Side effects of NSAIDs and dosing recommendations for ketorolac

We reviewed the pathogenesis of the most important side effects of non-steroidal antiinflammatory drugs (NSAIDs). Short-term treatments for postoperative pain are not generally associated with gastric damage. Pharmacoepidemiological studies have shown that for ketorolac the risk of gastrointestinal bleeding was only important in older patients and when doses > 90 mg/day were used. Although NSAIDs cause platelet dysfunction resulting in prolonged bleeding time, these drugs do not affect clot formation. Therefore, NSAIDs should be used with caution in surgical procedures involving considerable dissection of tissues and where any reduction in hemostatic function could be hazardous. Acute reversible renal dysfunction may occur when volume depletion or reduced renal function are present, in particular in elderly patients. NSAIDs should also be used with great caution in asthmatic patients. In general, the adverse events associated with ketorolac are similar to other NSAIDs. Provided the current European Community label prescription of ketorolac is not exceeded and with due observation of the contra-indications for use of NSAIDs, this agent is not likely to induce an increased risk of adverse events.