Ketorolac
Ketorolac tromethamine
Also known as: Toradol · Acular · RS-37619-00-31-3 · Ketorolac trometamol
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| As an analgesic | 0.5 mg/kg IV three times daily or 0.3 mg/kg PO twice daily | IV, PO | TID (IV) or BID (PO) | < 3 days | 🌎 NA |
| As an analgesic | 0.3-0.5 mg/kg IV , IM q8-12h for one or two doses | IV, IM | q8-12h | 1-2 doses | 🌎 NA |
| Anterior uveitis and ulcerative keratitis | 1 drop per eye | topical | q6-24h | — | 🌍 EU |
- As an analgesic: Repeated doses have considerable potential for causing GI or renal toxicity. Treated dogs should receive misoprostol.
- Anterior uveitis and ulcerative keratitis: Frequency depends on the severity of inflammation.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| As an analgesic | 0.25 mg/kg IM q8-12h for one or two doses | IM | q8-12h | 1-2 doses | 🌎 NA |
| Anterior uveitis and ulcerative keratitis | 1 drop per eye | topical | q6-24h | — | 🌍 EU |
- Anterior uveitis and ulcerative keratitis: Frequency depends on the severity of inflammation.
Small Mammals
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| As an analgesic (Mice) | 0.7-10 mg/kg PO once daily | PO | once daily | — | 🌎 NA |
| As an analgesic (Rats) | 3-5 mg/kg PO once to twice a day; 1 mg/kg IM once to twice a day | PO, IM | once to twice a day | — | 🌎 NA |
Goats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| As an analgesic | 0.3-0.7 mg/kg IV , IM, SC, PO three times daily | IV, IM, SC, PO | three times daily | — | 🌎 NA |
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Ketorolac is a highly potent non-steroidal anti-inflammatory drug (NSAID) used primarily for short-term analgesia in veterinary medicine.
- Clinical Pearl: While ketorolac provides profound pain relief (often compared to opioids in human medicine), its use in dogs and cats is highly controversial and generally discouraged due to the availability of safer, veterinary-approved NSAIDs.
- It carries a very high risk of gastrointestinal toxicity (ulceration and perforation) and renal toxicity, especially with repeated dosing.
- If used in dogs, most clinicians strictly limit treatment to less than 3 days and strongly recommend concurrent administration of gastroprotectants like misoprostol (with or without sucralfate).
Mechanism of action
Ketorolac exerts its analgesic, anti-inflammatory, and antipyretic effects by non-selectively inhibiting cyclooxygenase (COX-1 and COX-2) enzymes.
Arachidonic Acid → COX-1/COX-2 Inhibition → Decreased synthesis of prostaglandins and thromboxanes.
By blocking prostaglandin production, it reduces inflammation and pain signaling. However, the profound inhibition of constitutive COX-1 also depletes protective prostaglandins in the gastric mucosa and kidneys, leading to its severe ulcerogenic and nephrotoxic side effect profile in small animals.
Safety & warnings
Contraindications
- Active GI ulcers
- History of hypersensitivity to ketorolac
- Pre-existing hematologic, renal, or hepatic disease (relative contraindication)
- Known hypersensitivity to NSAIDs
- Use with extreme caution in patients with deep or progressive corneal ulcers
Adverse effects
- Gastrointestinal ulceration and erosion
- Gastrointestinal perforation
- Renal toxicity
- Hepatic toxicity
- Platelet inhibition (increased bleeding risk)
- Local ocular irritation
- Delayed corneal epithelial healing
- Increased intraocular pressure (IOP)
- Corneal 'melting' (keratomalacia) - reported in humans, theoretical risk in animals
Precautions
Use cautiously in patients with a history of GI ulcers, heart failure (may cause fluid retention), and in geriatric patients. Long-term use (>3 days) is not recommended in dogs due to a high tendency to cause gastric erosion and ulcers. Animals suffering from inflammation secondary to concomitant infection should receive appropriate antimicrobial therapy.
