Ketorolac Nasal Spray

Ketorolac is used for the short-term relief of moderate to moderately severe pain and should not be used for longer than 5 days in a row, for mild pain, or for pain from chronic (long-term) conditions. You may be given ketorolac to take by mouth or as an injection before you begin using ketorolac nasal spray. You must stop using nasal ketorolac on the fifth day after you receive your first dose of ketorolac in any form. Talk to your doctor if you still have pain after 5 days of treatment with ketorolac.

Ketorolac nasal spray should not be used to relieve pain in children 17 years of age or younger.

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, bleeding or clotting problems, 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 than 65 years of 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 (Coumadin); aspirin; or oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); or selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). Do not take aspirin or other NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) 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 or bleeding in your stomach or intestines. 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.

Ketorolac may cause an increased risk of bleeding. It may take longer than usual for you to stop bleeding if you are cut or injured. Tell your doctor if you have or have ever had a bleeding disorder, or bleeding in your brain. Your doctor will probably tell you not to use ketorolac nasal spray. Call your doctor if you have bleeding that is unusual or if you fall and get hurt, especially if you hit your head.

Ketorolac may cause kidney failure. Tell your doctor if you have kidney or liver disease, if you have had severe vomiting or diarrhea or think you may be dehydrated, and if you are taking angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); angiotensin II receptor blockers such as azilsartan (Edarbi), candesartan(Atacand), eprosartan (Teveten), irbesartan (Avapro, in Avalide), losartan (Cozaar, in Hyzaar), olmesartan (Benicar, in Azor), telmisartan (Micardis), and valsartan (Diovan, in Exforge); or diuretics ('water pills'). If you experience any of the following symptoms, stop using ketorolac and call your doctor: swelling of the hands, arms, feet, ankles, or lower legs; unexplained weight gain; decreased urination, confusion; or seizures.

Keep all appointments with your doctor. Be sure to tell your doctor how you are feeling so that your doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with ketorolac. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (https://www.fda.gov/Drugs) to obtain the Medication Guide.

Talk to your doctor about the risks of using ketorolac nasal spray.

Ketorolac nasal spray is used for the short-term relief of moderate to moderately severe pain. Ketorolac is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

Nasal ketorolac comes as a liquid to spray in the nose. It is usually used once every 6 to 8 hours as needed to control pain for up to 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.

Before you use ketorolac nasal spray for the first time, read the written instructions that come with the medication. Be sure that you understand how to prepare the bottle before the first use and how to use the spray. Ask your doctor or pharmacist if you have any questions about how to use this medication.

Ketorolac nasal spray is only for use in the nose. Be careful not to get the medication 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.

You may have an uncomfortable feeling in your throat after you use ketorolac nasal spray. If this happens, drink a sip of water.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using ketorolac nasal spray,

• Tell your doctor if you are allergic to ketorolac, aspirin or other NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn), any other medications, or ethylendiamine tetraacetic acid (EDTA; an ingredient found in some foods and medications), or any of the other ingredients in ketorolac nasal spray. Ask your pharmacist for a list of the ingredients.
• tell your doctor if you are taking pentoxifylline (Pentoxil, Trental) or probenecid. Your doctor will probably tell you not to use ketorolac nasal spray if you are taking these medications.
• 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 using ketorolac nasal spray with your doctor and pharmacist. Before starting, stopping, or changing any medications while using ketorolac nasal spray, please get the advice of your doctor or pharmacist.
• the following nonprescription products may interact with ketorolac nasal spray: aspirin and inonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve). Be sure to let your doctor and pharmacist know that you are taking these medications before you start using ketorolac nasal spray. Do not start any of these medications while using ketorolac nasal spray without discussing with your healthcare provider.
• 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), 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).
• tell your doctor if you are pregnant, plan to become pregnant; or are breast-feeding. Ketorolac nasal spray may harm the fetus and cause problems with delivery if it is used around 20 weeks or later during pregnancy. Do not use ketorolac nasal spray around or after 20 weeks of pregnancy, unless you are told to do so by your doctor. If you become pregnant while using ketorolac nasal spray, call your doctor.
• If you are having surgery, including dental surgery, tell the doctor or dentist that you are using ketorolac nasal spray.

Make sure you drink plenty of fluids while using ketorolac nasal spray.

Unless your doctor tells you otherwise, continue your normal diet.

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.

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
• difficulty breathing or swallowing
• hoarseness
• 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
• blistering or peeling skin
• slow heartbeat

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).

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).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

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)

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.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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