Ketorolac vs. Ibuprofen (Advil)

NSAIDs reduce blood clotting, increasing bleeding after an injury.

Ibuprofen may cause stomach or intestinal ulcers, which can lead to bleeding. Ulcers may be asymptomatic, with signs limited to black stools, weakness, and dizziness upon standing (orthostatic hypotension).

Ulcers can occur without abdominal pain and result in the following symptoms:

• Black stools
• Weakness
• Dizziness upon standing (orthostatic hypotension)

NSAIDs reduce kidney blood flow and impair kidney function, especially in those with pre-existing kidney dysfunction or congestive heart failure. Caution should be exercised when using NSAIDs in these patients.

Ibuprofen should not be used by individuals with allergies to other NSAIDs, including aspirin.

Asthmatic individuals are more susceptible to allergic reactions to ibuprofen and other NSAIDs.

Other serious side effects associated with NSAIDs include:

• Fluid retention (edema)
• Blood clots
• Heart attacks
• High blood pressure (hypertension)
• Heart failure

NSAIDs (excluding low-dose aspirin) can increase the risk of potentially fatal heart attacks, strokes, and related conditions in individuals with or without heart disease or risk factors. The risk is highest in patients with underlying risk factors and may occur as early as the first week of use. Therefore, NSAIDs should not be used to treat pain following coronary artery bypass graft surgery (CABG).

What is the dosage of ketorolac vs. ibuprofen?

Ketorolac dosage

• Begin treatment with ketorolac injection.
• Use tablets if treatment continues after patients can eat and drink.
• Therapy should not exceed 5 days due to the risk of gastrointestinal bleeding and other side effects.
• The recommended adult intravenous single dose is 15 to 60 mg.
• Multiple intravenous doses of 15 or 30 mg every 6 hours, not exceeding 60 or 120 mg daily, may be used.
• Following intravenous therapy, the recommended dose is 1 (10 mg) or 2 (20 mg) tablets initially, followed by 1 (10 mg) tablet every 4 to 6 hours, not exceeding 40 mg daily.
• Use the lower dose for patients with poor kidney function or those over 65 years old.
• Oral ketorolac is not approved for individuals under 17 years old.

Ibuprofen dosage

• For minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is 200 or 400 mg every 4 to 6 hours.
• Arthritis is treated with 300 to 800 mg 3 or 4 times daily.
• The maximum dose of ibuprofen is 3.2 g daily under a physician’s care. Otherwise, the maximum dose is 1.2 g daily.
• Do not use ibuprofen for more than 10 days for pain treatment or more than 3 days for fever treatment without physician direction.
• Children 6 months to 12 years old are usually given 5 to 10 mg/kg of ibuprofen every 6 to 8 hours for fever and pain. The maximum dose is 40 mg/kg daily.
• Juvenile arthritis is treated with 20 to 40 mg/kg/day in 3 to 4 divided doses.
• Take ibuprofen with meals to prevent stomach upset.

What drugs interact with ketorolac and ibuprofen?

Ketorolac drug interactions

• Combining ketorolac with probenecid reduces elimination of ketorolac by the kidneys, potentially causing increased levels and side effects.
• Ketorolac may increase blood levels of lithium by reducing its elimination by the kidneys, which can lead to lithium toxicity.
• Concomitant use of ketorolac and angiotensin-converting enzyme (ACE) inhibitors may impair kidney function.
• Avoid ketorolac when taking oral blood thinners or anticoagulants, such as warfarin, due to the increased risk of bleeding.

Ibuprofen drug interactions

Ibuprofen has several suspected or probable interactions that can affect the action of other drugs.

• Ibuprofen may increase blood levels of lithium by reducing its excretion by the kidneys, leading to lithium toxicity.
• Ibuprofen may reduce the blood pressure-lowering effects of drugs prescribed for hypertension as prostaglandins help regulate blood pressure.
• When combined with methotrexate or aminoglycosides, ibuprofen may increase blood levels of these drugs, potentially increasing their side effects.
• Ibuprofen enhances the negative effect of cyclosporine on kidney function.
• Avoid ibuprofen when taking oral blood thinners or anticoagulants, like warfarin, due to the increased risk of bleeding.
• Combining ibuprofen with aspirin increases the risk of ulcers.
• Combining ibuprofen with more than three alcoholic beverages per day increases the risk of stomach ulcers and bleeding.
• Combining NSAIDs with selective serotonin reuptake inhibitors (SSRIs), like fluoxetine, citalopram, or paroxetine, may increase the likelihood of upper gastrointestinal bleeding.

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Are ketorolac and ibuprofen safe to use while pregnant or breastfeeding?

Ketorolac

• There are no adequate studies in pregnant women. Ketorolac should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. NSAIDs may cause cardiovascular side effects during late pregnancy.
• Ketorolac should not be used by nursing mothers as it is excreted in breast milk.

Ibuprofen

• There are no adequate studies of ibuprofen in pregnant women. Therefore, ibuprofen is not recommended during pregnancy. Ibuprofen should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus in the fetal heart.
• Ibuprofen is excreted in breast milk, but the American Academy of Pediatrics states that it is compatible with breastfeeding.

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Summary

Ketorolac and ibuprofen (Advil) are nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat various levels of pain. Ketorolac is used for short-term management (up to 5 days) of moderately severe acute pain that would typically require narcotics. Ibuprofen is used to treat mild to moderate pain, inflammation, and fever associated with different diseases.