Alcohol
Contraindicated
Textbook-cited
Increased risk of gastric bleeding
Concurrent use is contraindicated
Source: KDT 7e · p950
Drug reference
Ketorolac
NSAID (non-selective COX inhibitor, pyrrolizine carboxylic acid derivative) · Analgesic
Also known as Ketorolac tromethamine
START
IV/IM: 30 mg; PO: 10 mg; use for maximum 5 days only; check baseline renal function and bleeding risk; use PPI gastroprotection
TYPICAL MAX
120 mg/day parenteral; 40 mg/day oral; 5 days TOTAL maximum
STOP IF
GI bleeding, eGFR drop >25%, severe pain persisting >48h (reassess diagnosis), 5-day limit reached
WATCH
Renal function daily if >2 days, GI symptoms, bleeding time if surgical patient, BP
CDSCO approvedSchedule HJan AushadhiNPPA price-controlledATC M01AB15
KDIGO 2024 + manufacturer label
- ONSET
- 30min · IM: 10 min; PO: 30-60 min
- PEAK
- 45min · IM peak
- t½
- 5h · 5-6 hours
- DURATION
- 5h · 4-6 hours analgesia
EXCRETION
Renal (91%, metabolites)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated in third trimester; avoid in first and second trimesters
FDA category + note
Top interactionssee all 12 →
- AlcoholContraindicatedTextbook-citedKDT 7e · p950
- MethylprednisoloneContraindicatedTextbook-citedKDT 7e · p950
- AspirinContraindicatedDatabaseKimi deep-research + Cla
- CiprofloxacinSevereTextbook-citedKDT 7e · p949
Available in India
189 branded formulations and 75 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Non-selective inhibition of cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2), reducing prostaglandin synthesis. Potent analgesic with moderate anti-inflammatory activity. One of the most potent NSAID analgesics available.
Indications
Short-term management of moderately severe acute pain (post-operative, renal colic, musculoskeletal)Single-dose or short-course therapy only (max 5 days)
Dosing
- Adult
- IM/IV: 30-60 mg loading, then 15-30 mg q6h PRN (max 120 mg/day parenteral). PO: 10 mg q4-6h PRN (max 40 mg/day oral). COMBINED: max 5 days TOTAL (parenteral + oral)
- Pediatric
- Not recommended under 16 years
- Renal adjustment
- eGFR 30-59: max 60 mg/day; eGFR <30: avoid
- Hepatic adjustment
- Reduce dose; avoid in severe hepatic impairment
- Geriatric
- Start at lower end of dosing range; max 60 mg/day IM/IV; max 40 mg/day PO
- Max dose
- 120 mg/day (parenteral); 40 mg/day (oral); 5 days maximum duration TOTAL
Pharmacokinetics
Onset
IV: immediate; IM: 10 minutes; PO: 30-60 minutes
Peak effect
IM: 30-60 minutes; PO: 1-1.5 hours
Duration
4-6 hours
Half-life
4-6 hours
Bioavailability
PO: 80-100%
Protein binding
99%
Metabolism
Hepatic glucuronidation and hydroxylation (minor CYP involvement)
Excretion
Renal (91.4%, primarily as metabolites and conjugates); fecal (6.1%)
Contraindications
- Active or history of peptic ulcer disease or GI bleeding
- Severe renal impairment (eGFR <30 or risk of renal failure)
- Hypovolemia or dehydration
- Hemorrhagic diathesis or coagulation disorders
- History of asthma with NSAID sensitivity
- Peri-operative pain in CABG surgery (black box warning)
- Severe hepatic impairment
- Third trimester pregnancy
- Concurrent aspirin or other NSAIDs
- Prophylactic use before major surgery
- Labor and delivery
Side effects
Common
DrowsinessDizzinessHeadacheNauseaDyspepsiaAbdominal painEdemaHypertension
Serious
- GI bleeding, ulceration, perforation (black box warning)
- Renal failure / nephrotoxicity
- Hemorrhage (prolonged bleeding time)
- Anaphylaxis
- Hepatotoxicity
- Cardiovascular thrombotic events
Pregnancy & lactation
Pregnancy
Contraindicated in third trimester; avoid in first and second trimesters
Lactation
Excreted in breast milk; avoid during breastfeeding
Drug interactions
Methylprednisolone
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Aspirin
Contraindicated
Database
Additive GI bleeding and renal toxicity; no additional analgesic benefit
Do not combine with other NSAIDs or aspirin
Source: Kimi deep-research + Cla
Ciprofloxacin
Severe
Textbook-cited
Enhanced CNS toxicity including seizures.
Avoid concurrent use
Source: KDT 7e · p949
Dexamethasone
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Glibenclamide
Severe
Textbook-cited
Hypoglycemia
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Gliclazide
Severe
Textbook-cited
Hypoglycemia
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Glimepiride
Severe
Textbook-cited
Hypoglycemia.
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Glipizide
Severe
Textbook-cited
Hypoglycemia.
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Heparin
Severe
Textbook-cited
Increased bleeding risk.
Avoid concurrent use
Source: KDT 7e · p949
Hydrocortisone
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Levofloxacin
Severe
Textbook-cited
Enhanced CNS toxicity, seizure risk.
Avoid concurrent use
Source: KDT 7e · p949
Related guidelines
Ask House about Ketorolac
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19