For patients who are frequently re-admitted to the hospital, such as patients with sickle cell disease, are there any recommendations for when a repeat course of ketorolac is appropriate? Does there need to be a "wash-out" period between courses or is there a maximum number of doses per month?

Comment by InpharmD Researcher

There is no consensus regarding when ketorolac may be resumed or reattempted after 5 consecutive days of use. Data consistently indicate that the recommended maximum duration of ketorolac use is 5 days primarily due to safety considerations. Available evidence suggests short-term use is generally well tolerated, while longer use may increase the risk of acute kidney injury and serious gastrointestinal complications (e.g., lesion formation, hemorrhage, or perforation). Notably, there is no consensus on when ketorolac may be safely restarted after a full course, and patients requiring extended analgesia may benefit more from alternative agents. Assessment of patient-specific factors, such as previous clinical response, anticipated duration of use, and gastrointestinal risk are likely most influential in determining appropriate restart time. A comprehensive literature search was unable to identify any study evaluating restarting, extending, or repeating ketorolac beyond the 5-day maximum duration.

Background

The 2020 American Society of Hematology (ASH) guidelines on the management of acute and chronic sickle cell disease (SCD) pain provided recommendations on non-steroidal anti-inflammatory drug (NSAID) duration of therapy. For acute SCD pain, the panel conditionally suggests a short course of NSAIDs (5 to 7 days) added to opioids, based on very low-certainty evidence that ketorolac reduced pain vs meperidine, decreased pain and eliminated opioid use in the emergency department, and shortened length of stay in one inpatient study, though two other inpatient studies showed no benefit. For chronic pain, the guidance states NSAID risks are likely dose- and duration-dependent, favoring individualized, time-limited trials over open-ended use, particularly given unresolved cardiovascular, renal, and bleeding concerns. Notably, the panel does not provide any guidance on management of multiple/repeat readmissions for SCD pain or need to repeat NSAID treatment; the panel holds firmly to the short duration of NSAID treatment recommendation and suggests consideration of alternate analgesic medications for patients requiring longer course of treatment. [1]

Relevant Prescribing Information

BOXED WARNING [2]
Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug (NSAID), is indicated for the short-term (up to 5 days in adults) management of moderately severe acute pain that requires analgesia at the opioid level. Oral ketorolac tromethamine is indicated only as continuation treatment following intravenous or intramuscular dosing of ketorolac tromethamine, if necessary. The total combined duration of use of oral ketorolac tromethamine and ketorolac tromethamine injection should not exceed 5 days.

Ketorolac tromethamine is not indicated for use in pediatric patients and it is NOT indicated for minor or chronic painful conditions. Increasing the dose of ketorolac tromethamine beyond the label recommendations will not provide better efficacy but will increase the risk of developing serious adverse events.

CONTRAINDICATIONS [2]
Previously demonstrated hypersensitivity to ketorolac tromethamine.
Patients with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or perforation and in patients with a history of peptic ulcer disease or gastrointestinal bleeding.
Patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
As a prophylactic analgesic before any major surgery.
In the setting of coronary artery bypass graft (CABG) surgery.
Patients with advanced renal impairment or in patients at risk for renal failure due to volume depletion.
In labor and delivery because it may adversely affect fetal circulation and inhibit uterine musculature, thus increasing the risk of uterine hemorrhage.
Patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis and those at high risk of bleeding.
Patients currently receiving aspirin or NSAIDs because of the cumulative risks of inducing serious NSAID-related adverse events.
Concomitant use of ketorolac tromethamine and probenecid.
Concomitant use of ketorolac tromethamine and pentoxifylline.
For neuraxial (epidural or intrathecal) administration due to its alcohol content.

DOSAGE AND ADMINISTRATION [2]
Ketorolac tromethamine is indicated for the short-term (≤ 5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting. Therapy should always be initiated with intravenous or intramuscular dosing of ketorolac tromethamine, and oral ketorolac tromethamine is to be used only as continuation treatment, if necessary.

The total combined duration of use of ketorolac tromethamine injection and oral ketorolac tromethamine is not to exceed 5 days of use because of the potential of increasing the frequency and severity of adverse reactions associated with the recommended doses. Patients should be switched to alternative analgesics as soon as possible, but ketorolac tromethamine therapy is not to exceed 5 days.

