Ketorolac vs. hydrocodone: What’s the difference?
- Ketorolac and hydrocodone are used to treat severe pain.
- Ketorolac is used for short-term management (up to 5 days) of moderately severe acute pain that otherwise would require narcotics.
- Hydrocodone is used for long-term treatment of severe pain.
- Brand names for ketorolac include Acuvail, Acular LS, Omidria, and Sprix. The Toradol brand of ketorolac has been discontinued in the U.S.
- Brand names for hydrocodone include Vicodin, Zohydro ER, Hycet, and Xodol 5/300.
- Ketorolac and hydrocodone belong to different drug classes. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) and hydrocodone is an opioid narcotic pain-reliever.
- Side effects of ketorolac and hydrocodone that are similar include dizziness, drowsiness, nausea, and constipation.
- Side effects of ketorolac that are different from hydrocodone include rash, ringing in the ears, headaches, abdominal pain, diarrhea, indigestion, itching, heartburn, and fluid retention.
- Side effects of hydrocodone that are different from ketorolac include lightheadedness, sedation, vomiting, and difficulty urinating.
- Withdrawal symptoms may occur if you suddenly stop taking hydrocodone.
What are ketorolac and hydrocodone?
Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term management (up to 5 days) of moderately severe pain that otherwise might require use of narcotics. Ketorolac should not be used for minor or chronic pain. Other NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), but ketorolac is more effective than these in reducing pain. Ketorolac reduces the production of prostaglandins, chemicals the immune system makes that cause the redness, fever, and pain of inflammation and that also are thought to be important in the production of non-inflammatory pain. Ketorolac blocks enzymes that cells use to make prostaglandins (cyclooxygenase 1 and 2) and, as a result, reduces pain and inflammation, and signs and symptoms of redness, swelling, and fever.
Hydrocodone is an opioid narcotic pain-reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioids prescribed for the long-term treatment of severe pain for which other treatment options are not effective, not tolerated, or would most likely not be strong enough to adequately manage the pain. Hydrocodone, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain (the amount of stimulation it takes to feel pain) and reduce the perception of pain (the perceived importance of the pain).
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What are the side effects of ketorolac and hydrocodone?
Ketorolac
Common side effects from ketorolac include:
- Rash
- Ringing in the ears
- Headaches
- Dizziness
- Drowsiness
- Abdominal pain
- Nausea
- Diarrhea
- Constipation
- Indigestion
- Itching
- Heartburn
- Fluid retention
Rare side effects of ketorolac include:
- Abnormal thinking
- Serious allergic reactions
- Blurred vision
- Bronchospasm
- Jaundice
- Depression
- Difficulty concentrating
- Taste abnormality
- Euphoria
- Hemolytic-uremic syndrome
- High potassium blood levels
- Low sodium levels
Serious side effects of ketorolac include:
- Stomach ulcers
- Intestinal bleeding
- Reduced kidney function
- Liver failure
Other serious adverse events include:
- NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury. Ketorolac may cause ulcers and bleeding in the stomach and intestines, particularly with use for more than five days. Sometimes, stomach ulceration and intestinal bleeding can occur without any abdominal pain. Sometimes, the only signs or symptoms of bleeding may be:
- Black tarry stools
- Weakness
- Dizziness upon standing (orthostatic hypotension)
- NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients with preexisting impairment of kidney function or congestive heart failure, and use of NSAIDs in these patients should be done cautiously.
- Liver failure has also been associated with ketorolac.
- People who are allergic to aspirin and other NSAIDs should not use ketorolac.
- Individuals with asthma or nasal polyps are more likely to experience allergic reactions to NSAIDs.
Hydrocodone
The most frequent adverse reactions include:
- Lightheadedness
- Dizziness
- Sedation
- Nausea
- Vomiting
Other side effects include:
- Drowsiness
- Constipation
- Spasm of the ureter, which can lead to difficulty in urinating
Other patient warnings include:
- Hydrocodone can impair thinking and the physical abilities required for driving or operating machinery.
- Hydrocodone can depress breathing, and should be used with caution in elderly, debilitated patients, and in patients with serious lung disease.
- Hydrocodone is habit forming. Mental and physical dependence can occur when used long-term.
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What is the dosage of ketorolac vs. hydrocodone?
Ketorolac
- Treatment should begin with ketorolac injection.
- Tablets are used only if treatment is continued after patients begin to eat and drink.
- The total duration of therapy should not exceed 5 days because of the potential for 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 to exceed 60 or 120 mg a day, also 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 to exceed 40 mg daily.
- The smaller dose is used for patients with poor kidney function or those older than 65 years.
- Oral ketorolac is not approved for individuals less than 17 years of age.
Hydrocodone
- The initial dose for adults is 10 mg orally every 12 hours.
- The dose may be increased every 3 to 7 days by 10 mg every 12 hours as needed to control pain.
- Capsules must be swallowed whole and not chewed.
What drugs interact with ketorolac and hydrocodone?
Ketorolac
- Probenecid (Benemid) should not be combined with ketorolac because it reduces the elimination of ketorolac by the kidneys. This may lead to increased levels of ketorolac in the body and increased side effects from ketorolac.
- Ketorolac may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the elimination of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
- Concomitant use of ketorolac and angiotensin converting enzyme (ACE) inhibitors may reduce the function of the kidneys.
- Individuals taking oral blood thinners or anticoagulants — for example, warfarin (Coumadin, Jantoven) — should avoid ketorolac because ketorolac also thins the blood, and excessive blood thinning may lead to bleeding.
Hydrocodone
WARNING: Do not consume alcohol or any products containing alcohol while taking hydrocodone. Using products containing alcohol during treatment with hydrocodone may cause overdose and death.
- Concomitant use with CYP3A4 inhibitors (or discontinuation of CYP3A4 inducers) can result in a fatal overdose of hydrocodone.
- Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.
- The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome.
- MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (e.g., respiratory depression, coma).
- Mixed agonist/antagonist and partial agonist opioid analgesics may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms.
- Hydrocodone may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression.
- Opioids can reduce the efficacy of diuretics.
- The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus.
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Are ketorolac and hydrocodone 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 because it is excreted in breast milk.
Hydrocodone
There are no adequate studies of hydrocodone in pregnant women.
Hydrocodone is excreted in breast milk and, therefore, should not be used by nursing mothers.