[Ref]


A large postmarketing observational study (n=10,000) revealed the incidence of clinically serious gastrointestinal (GI) bleeding was dose dependent and more than double in patients 65 years or older. The incidence of clinically serious GI bleeding after up to 5 days of treatment with doses of 60 mg or less, greater than 60 to 90 mg, greater than 90 to 120 mg, or greater than 120 mg, respectively was 0.4%, 0.4%, 0.9%, and 4.6% in those less than 65 years compared with 1.2%, 2.8%, 2.2%, and 7.7% in those 65 years or older. Among patients with a history of GI perforation, ulcer, or bleeding, these numbers were 2.1%, 4.6%, 7.8%, and 15.4% compared with 4.7%, 3.7%, 2.8%, and 25%, in younger and older patients, respectively.[Ref]

Very common (10% or more): Abdominal pain, dyspepsia, nausea
Common (1% to 10%): Constipation, diarrhea, flatulence, gastrointestinal (GI) fullness, GI ulcers (gastric/duodenal), gross bleeding/perforation, heartburn, stomatitis, vomiting, throat irritation (nasal spray)
Frequency not reported: Anorexia, dry mouth, eructation, esophagitis, excessive thirst, gastritis, glossitis, hematemesis, melena, rectal bleeding, increased appetite, peptic ulcers, ulcers, hematemesis, gastritis
Postmarketing reports: Acute pancreatitis, liver failure, ulcerative stomatitis, exacerbation of inflammatory bowel disease (ulcerative colitis, Crohn's disease), eructation[Ref]


Common (1% to 10%): Anemia, increased bleeding time
Frequency not reported: Bleeding, hematoma, postoperative wound hemorrhage
Postmarketing reports: Agranulocytosis, aplastic anemia, hemolytic anemia, lymphadenopathy, pancytopenia, thrombocytopenia purpura, thrombocytopenia, neutropenia, postoperative wound hemorrhage (rarely requiring blood transfusion)[Ref]

Serious events of bleeding (n=4) or hematoma (n=3) at the operative site were reported in controlled clinical trials in patients (n=455) undergoing major surgeries (primarily knee and hip replacements, and abdominal hysterectomies) receiving ketorolac nasal spray compared with 1 patient in the placebo group (hematoma).

In pediatric patients, an increased risk of bleeding was observed following tonsillectomy. In a retrospective analysis, risk of bleeding following a tonsillectomy with or without adenoidectomy was 10.1% in patients receiving this drug compared with 2.2% in those receiving opioids. The postoperative hemorrhage rate in patients 12 years and younger was 6.5% with ketorolac treatment versus 3.3% without. In a prospective study in patients 3 to 9 years undergoing tonsillectomy with or without adenoidectomy, the overall incidence of bleeding in patients receiving this drug was 16.3% compared with 17% in children receiving morphine. However, during the first 24 hours after surgery, bleeding was observed in 14.3% of the ketorolac group versus 4.2% of the morphine group.[Ref]


Common (1% to 10%): Edema, hypertension, bradycardia
Frequency not reported: Congestive heart failure, palpitations, pallor, tachycardia, syncope, cardiac failure
Postmarketing reports: Arrhythmia, chest pain, flushing, hypotension, myocardial infarction, vasculitis[Ref]

Clinical trials of several cyclooxygenase (COX)-2 selective and nonselective NSAIDs of up to 3 years duration have shown an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs appear to have a similar risk. There is no consistent evidence that concurrent use of aspirin mitigates this increased risk and may be associated with an increased risk of serious gastrointestinal events.[Ref]


Common (1% to 10%): Rash, pruritus, purpura, sweating
Very rare (less than 0.01%):
Frequency not reported: Alopecia, photosensitivity, urticaria
Postmarketing reports: Angioedema, exfoliative dermatitis, erythema multiforme, Lyell's syndrome, bullous reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis[Ref]


Frequency not reported: Anaphylactoid reactions
Postmarketing reports: Laryngeal edema, tongue edema[Ref]


Common (1% to 10%): Abnormal renal function, oliguria
Postmarketing reports: Acute renal failure, nephrotic syndrome[Ref]


Common (1% to 10%): Elevated liver enzymes
Frequency not reported: Hepatitis, jaundice, liver failure[Ref]


Frequency not reported: Weight change
Postmarketing reports: Hyperglycemia, hyperkalemia, hyponatremia[Ref]


Very common (10% or more): Nasal discomfort (15%, nasal spray), rhinalgia (13%, nasal spray)
Common (1% to 10%): Rhinitis (nasal spray)
Frequency not reported: Epistaxis, pulmonary edema, asthma
Postmarketing reports: Bronchospasm, respiratory depression, pneumonia[Ref]

Nervous system

Very common (10% or more): Headaches
Common (1% to 10%): Drowsiness, dizziness
Frequency not reported: Extrapyramidal symptoms, hyperkinesis, inability to concentrate, insomnia, paresthesia, somnolence, stupor, tremors
Postmarketing reports: Aseptic meningitis, convulsions, coma, taste abnormality[Ref]


Common (1% to 10%): Injection site pain[Ref]


Common (1% to 10%): Lacrimation increased (nasal spray)
Postmarketing reports: Conjunctivitis, optic neuritis, visual disturbances, abnormal vision[Ref]


Frequency not reported: Anxiety, depression, euphoria, hallucinations, abnormal dreams, abnormal thinking
Postmarketing reports: Psychosis[Ref]


Common (1% to 10%): Tinnitus
Frequency not reported: Fever, asthenia, malaise, vertigo, hearing loss[Ref]


Frequency not reported: Female infertility[Ref]


Postmarketing reports: Flank pain with or without hematuria and/or azotemia, hemolytic uremia syndrome, increased urinary frequency, oliguria, interstitial nephritis, urinary retention[Ref]


Frequency not reported: Infections, sepsis[Ref]


Postmarketing reports: Myalgia[Ref]


1. "Product Information. Toradol (ketorolac)." Roche Laboratories, Nutley, NJ.

2. Cerner Multum, Inc. "Australian Product Information." O 0

3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

4. "Product Information. Sprix (ketorolac)." American Regent Laboratories Inc, Shirley, NY.

5. "Product Information. Ketorolac Tromethamine (ketorolac)." Hospira Inc, Lake Forest, IL.

More about ketorolac

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  • During Pregnancy or Breastfeeding
  • Dosage Information
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Consumer resources

  • Ketorolac
  • Ketorolac spray
  • Ketorolac tablets
  • Ketorolac nasal
  • Ketorolac Nasal (Advanced Reading)
  • Ketorolac Oral, Intravenous, Injection, Intramuscular (Advanced Reading)
  • Other brands: Toradol, Toradol IM, Toradol IV/IM, Sprix

Professional resources

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Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.