Literature Review

A search of the published medical literature revealed 6 studies investigating the researchable question:

Level of evidence

C - Multiple studies with limitations or conflicting results Read more→

Please see Tables 1-6 for your response.

Comparison of Long-Term Safety of Ketorolac Tromethamine and Aspirin in the Treatment of Chronic Pain
Design	Randomized, multicenter, double-blind trial N= 823
Objective	To compare the long-term safety and efficacy of orally administered ketorolac with that of aspirin, with the primary focus on safety
Study Groups	Ketorolac (n= 553) Aspirin (n= 270)
Inclusion criteria	21 years or older, orthopedic pain (osteoarthritis, chronic fibromyopathies or fibromyalgias), other nonarticular chronic soft tissue pain syndromes, or chronic headaches
Exclusion criteria	N/A
Methods	Patients were randomized 2:1 to receive either ketorolac tromethamine 10 mg or aspirin 650 mg QID PRN.
Duration	Follow-up: up to 52 weeks of therapy
Outcome Measures	PrimaryL safety
Baseline Characteristics		Ketorolac (n= 553)	Aspirin (n= 270)
	Age	21 to 88 years	21 to 88 years
	Average daily dose	30 mg	1,850 mg
	Source of pain Osteoarthritis Fibrositis	74% 6%	71% 5%
	Completed 52 weeks of treatment	241 (44%)	85 (31%)
	Reasons for withdrawals Total withdrawal Adverse events Adverse events and lack of efficacy Lack of efficacy Lost to follow up Other	312 (56%) 131 (24%) 18 (3%) 94 (17%) 36 (7%) 33 (6%)	185 (69%) 64 (24%) 18 (7%) 68 (25%) 18 (7%) 17 (6%)
Results		Ketorolac (n= 553)	Aspirin (n= 270)
	Gastrointestinal pain Peptic ulcer/gastrointestinal bleeding	24% 9 (1.6%)*	21% 3 (1.1%)
	Central Nervous system Headache Dizziness Somnolence	30% 14% 8%	24% 12% 6%
	Dyspepsia	22%	30%
	Nausea	18%	19%
	Diarrhea	14%	9%
	Constipation	8%	10%
	*8 of these patients had been taking ketorolac for 84 days or longer, and most had one or more of the following risk factors: advanced age (5 were over age 70 yrs), recent history of peptic ulcer, and recent use of other NSAIDs.
Study Author Conclusions	Early withdrawal for safety-related reasons alone was similar for those taking aspirin and ketorolac. As with all drugs that inhibit prostaglandin synthesis, ketorolac may contribute to gastrointestinal bleeding and peptic ulcer disease, particularly in high-risk patients (age >70 yrs, > l l wks dosing, concurrent or recent use of other NSAlDs, and a history of recent peptic ulcers), but this risk appears to be similar to that of other agents of this therapeutic class.
Critique	Patients were able to take other NSAIDs while in the trial, which may have introduced confounding. There was no defined length of therapy for patients, with less than half completing the full 52 weeks.

Table 1 References:
[3] Rubin P, Yee JP, Ruoff G. Comparison of long-term safety of ketorolac tromethamine and aspirin in the treatment of chronic pain. Pharmacotherapy. 1990;10(6 (Pt 2)):106S-110S.

