People who use nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as ketorolac may have a higher risk of having a heart attack or a stroke than people who do not use these medications. These events may happen without warning and may cause death. This risk may be higher for people who use NSAIDs for a long time. Tell your doctor if you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke or 'ministroke'; if you smoke; and if you have or have ever had high cholesterol, high blood pressure, or diabetes. Get emergency medical help right away if you experience any of the following symptoms: chest pain, shortness of breath, numbness or weakness in one part or side of the body, trouble seeing in one or both eyes, trouble walking or loss of balance or coordination, severe headache with no known cause, or slurred speech.
If you will be undergoing a coronary artery bypass graft (CABG; a type of heart surgery), you should not use ketorolac right before or right after the surgery.
NSAIDs such as ketorolac may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, are older in age, have poor health, drink alcohol, or smoke while using ketorolac. Tell your doctor if you take any of the following medications: anticoagulants ('blood thinners') such as warfarin; aspirin; or oral steroids such as dexamethasone, methylprednisolone, and prednisone; or selective serotonin reuptake inhibitors (SSRIs) or serotnin reuptake inhibitors (SNRIs) such as citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline. Do not take aspirin or other NSAIDs such as ibuprofen and naproxen or any other forms of ketorolac while you are using ketorolac nasal spray. Also tell your doctor if you have or have ever had ulcers, bleeding in your stomach or intestines, or any other bleeding or blood clotting disorders. If you experience any of the following symptoms, stop using ketorolac and call your doctor: stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools.
Keep all appointments with your doctor.
You will be given the Medication Guide. Read the information carefully and ask your doctor or pharmacist if you have any questions
Talk to your doctor about the risks of using ketorolac nasal spray.
Why is this medicine prescribed?
Ketorolac nasal spray is used for the short-term relief of moderate to moderately severe pain. Ketorolac is in a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by stopping the body's production of a substance that causes pain, fever, and inflammation.
Are there other uses for this medicine?
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
How should this medicine be used?
Nasal ketorolac comes as a liquid to spray in the nose. Use it once every 6 to 8 hours as needed to control pain. Ketorolac use in all forms (nasal, oral, intravenous (in a vein), or intramuscular (in a muscle should not exceed 5 days.
Use ketorolac nasal spray exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Ketorolac nasal spray comes in bottles that each contain a one-day supply of medication. Do not use any single bottle of ketorolac nasal spray for more than one day. Dispose of the bottle within 24 hours of using the first dose, even if the bottle still contains some medication. You will receive enough bottles of medication so that you have a new bottle to use for each day of treatment.
Ketorolac nasal spray is only for use in the nose. Do not swallow or inhale the nasal spray and be careful not to get it in your eyes. If you do get ketorolac nasal spray in your eye, wash out the eye with water or sterile saline solution and call your doctor if irritation lasts longer than an hour.
To use the nasal spray, follow these steps:
- Read all of the manufacturer's instructions for using the nasal spray before you use your first dose.
- Follow the manufacturer's instructions for priming the nasal spray to ensure it is ready for use.
- Blow your nose.
- Sit up straight or stand.
- Remove the cap.
- Place the tip of the bottle in the nostril.
- Hold the bottle upright and aim the tip toward the back of your nose.
- Hold your breath and spray one time into the nostril by pressing down on both sides of the finger flange.
- Breathe gently through your mouth or pinch your nose to keep the medicine in the nose.
- If your doctor has prescribed more than one dose, repeat steps 6 to 9.
What special precautions should I follow?
Before using ketorolac nasal spray,
- tell your doctor if you are allergic to this medication, any part of this medication, or any other medications, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
- you should know that some medications should not be taken with ketorolac nasal spray. Other medications may cause dosing changes or extra monitoring when taken with ketorolac nasal spray. Make sure you have discussed any medications you are currently taking or plan to take before starting ketorolac nasal spray with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking ketorolac nasal spray, please get the advice of your doctor or pharmacist.
- tell your doctor if you are pregnant, plan to become pregnant; or are breast-feeding. If you become pregnant while taking ketorolac nasal spray, call your doctor.
- tell your doctor if you have or have ever had the conditions listed in the IMPORTANT WARNING section or asthma, especially if you also have frequent stuffed or runny nose or nasal polyps (swelling of the lining of the nose), hives, allergic reaction to aspirin or any other NSAIDs, inflammatory bowel disease such as Crohn's disease (a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea, weight loss, and fever) or ulcerative colitis (a condition which causes swelling and sores in the lining of the colon [large intestine] and rectum), high blood pressure, heart failure, liver or kidney disease.
- you should know that your blood pressure may increase during your treatment with ketorolac nasal spray. Your doctor may monitor your blood pressure during your treatment.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are using ketorolac nasal spray.
What special dietary instructions should I follow?
Make sure you drink plenty of fluids while using ketorolac nasal spray.
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget to take a dose?
This medication is usually used as needed. If your doctor has told you to use ketorolac nasal spray regularly, use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.
What should I do in case of overdose?
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help . If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.
Symptoms of overdose may include the following:
- stomach pain
- nausea
- vomiting
- decreased urination
- bloody, black, or tarry stools
- vomit that is bloody or looks like coffee grounds
- drowsiness
- slowed breathing
- coma (loss of consciousness for a period of time)
What side effects can this medicine cause?
Ketorolac nasal spray may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- pain, discomfort, or irritation in your nose
- increased tears
- irritation in your throat
Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:
- rash; hives; itching; blistering or peeling skin; difficulty breathing or swallowing; swelling of the face or throat
- extreme tiredness, lack of energy, loss of appetite, pain in the upper right part of the stomach, yellowing of the eyes or skin, flu-like symptoms
- fever
- slow heartbeat
- shortness of breath, decreased urination, unusual weight gain, swelling of the arms, legs, hands, and feet
- seizure
Ketorolac nasal spray may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( https://www.fda.gov/Safety/MedWatch ) or by phone ( 1-800-332-1088).What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from direct sunlight, excess heat and moisture (not in the bathroom).
Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.What other information should I know?
Keep all appointments with your doctor.
Do not let anyone else use your medication. This prescription is not refillable. If you continue to have pain after you finish using ketorolac nasal spray, call your doctor.
Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.