Sprix

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

Ketorolac is a nonsteroidal anti inflammatory drug (NSAID). This medicine works by reducing substances in the body that cause pain, fever, and inflammation.

Ketorolac nasal (for the nose) is used short-term (5 days or less) to treat moderate to severe pain.

Ketorolac may also be used for purposes not listed in this medication guide.

You should not use ketorolac nasal if you have severe kidney disease, a bleeding or blood clotting disorder, bleeding in your brain, a stomach ulcer or history of stomach bleeding, or if you are breast-feeding a baby. Do not use this medicine for longer than 5 days.

Ketorolac can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Ketorolac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using ketorolac nasal, especially in older adults.

Pentoxifylline or probenecid can interact with ketorolac nasal and should not be used at the same time.

Ketorolac can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Even people without heart disease or risk factors could have a stroke or heart attack while taking this medicine.

Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Ketorolac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using ketorolac nasal, especially in older adults.

You should not use this medicine if you are allergic to ketorolac, or if you have:

• severe kidney disease;
• a bleeding or blood clotting disorder;
• a closed head injury or bleeding in your brain;
• a stomach ulcer, perforation, or a history of stomach or intestinal bleeding;
• if you are breast-feeding a baby; or
• if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID.

Pentoxifylline or probenecid can interact with ketorolac nasal and should not be used at the same time.

Do not use ketorolac nasal if you are already taking aspirin or other NSAIDs, or using other forms of ketorolac (such as injections or pills you take by mouth).

To make sure ketorolac nasal is safe for you, tell your doctor if you have:

• heart disease, high blood pressure, high cholesterol, diabetes, or if you smoke;
• a history of heart attack, stroke, or blood clot;
• a history of stomach ulcers or bleeding;
• ulcerative colitis or Crohn's disease;
• asthma;
• liver or kidney disease;
• fluid retention; or
• if you have recently had surgery.

Using ketorolac nasal during the last 3 months of pregnancy may harm the unborn baby. Ketorolac may also increase the risk of uterine bleeding and is not for use during labor and delivery. Tell your doctor if you are pregnant.

Ketorolac nasal can pass into breast milk and may harm a nursing baby. Do not breast-feed while using this medicine.

Ketorolac nasal is not approved for use by anyone younger than 18 years old.

Get emergency medical help if you have signs of an allergic reaction: sneezing, runny or stuffy nose; wheezing or trouble breathing; hives; swelling of your face, lips, tongue, or throat.

Get emergency medical help if you have heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; or signs of a stroke--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance.

Stop using ketorolac and call your doctor at once if you have:

• shortness of breath (even with mild exertion);
• swelling or rapid weight gain;
• the first sign of any skin rash, no matter how mild;
• signs of stomach bleeding--bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
• liver problems--nausea, upper stomach pain, itching, tired feeling, flu-like symptoms, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• kidney problems--little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath;
• low red blood cells (anemia)--pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or
• severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

• pain or irritation in your nose;
• runny nose;
• watery eyes;
• throat irritation; or
• mild rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Avoid drinking alcohol. It may increase your risk of stomach bleeding.

Avoid taking aspirin or other NSAIDs while you are using ketorolac nasal.

Ask a doctor or pharmacist before using any cold, allergy, or pain medication. Many medicines available over the counter contain aspirin or other medicines similar to ketorolac. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.

Ask your doctor before using ketorolac if you take an antidepressant such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed easily.

Tell your doctor about all your current medicines and any you start or stop using, especially:

• lithium;
• methotrexate;
• heparin or warfarin (Coumadin, Jantoven);
• antipsychotic medicine;
• heart or blood pressure medication, including a diuretic or "water pill";
• seizure medicine (carbamazepine, phenytoin); or
• steroid medicine (such as prednisone).

This list is not complete. Other drugs may interact with ketorolac nasal, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Ketorolac is a prescription medication used for the short-term treatment (up to 5 days) of moderately severe pain following surgery. It is also used for back pain, cancer pain, and pain caused by kidney stones. Ketorolac ophthalmic solution is used to treat itchy eyes caused by allergies and swelling and redness (inflammation) that can occur after cataract surgery. 

Ketorolac belongs to a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

This medication comes in tablet, injectable (intravenous or intramuscular), nasal spray, and ophthalmic solution forms. Ketorolac ophthalmic solution can be taken for up to 2 weeks after cataract surgery.

The side effects you can expect depend upon which form you are taking. For instance, the ophthalmic solution may cause burning and stinging of the eyes and blurry vision. Ketorolac nasal spray may cause nasal pain and discomfort, tearing, runny nose and throat irritation.

Ketorolac tablets may cause drowsiness, dizziness and headache. Do not drive or operate heavy machinery until you know how it affects you.

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of ketorolac, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking ketorolac, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to ketorolac or any other medication, especially aspirin or other NSAIDs
• have had or will have surgery of any sort
• have diabetes, asthma, congestive heart failure, or high blood pressure
• have liver or kidney disease
• have bleeding problems
• have ulcerative colitis or crohn's disease
• have stomach ulcers
• have eye problems
• have rheumatoid arthritis
• frequently use alcohol
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

• Store at room temperature.
• Protect from light.
• Keep this and all medicines out of the reach of children.

Use this medicine only as directed by your doctor to benefit your condition as much as possible. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. Do not use it for more than 5 days in a row. The total number of days also includes any doses of ketorolac that may be given in a hospital or clinic setting. Using too much of this medicine increases the chance of side effects, especially in elderly patients.

This medicine should come with a Medication Guide and patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.

This medicine is only used in the nose. Do not breathe in (inhale) this medicine while spraying. Do not get any of it in your eyes. If it does get in the eyes, rinse them with water or saline right away and call your doctor.

Drink extra fluids while you are using this medicine. This will keep your kidneys working well and help prevent kidney problems.

To use:

• If you are using the nasal spray for the first time, you will need to prime the spray. To do this, pump the bottle 5 times until some of the medicine sprays out. Now it is ready to use.
• Gently blow your nose to clear the nostrils.
• Sit or stand up straight and tilt your head slightly forward.
• Insert the tip of the bottle into your right nostril. Point the bottle away from the center of your nose.
• Hold your breath and spray once into your right nostril. Slowly breathe in through your mouth. You may want to pinch your nose, to allow the medicine to be absorbed in through the skin in your nose.
• If your dose is 2 sprays, spray once into your left nostril the same way.
• After using the spray, wipe the tip of the bottle with a clean tissue and put the clear plastic cover back on.
• Do not use the bottle for more than 24 hours after your first dose. Throw the bottle away after 24 hours even if it still has liquid in it.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For nasal dosage form (spray):
  • For pain:
    • Adults weighing 50 kilograms (kg) or more—31.5 milligrams (mg) or 1 spray in each nostril every 6 to 8 hours. Your doctor may adjust your dose if needed. However, the dose is not more than 126 mg (a total of 8 sprays) per day.
    • Older adults and adults weighing less than 50 kg—15.75 mg or 1 spray in only one nostril every 6 to 8 hours. However, the dose is usually not more than 63 mg (a total of 4 sprays) per day.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Keep the unopened bottle in the refrigerator. Protect it from light and freezing. Once opened, store the bottle at room temperature, away from heat and direct sunlight. Throw away any unused medicine 24 hours after you opened the bottle and used your first dose.

• Store unopened containers in a refrigerator. Do not freeze.
• Store opened nose spray bottle at room temperature. Throw away any unused drug after 24 hours.
• Protect from light.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Check with your pharmacist about how to throw out unused drugs.