A Multi-institutional Evaluation of the Analgesic Efficacy and Safety of Ketorolac Tromethamine, Acetaminophen plus Codeine, and Placebo in Cancer Pain
Design	Multicenter, double-blind, randomized, controlled trial N= 75
Objective	To compare the analgesic efficacy and toxicity of ketorolac tromethamine to those of acetaminophen (APAP) plus codeine and of placebo in patients with moderate to severe cancer pain
Study Groups	Placebo (n= 26) Ketorolac (n= ) APAP plus codeine (n= 27)
Inclusion criteria	Cancer diagnosis, moderate to severe cancer pain for at least 1 week, ≥18 years old, able to take oral medications, were willing to abstain from using narcotics during the study period, platelet count of 100,000 or greater, no known coagulopathy
Exclusion criteria	Pregnant or nursing, had received methadone within 6 hours or other narcotics within 4 hours of study initiation, on any medications, or had any pre-existing conditions that would interact with the study drugs
Methods	Patients were randomly assigned in a double-blind fashion to receive a single dose of placebo, ketorolac tromethamine 10 mg, or acetaminophen 600 plus codeine 60 mg, and were observed for an initial 6 hours. Patients assigned to ketorolac tromethamine or acetaminophen plus codeine continued on their current dose QID for 7 additional days. Those who initially received placebo were randomly assigned in a double-blind fashion to receive one of those medications with the same dosing schedule.
Duration	7 days
Outcome Measures	Primary outcome: pain intensity and adverse events
Baseline Characteristics		Placebo (n= 26)	Ketorolac (n= 22)	APAP + codeine (n= 27)
	Age, years	65	58	63
	Women	9 (35%)	9 (41%)	14 (52%)
Results		Ketorolac (n= 34)	APAP + codeine (n= 40)
	Any complaint	21 (62%)	19 (48%)
	Digestive complaint Nausea Diarrhea Vomiting Gastrointestinal pain	7 (21%) 6 (18%) 3 (9%) 5 (15%)	12 (30%) 0 5 (13%) 4 (10%)
Adverse Events	Common Adverse Events: Nausea and vomiting were both slightly more common with acetaminophen plus codeine; diarrhea occurred in 18% of patients taking ketorolac and none of those receiving acetaminophen plus codeine. Headache was noted in 21 % of the ketorolac group but in only 3% of the acetaminophen plus codeine group.
	Percentage that Discontinued due to Adverse Events: 5 patients (15%) from the ketorolac group and 4 patients (10%) from the acetaminophen and codeine group
Study Author Conclusions	The results of the current study suggest that ketorolac, in the dose and schedule used, may play an important role in the treatment of cancer pain in patients who require nonopioid analgesics alone, or perhaps in combination with an opioid in patients with pain refractory to treatment with a nonopioid only.
Critique	The baseline characteristics are not reflective of the groups once those receiving placebo were assigned to drug treatment. Both treatments were carried out for 7 days, and although more side effects were noted in the ketorolac group, there were no reported episodes of gastrointestinal bleeding or ulcers.

Table 2 References:
[4] Carlson RW, Borrison RA, Sher HB, Eisenberg PD, Mowry PA, Wolin EM. A multiinstitutional evaluation of the analgesic efficacy and safety of ketorolac tromethamine, acetaminophen plus codeine, and placebo in cancer pain. Pharmacotherapy. 1990;10(3):211-6.

Parenteral Ketorolac and Risk of Gastrointestinal and Operative Site Bleeding: A Postmarketing Surveillance Study
Design	Postmarketing surveillance inception cohort study N= 20,519 (10,272 ketorolac courses, 10,247 opiate courses)
Objective	To evaluate the risk of gastrointestinal and operative site bleeding associated with the use of parenteral ketorolac tromethamine
Study Groups	Ketorolac (n= 10,272 courses) Opiates (n= 10,247 courses)
Inclusion Criteria	Patients who received intramuscular or intravenous ketorolac during the data collection period and could be identified from hospital pharmacy records
Exclusion Criteria	None specified
Methods	Medical records were reviewed for demographics, medical history, doses and duration of study drug, hospital course details, and adverse events. Multivariate logistic regression models were used to adjust for potential confounding variables. Dose-response and duration-response analyses were conducted.
Duration	November 1991 to August 1993
Outcome Measures	Primary: Risk of gastrointestinal bleeding, risk of operative site bleeding Secondary: Dose-response relationship, duration-response relationship
Baseline Characteristics		Ketorolac (n= 10,272)	Opiates (n= 10,247)
	Female	60.3%	56.9%
	Mean age, years	51.3	52.0
	White	87%	87%
	History of gastrointestinal bleeding	4.1%	4.8%
	History of hypertension	26.8%	28.6%
Results		Ketorolac (n= 10,272)	Opiates (n= 10,247)	Adjusted OR (95% CI)
	Gastrointestinal bleeding	4.0%	3.6%	1.3 (1.1 to 1.52)
	Clinically serious gastrointestinal bleeding	1.3%	1.0%	1.44 (1.09 to 1.89)
	Operative site bleeding	39.6%	38.6%	1.02 (0.95 to 1.1)
	Clinically serious operative site bleeding	1.5%	1.8%	1.04 (0.79 to 1.36)
	Abbreviations: CI = confidence interval; OR = odds ratio. A dose-response relationship was evident between average daily ketorolac dose and both gastrointestinal bleeding and operative site bleeding (p< 0.001 for both). When analgesic therapy lasted ≤5 days, ketorolac was associated with only a small increased risk of gastrointestinal bleeding (OR 1.17; 95% CI 0.99 to 1.30); when therapy was prolonged >5 days, the OR was 2.20 (95% CI 1.36 to 3.57).
Adverse Events	The risk of gastrointestinal bleeding was higher in older patients and with higher doses of ketorolac. Operative site bleeding was not significantly affected by the duration of therapy.
Study Author Conclusions	The overall associations between ketorolac use and both gastrointestinal bleeding and operative site bleeding are small. However, the risk is larger and clinically important when ketorolac is used in higher doses, in older subjects, and for more than 5 days. Limiting the dose and duration of ketorolac use, especially in the elderly, should enhance its overall risk-benefit balance.
Critique	The study's strengths include a large sample size and comprehensive data collection. However, the retrospective design may introduce selection bias, and the inability to control drug use limits the comparability of study groups. The study reflects real-world use but may not account for all confounding factors. The findings are limited by potential information bias and the lack of blinding in data collection.

