What is this medication?

KETOROLAC (kee toe ROLE ak) treats short-term moderate to severe pain. It works by decreasing inflammation. It belongs to a group of medications called NSAIDs.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): SPRIX

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Bleeding disorders
• Cigarette smoker
• Coronary artery bypass graft (CABG) surgery within the past 2 weeks
• Drink more than 3 alcohol-containing drinks a day
• Heart disease
• High blood pressure
• History of stomach bleeding
• Kidney disease
• Liver disease
• Lung or breathing disease, like asthma
• Stomach or intestine problems
• An unusual or allergic reaction to ketorolac, aspirin, other NSAIDs, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

This medication is for use in the nose. Follow the directions on the prescription label. Take your medication at regular intervals. Do not take it more often than directed.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your care team about the use of this medication in children. This medication is not approved for use in children.

Patients over 65 years old may have a stronger reaction and need a smaller dose.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

What may interact with this medication?

Do not take this medication with any of the following:

• Aspirin and aspirin-like medications
• Cidofovir
• Methotrexate
• NSAIDs, medications for pain and inflammation, like ibuprofen or naproxen
• Pemetrexed
• Pentoxifylline
• Probenecid

This medication may also interact with the following:

• Alcohol
• Alendronate
• Alprazolam
• Carbamazepine
• Certain medications that treat or prevent blood clots like warfarin, enoxaparin, and dalteparin
• Diuretics
• Flavocoxid
• Fluoxetine
• Garlic
• Ginger
• Ginkgo
• Lithium
• Medications for blood pressure
• Muscle relaxants
• Phenytoin
• Thiothixene

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse.

Do not use this medication for more than 5 days. It is only used for short-term treatment of moderate to severe pain. The risk of side effects such as kidney damage and stomach bleeding are higher if used for more than 5 days.

Do not take other medications that contain aspirin, ibuprofen, or naproxen with this medication. Side effects such as stomach upset, nausea, or ulcers may be more likely to occur. Many non-prescription medications contain aspirin, ibuprofen, or naproxen. Always read labels carefully.

This medication can cause serious ulcers and bleeding in the stomach. It can happen with no warning. Smoking, drinking alcohol, older age, and poor health can also increase risks. Call your care team right away if you have stomach pain or blood in your vomit or stool.

Alcohol may interfere with the effect of this medication. Avoid alcoholic drinks.

This medication may cause serious skin reactions. They can happen weeks to months after starting the medication. Contact your care team right away if you notice fevers or flu-like symptoms with a rash. The rash may be red or purple and then turn into blisters or peeling of the skin. Or, you might notice a red rash with swelling of the face, lips or lymph nodes in your neck or under your arms.

This medication does not prevent a heart attack or stroke. This medication may increase the chance of a heart attack or stroke. The chance may increase the longer you use this medication or if you have heart disease. If you take aspirin to prevent a heart attack or stroke, talk to your care team about using this medication.

Talk to your care team if you are pregnant before taking this medication. Taking this medication between weeks 20 and 30 of pregnancy may harm your unborn baby. Your care team will monitor you closely if you need to take it. After 30 weeks of pregnancy, do not take this medication.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medication affects you. Do not stand up or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
• Heart failure—shortness of breath, swelling of ankles, feet, or hands, sudden weight gain, unusual weakness or fatigue
• Increase in blood pressure
• Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
• Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
• Low red blood cell count—unusual weakness or fatigue, dizziness, headache, trouble breathing
• Rash, fever, and swollen lymph nodes
• Redness, blistering, peeling, or loosening of the skin, including inside the mouth
• Stomach bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds
• Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Dryness or irritation inside the nose
• Increased tears after use
• Irritation in the throat

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store unopened bottles of this medication in the refrigerator. Do not freeze. After opening, store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Get rid of open bottles within 24 hours of opening. Get rid of any unused medication after the expiration date.

To get rid of medications that are no longer needed or expired:

• Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location.
• If you cannot return the medication, ask your pharmacist or care team how to get rid of the medication safely.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.