Drug interactions
Increased risk for nephrotoxicity
Hallucinations reported in some human patients taking with ketorolac
Increased risk for nephrotoxicity
Increased risk for bleeding possible
Increased likelihood of GI adverse effects (blood loss)
May increase risk for GI ulceration
Concomitant administration with NSAIDs may significantly increase the risks for GI adverse effects
May increase risk for nephrotoxicity
May increase NSAID levels
Hallucinations reported in some human patients taking with ketorolac
Ketorolac may reduce the saluretic and diuretic effects of furosemide
Serious toxicity has occurred when NSAIDs have been used concomitantly; use together with extreme caution
Ketorolac may potentiate effects
May cause a significant increase in serum levels and half-life of ketorolac
May lead to increased corneal penetration of the NSAID
Concurrent use is a identified risk factor for precipitating severe corneal problems (e.g., corneal melting)
Monitoring
- Analgesic and anti-inflammatory efficacy
- Gastrointestinal signs (appetite, vomiting, diarrhea, occult blood in feces)
- Renal function parameters (BUN, creatinine, urinalysis) with repeated use
- Intraocular pressure (IOP), especially in predisposed breeds
- Corneal healing via fluorescein staining
- Signs of corneal melting or worsening ulceration
Pharmacokinetics
Half-life
Absorption
Rapidly absorbed after oral administration; in dogs peak levels occur in about 50 minutes and oral bioavailability is about 50-75%.
Distribution
Distributed marginally through the body. Highly bound to plasma proteins (99%). Volume of distribution in dogs is about 0.33-0.42 L/kg. Crosses the placenta but does not appear to cross the blood-brain barrier.
Metabolism
Primarily metabolized via glucuronidation and hydroxylation.
Elimination
Both unchanged drug and metabolites are excreted mainly in the urine. Patients with diminished renal function will have longer elimination times.
Overdose
Ketorolac has a narrow margin of safety in small animals.
- Cats: Have developed renal toxicity at doses as low as 0.7 mg/kg.
- Mice: The oral LD50 is 200 mg/kg.
- Clinical Signs: GI effects, including severe GI ulceration and bleeding, are highly likely in overdoses in small animals. Metabolic acidosis has been reported in humans.
- Treatment: Consider GI emptying for large, recent overdoses. Patients must be closely monitored for GI bleeding and renal impairment. Treat aggressively with GI protectants (sucralfate) and consider giving misoprostol early.
Available products
Formulations
- Tablets
- Injection
- Ophthalmic drops: 0.5% solution
Human-labeled
- Ketorolac Tromethamine Tablets: 10 mg
- Ketorolac Tromethamine Injection: 15 mg/mL & 30 mg/mL in 1 mL, 2 mL single-dose vials, & 10 mL multiple-dose vials
- Acular 0.5% eye drops (5 ml bottle)
Regulatory status
Human authorized product (Acular) used off-label under the cascade.
Human authorized product (Acular) used off-label under the cascade.
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store tablets and injection at room temperature and protect from light. Protect tablets from excessive humidity. The injection is stable for at least 48 hours in commonly used IV solutions. It is recommended not to mix the injection with other drugs in the same syringe.
Client information
Important Safety Warning: Ketorolac is a very strong pain reliever, but it can cause severe stomach ulcers and kidney damage in pets if not used exactly as directed.
- Strict Dosing: Never give this medication for longer than prescribed (usually limited to 1-3 days maximum). Do not give more frequently than directed.
- Watch for Side Effects: Stop the medication immediately and notify your veterinarian if you notice any signs of stomach upset, including loss of appetite, vomiting, diarrhea, black/tarry stools, or blood in the stool.
- Behavioral Changes: Contact your vet if your pet becomes unusually depressed, lethargic, or weak.
- Do Not Mix: Never give ketorolac with other pain relievers (like aspirin, Rimadyl, Metacam, or steroids) unless specifically instructed by your veterinarian.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.