Table 3 References:
[5] Strom BL, Berlin JA, Kinman JL, et al. Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study. JAMA. 1996;275(5):376-382.

Parenteral Ketorolac: The Risk for Acute Renal Failure
Design	Retrospective cohort study N= 20,364 (10,219 courses of ketorolac and 10,145 courses of opioids)
Objective	To compare the risk for acute renal failure associated with ketorolac with that associated with opioids
Study Groups	Ketorolac (n= 10,219 courses) Opioids (n= 10,145 courses)
Inclusion Criteria	Patients identified from hospital pharmacy records as having received parenteral ketorolac or opioids during the data collection period
Exclusion Criteria	Patients receiving long-term dialysis
Methods	Data were abstracted from hospital charts, including demographic characteristics, medical history, dose and duration of ketorolac or opioid therapy, and adverse events. Acute renal failure was defined by specific increases in serum creatinine concentration. Multivariate proportional hazards models were used to adjust for confounding variables.
Duration	Data collection: 18 November 1991 to 31 August 1993
Outcome Measures	Incidence of acute renal failure
Baseline Characteristics		Ketorolac (n= 10,219)	Opioids (n= 10,145)
	Men	40%	43%
	White	87%	87%
	Black	9%	9%
	Mean age, years	51 ± 20	52 ± 21
Results		Ketorolac (n= 10,219)	Opioids (n= 10,145)	p-value
	Incidence of acute renal failure	1.07%	1.11%	0.97
	Rate ratio for >5 days of therapy (ketorolac vs. opioids)	2.08 (95% CI 1.08 to 4.0)		0.03
Adverse Events	Acute renal failure was uncommon overall. No significant difference in risk between ketorolac and opioids for therapy ≤5 days. Increased risk for therapy >5 days.
Study Author Conclusions	Overall, acute renal failure was uncommon in this hospitalized population. Compared with opioids, ketorolac administered for 5 days or less did not increase the rate of renal failure. However, among patients who were treated with analgesics for more than 5 days, ketorolac may be associated with an elevated rate of acute renal failure
Critique	The study's retrospective design may limit the ability to establish causality. The matching of patients by hospital and service helps control for confounding, but the lack of randomization could introduce bias. The study's large sample size is a strength, but the potential for unmeasured confounders remains a limitation. The findings suggest caution with prolonged ketorolac use, but further research is needed to confirm these results

Table 4 References:
[6] Feldman HI, Kinman JL, Berlin JA, et al. Parenteral ketorolac: the risk for acute renal failure. Ann Intern Med. 1997;126(3):193-199. doi:10.7326/0003-4819-126-3-199702010-00003

