Ketorolac (nasal)

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID).

Ketorolac nasal (for the nose) is used for a short time (5 days or less) to treat moderate to severe pain.

Ketorolac may also be used for reasons not mentioned in this medication guide.

You should not use ketorolac if you have severe kidney disease, a bleeding or blood clotting disorder, bleeding in your brain, a stomach ulcer or a history of stomach bleeding, or if you have ever had a severe allergic reaction after taking aspirin or an NSAID. Do not use this medicine for longer than 5 days.

Ketorolac can increase your risk of a fatal heart attack or stroke, even if you do not have any risk factors. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Ketorolac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults.

Pentoxifylline or probenecid can interact with ketorolac and should not be used at the same time.

Ketorolac can increase your risk of a fatal heart attack or stroke, even if you do not have any risk factors. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Ketorolac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can happen without warning while you are using this medicine, especially in older adults.

You should not use this medicine if you are allergic to ketorolac, or if you have:

• severe kidney disease;
• a bleeding or blood clotting disorder;
• a closed head injury or bleeding in your brain;
• a stomach ulcer, perforation, or a history of stomach or intestinal bleeding; or
• if you are breast-feeding a baby; or
• if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID.

Pentoxifylline or probenecid can interact with ketorolac and should not be used at the same time.

Do not use ketorolac nasal if you are already taking aspirin or other NSAIDs, or using other forms of ketorolac (such as injections or pills you take by mouth).

Tell your doctor if you have ever had:

• heart disease, high blood pressure;
• a heart attack, stroke, or blood clot;
• stomach ulcers or bleeding;
• ulcerative colitis or Crohn's disease;
• asthma;
• liver or kidney disease;
• fluid retention; or
• if you smoke.

If you are pregnant, you should not use ketorolac nasal unless your doctor tells you to. Using an NSAID during the last 20 weeks of pregnancy can cause serious heart or kidney problems in the unborn baby and possible complications with your pregnancy.

Ketorolac may affect ovulation, which could temporarily affect fertility (your ability to have children).

Tell your doctor if you are breastfeeding.

Ketorolac nasal is not approved for use by anyone younger than 2 years old.

Get emergency medical help if you notice signs of an allergic reaction (hives, trouble breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Get emergency medical help if you have signs of a heart attack or stroke: chest pain that spreads to your jaw or shoulder, sudden numbness or weakness on one side of your body, slurred speech, leg swelling, or feeling short of breath.

Ketorolac may cause serious side effects. Stop using ketorolac and call your doctor right away if you have:

• any skin rash, no matter how mild;
• high blood pressure—severe headache, blurred vision, pounding in your neck or ears;
• heart problems—swelling, rapid weight gain, feeling short of breath;
• kidney problems—little or no urination, swelling in your feet or ankles, feeling tired or short of breath;
• liver problems—nausea, upper stomach pain, itching, tiredness, flu-like symptoms, dark urine, jaundice (yellowing of the skin or eyes);
• low red blood cells (anemia)—pale skin, unusual tiredness, feeling light-headed or short of breath, cold hands and feet; or
• signs of stomach bleeding—bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.

Common side effects of ketorolac may include:

• heartburn, stomach pain, gas, nausea, vomiting;
• diarrhea, constipation;
• slow heartbeats;
• decreased urination;
• abnormal liver function tests;
• increased blood pressure;
• pain or irritation in your nose;
• runny nose;
• watery eyes;
• throat irritation; or
• rash.

This is not a complete list of side effects, and others may happen. Call your doctor for medical advice about side effects. You can report side effects to the FDA at 1-800-FDA-1088.

Follow all directions on your prescription label and read all medication guides. Use the lowest dose that is effective in treating your condition.

Ketorolac nasal is usually given every 6 to 8 hours. Use only the number of sprays prescribed by your doctor.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

Do not use ketorolac for longer than 5 days unless your doctor has told you to.

Each bottle of ketorolac contains 8 sprays for use within a 24-hour period. Throw the bottle away 24 hours after your first use, even if there is still medicine left inside.

Store unopened nasal spray bottles in a refrigerator. Do not freeze.

After opening a bottle, store it at room temperature in a dry place, out of direct sunlight.

Use the medicine as soon as you can, but skip the missed dose if it is nearly time for your next dose. Do not use two doses at the same time.

Seek emergency medical help or call the Poison Help line at 1-800-222-1222.

Do not get this medication in your eyes. If this happens, rinse your eyes with water or saline solution. Call your doctor if you have eye irritation for more than 1 hour.

Avoid drinking alcohol. It may raise your risk of stomach bleeding.

Do not take aspirin or other NSAIDs while you are using ketorolac (nasal).

Ask a doctor or pharmacist before using other medicines for pain, fever, swelling, or cold/flu symptoms. They may have ingredients similar to ketorolac (such as aspirin, ibuprofen, ketoprofen, or naproxen).

Sometimes it is not safe to use certain medications together. Some drugs can change the levels of other drugs in your blood, which may increase side effects or make the medications less effective.

Ask your doctor before using ketorolac if you take an antidepressant. Taking certain antidepressants with an NSAID may cause you to bruise or bleed easily.

Tell your doctor about all your other medicines, especially:

• lithium;
• methotrexate;
• a blood thinner--warfarin, Coumadin, Jantoven;
• heart or blood pressure medication, including a diuretic or "water pill"; or
• seizure medicine--carbamazepine, phenytoin.

This list is not complete. Other drugs may affect ketorolac, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.