Minimising the adverse effects of ketorolac

Gastrointestinal bleeding and perforation, platelet inhibition with altered haemostasis, and renal impairment are among the list of adverse effects as sociated with the administration of ketorolac. The incidence of serious adv erse events has declined since dosage guidelines were revised. Most of the published literature suggests that the overall risk of gastrointestinal or operative site bleeding related to ketorolac therapy is only slightly highe r than with opioids. The risk for adverse events, however, increases with h igh doses, with prolonged therapy (>5 days) or in vulnerable patients (e.g. the elderly). Acute renal failure has been reported after ketorolac treatm ent but is usually reversible after discontinuation of the drug. As with ot her nonsteroidal anti-inflammatory drugs (NSAIDs), ketorolac may trigger al lergic or hypersensitivity reactions. Careful patient selection is essential if use of ketorolac is considered. C ontraindications to ketorolac use include a history of, or current risk of, gastrointestinal bleeding, risk of renal failure, compromised haemostasis, hypersensitivity to aspirin (acetylsalicylic acid) or other NSAIDs, labour , delivery and nursing. Ketorolac should be prescribed at the lowest dosage necessary to control pain; the duration of therapy should also be limited to as few days as possible. Practitioners should be familiar with, and foll ow, label warnings and dosage guidelines.