Ketorolac use in outpatients and gastrointestinal hospitalization: a comparison with other non-steroidal anti-inflammatory drugs in Italy
Design	Cohort and nested case-control study N= 201,357
Objective	To compare the risk of hospitalization for gastroduodenal ulcer associated with the use of ketorolac and other non-steroidal anti-inflammatory drugs (NSAIDs)
Study Groups	All patients (N= 201,357)
Inclusion Criteria	Residents of Umbria aged 35-84 years with at least one NSAID prescription from January 1993 to December 1994
Exclusion Criteria	Patients hospitalized for gastroduodenal ulcer, liver cirrhosis, alcohol-related causes, coagulopathies, cancer, or pregnant women during the study period
Methods	Exposure periods were classified as current (dispensing date through expected duration plus 30 days), recent (30 days after current exposure), and past (time thereafter). Hospitalizations for gastroduodenal ulcer, perforation, or hemorrhage were identified through linked discharge records and confirmed by chart review. Person-time incidence rates and adjusted rate ratios were calculated, and a nested case-control analysis with 10 matched controls per case assessed prior NSAID use, gastrotoxic medications, and anti-ulcer therapy in the preceding months.
Duration	January 1993 to December 1994
Outcome Measures	Rate ratios of hospitalization for gastroduodenal ulcer and rate ratios for gastrointestinal hemorrhage or perforation
Baseline Characteristics		All patients (N= 201,357)
	Median age	62
	Male/female ratio	0.7
Results		Rate ratio for peptic ulcer and upper gastrointestinal haemorrhage or perforation (95% CI)
	Piroxicam	4.6 (3.2-6.7)
	Ketorolac	3.4 (1.4-8.3)
	Piroxicam beta	3.0 (1.6-5.7)
	Ketoprofen	2.7 (1.4-5.3)
	Diclofenac	2.5 (1.7-3.7)
	Naproxen	2.1 (1.0-4.3)
	Nimesulide	2.0 (1.1-3.4)
	Other NSAIDs	1.4 (0.8-2.6)
	Any NSAID	2.8 (2.3-3.6)
	Abbreviations: CI, confidence interval. During the study, 201,357 subjects received at least one NSAID prescription, with a median prescription duration of 6 days for ketorolac and 33 days for naproxen (19 days for other NSAIDs). Of 681 potential hospitalization cases identified, 326 met inclusion criteria after chart review. Incidence of hospitalization for gastroduodenal ulcer increased with age and was lower in women than men. Current NSAID use was associated with a rate ratio of 2.8 (95% CI 2.3 to 3.6), and recent use with 1.4 (1.0 to 2.1). For severe events, ketorolac had the highest rate ratio (5.9). In the nested case-control analysis, concomitant gastrotoxic drug use (odds ratio [OR] 3.5), gastroprotective agent use (OR 2.4), and prior NSAID use (OR 1.2) were associated with hospitalization, but adjustment for these factors did not materially change risk estimates for current NSAID use. When current exposure was restricted to 15 days, the adjusted rate ratio for any NSAID increased to 4.2, with ketorolac at 8.3 and piroxicam at 7.0.
Adverse Events	See above.
Study Author Conclusions	In conclusion, considering the number of hospitalizations for ulcer, ketorolac does not currently appear to present a significant public health problem in Italy. Nonetheless, our findings support the need for adhering to the restrictions of indication and duration, and suggest that its use in general practice requires distinct caution. Ketorolac is among the more gastrotoxic NSAIDs, despite a very short typical duration of therapy (6 days for ketorolac vs a median of 19 days for other NSAIDs). At present, piroxicam requires attention because it is among the most gastrotoxic substances and is one of the most commonly prescribed NSAIDs in Italy. Given the already large amount of evidence available in the literature, the choice in general practice should be reoriented toward less gastrotoxic NSAIDs.
Critique	The study provides insights into NSAID gastrotoxicity, particularly for ketorolac. Limitations include lack of clinical indications, potential exposure misclassification, and reliance on prescription claims that may not reflect actual use. As the analysis was conducted within a single Italian regional NHS database, generalizability to other populations and health care systems is uncertain.

