Renal insufficiency associated with intramuscular administration of ketorolac tromethamine.
OBJECTIVE
To evaluate reports of renal toxicity associated with intramuscular ketorolac tromethamine. Medical charts were reviewed for all cases of renal toxicity associated with ketorolac therapy.


METHODS
Patients with possible ketorolac-associated nephrotoxicity were identified through our institution's adverse drug reaction reporting program. Patients were included in this report if: (1) renal insufficiency was temporally related to ketorolac administration; (2) resolution of renal insufficiency occurred after discontinuation of ketorolac; and (3) no other causes of renal insufficiency, including other medications, could be identified.


RESULTS
Six patients had renal insufficiency secondary to ketorolac administration. The mean age of the patients was 58 years and cardiovascular disease was present in five. Serum creatinine values increased from a mean of 106 +/- 26 mumol/L (1.2 +/- 0.3 mg/dL) to a mean peak value of 256 +/- 195 mumol/L (2.9 +/- 2.2 mg/dL). Recovery of renal function was observed after a mean of 2.3 +/- 0.5 days.


CONCLUSIONS
Short-term administration of ketorolac can be associated with reversible oliguric renal insufficiency. Indiscriminate use of ketorolac for pain management in place of narcotic analgesics should be avoided, especially in patients at high risk for toxicity induced by nonsteroidal antiinflammatory drugs.
Corelli
R L
RL
Division of Clinical Pharmacy, University of California, San Francisco 94143.
Gericke
K R
KR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced*; D014046:Tolmetin / Q000009:adverse effects / Q000031:analogs & derivatives*; D014325:Tromethamine / Q000009:adverse effects*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D014046:Tolmetin