Ketorolac events

Ketorolac tromethamine Ketorolac is indicated for the short-term (up to 5 days) management of moderately severe acute pain that requires analgesia at the opioid level. It is not indicated for minor or chronic painful conditions. Increasing the dose beyond the label recommendations will not provide better efficacy but will result in increasing risk of developing serious adverse events. 

Bromfenac 0.09% (Xibrom, ISTA) has been approved for topical application outside the United States for many years. Bromfenac has compiled an excellent safety record with only 13 reported postmarketing adverse events among 6 million prescriptions written. Perhaps its greatest advantage is reported less initial stinging on instillation (1.5% vs. 20% to 45% for ketorolac 0.4%).The current FDA approval is for the management of postoperative cataract surgery pain. 

The most frequent adverse event reported with ketorolac use is transient stinging and burning after instillation of the ophthalmic solution. Rarely, allergic reactions and superficial keratitis have occurred. Although inconsistent cases of corneal toxicity have been reported with NSAIDs, prolonged use of NSAIDs in a select group of patients showed the potential for corneal melt. Because other treatment options exist for allergic eye disease, NSAIDs do not need to be used in patients with compromised corneas or those at risk for potentially serious adverse corneal reactions. 

A review of bleeding events associated with the use of postoperative ketorolac revealed that a small number of patients were also taking pentoxifylline. The UK manufacturers therefore recommend that this drug combination should be avoided, whereas the US manufacturers make no mention of this tentative interaction. There seems to be no evidence regarding this interaction with other NSAIDs. 

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