Table 5 References:
[7] Menniti-Ippolito F, Maggini M, Raschetti R, Da Cas R, Traversa G, Walker AM. Ketorolac use in outpatients and gastrointestinal hospitalization: a comparison with other non-steroidal anti-inflammatory drugs in Italy. Eur J Clin Pharmacol. 1998;54(5):393-397. doi:10.1007/s002280050481

Double-blind evaluation of short-term analgesic efficacy of orally administered dexketoprofen trometamol and ketorolac in bone cancer pain
Design	Multicenter, randomized, double-blind, parallel-group study N= 115
Objective	To evaluate the efficacy and safety of orally administered dexketoprofen trometamol (25 mg q.i.d.) in comparison to ketorolac as the reference drug for the treatment of cancer pain associated with bone metastases.
Study Groups	Dexketoprofen group (n= 57) Ketorolac group (n= 58)
Inclusion criteria	Patients presenting with metastatic bone pain.
Exclusion criteria	Current or recent (past 15 days) treatment with the following: oral anti-coagulants, systemic corticosteroids, sulfonylurea, antitussives, anti-convulsants, anti-psychotics, tricyclic anti-depressants, lithium, and methotrexate. Known hypersensitivity to ketorolac, acetylsalicylic acid, or other NSAIDs. History of peptic ulcer or NSAID-related gastropathy, clinically significant renal, liver, or cardiac disease (acute myocardial infarction within the last 6 months), blood dyscrasia, asthma, bronchospasm or angioedema, poorly controlled hypertension or diabetes mellitus, epilepsy, psychosis or other personality disorders; drug or alcohol abuse; and participation in a clinical study in the previous 3 months. Pregnant/nursing mothers, women of childbearing potential not on adequate contraception.
Methods	Patients were randomized to receive either dexketoprofen trometamol 25 mg QID or ketorolac 10 mg QID Q6H for 7 (+1) days preferably with meals. Rescue medication with paracetamol 500 mg plus codeine phosphate 30 mg was allowed. If more than 1g paracetamol/60 mg codeine per day was needed, patients were withdrawn from the study.
Duration	Enrollment period: December 1997 to August 1999
Outcome Measures	Primary outcome: Pain intensity as measured on the visual analog scale (VAS) at day 7 (+1) Secondary outcome: Treatment-related adverse events (TEAEs)
Baseline Characteristics		Dexketoprofen group (n= 57)	Ketorolac group (n= 58)
	Age, years	72 ± 7	68 ± 10
	Women/men	14/42	13/44
	Weight, kg	69	72
	Height, cm	164	164
	Concomitant medication	37 (66%)	27 (47%)
	Current cancer Prostate Breast Lung Other	26 (46%) 8 (14%) 7 (13%) 15 (27%)	26 (46%) 10 (17%) 7 (12%) 14 (25%)
	VAS score at baseline, mm	69 ± 15	75 ± 16
Results	Endpoint	Dexketoprofen group (n= 57)	Ketorolac group (n= 58)	p-value
	VAS score at 7-day follow-up	32 ± 24	40 ± 30	Not significant
	Treatment-related adverse events (TEAEs) Gastrointestinal system Constipation Diarrhea Nausea/vomiting Gastrointestinal hemorrhage Other GI adverse events Liver and biliary system Nervous system/psychiatric Skin and appendages Other Total TEAEs	8 (12%) 3 (5%) 0 2 (3%) 0 3 (5%) 2 (3%) 1 (2%) 0 1 (2%) 12	12 (21%) 2 (3%) 2 (3%) 4 (7%) 1 (2%) 3 (5%) 4 (7%) 0 1 (2%) 2 (3%) 19
	Most TEAEs were mild/moderate. Both groups had 3.5% of participants experience serious adverse events. One of the serious TEAE's was gastrointestinal hemorrhage thought to be due to ketorolac.
Study Author Conclusions	Dexketoprofen trometamol 25 mg q.i.d. oral route is a good analgesic therapy in the treatment of bone cancer pain, comparable to ketorolac 10 mg q.i.d., with a good tolerability profile.
Critique	The study was primarily observing a drug versus control which was ketorolac and failed to achieve the sample size of 160 patients for their statistical analysis. For the inquiry, it can be inferred that this study observed over 20% of patients taking ketorolac experienced a GI-related adverse event from 7 days of therapy with one report of GI hemorrhage believed to be due to ketorolac. The time of TEAE onset was not reported so it is unknown if patients developed these symptoms beyond the 5-day recommended use.

Table 6 References:
[8] Rodriguez MJ, Contreras D, Galvez R, et al. Double-blind evaluation of short-term analgesic efficacy of orally administered dexketoprofen trometamol and ketorolac in bone cancer pain. Pain. 2003;104(1-2):103-110. doi:10.1016/s0304-3959(02)00470-0