Renal Function Considerations for Oral Ketorolac

Contraindications Based on Renal Function

Oral ketorolac tablets are absolutely contraindicated in patients with a creatinine clearance < 30 mL/min (or GFR < 30 mL/min/1.73 m²) according to NSAID class guidance and the KDOQI (Kidney Disease Outcomes Quality Initiative) recommendations. 1
For patients with GFR 30–60 mL/min/1.73 m², prolonged NSAID therapy is discouraged; short‑term use may be considered only with extreme caution. 1

A reduced initial oral dose of 10 mg (instead of 20 mg) is advised for patients who are ≥ 65 years old, weigh < 50 kg, or have any degree of renal impairment (even mild). 2

The American Gastroenterological Association (AGA) guidelines for cirrhosis advise discontinuing NSAIDs, including ketorolac, as soon as acute kidney injury (AKI) is diagnosed. 3
Extended use of NSAIDs in any patient with renal impairment markedly raises the risk of further kidney injury; clinicians should limit therapy duration accordingly. 1
Adequate hydration should be ensured before and throughout ketorolac treatment to lessen the likelihood of renal adverse events. 1
Elderly patients (≥ 65 years) who are also receiving diuretics, ACE inhibitors/ARBs, or who have baseline creatinine elevation face a substantially higher risk of AKI when treated with ketorolac. [2][1]