Ketorolac Cream: Uses, Safety, and How It Works
Prescription Topical Pain Relief, Applied Where It Hurts
Ketorolac cream is a topical form of ketorolac, a prescription nonsteroidal anti-inflammatory drug (NSAID). The FDA-approved ketorolac products are systemic (oral and injectable) and ophthalmic (eye drops); a topical ketorolac cream or gel is not itself an FDA-approved drug product. Instead, a compounding pharmacy prepares it to order, pursuant to a prescription, so a licensed provider is involved before anyone uses it.
Applied to one area, topical ketorolac concentrates more of the medication near the application site and less throughout the body than a swallowed pill. Topical does not mean zero systemic absorption or zero risk. The research base for topical NSAIDs as a category is encouraging, but it is broader than the evidence for any single compounded ketorolac formula, so it helps to understand what is established and what is not.
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Ketorolac Cream Key Takeaways
- Ketorolac is a prescription NSAID. It is one of the more potent NSAIDs used in clinical settings, and every form requires a prescription.
- "Compounded topical ketorolac" means a licensed pharmacy prepares a cream or gel to order from a prescription. It is not a mass-manufactured, FDA-approved topical drug product.
- Topical delivery may be considered for localized symptoms because it concentrates medication near the application site and lowers systemic exposure compared with oral NSAIDs.
- Category evidence for topical NSAIDs is informative but is not the same as a clinical trial of one specific compounded ketorolac formula. Topical use lowers, but does not remove, systemic exposure and risk.
- A licensed provider should evaluate whether prescription ketorolac is appropriate for you before you use it.
What Is Ketorolac Cream?
Ketorolac (sometimes written ketorolac tromethamine) is a nonsteroidal anti-inflammatory drug. In hospitals and clinics it is best known in injectable and oral forms for short-term moderate to severe pain, and there is also an ophthalmic version used as eye drops. Ketorolac cream takes that same active ingredient and puts it into a topical base that is rubbed onto the skin over a painful area.
There is an important distinction in how ketorolac cream reaches you. The injectable, oral, and ophthalmic forms are FDA-approved drug products. A topical ketorolac cream or gel is typically made by a compounding pharmacy: the pharmacy mixes the medication to a prescriber's specifications for an individual patient. Compounded preparations are not the same as an FDA-approved, mass-manufactured topical drug, and formulas can differ between pharmacies.
Drug Class
NSAID (nonsteroidal anti-inflammatory drug). Works by reducing the chemical signals that drive inflammation and pain.
Common Forms
Injectable (IV/IM) and oral tablets, ophthalmic eye drops, and compounded topical cream or gel.
FDA Status
Injectable, oral, and ophthalmic ketorolac are FDA-approved. Topical ketorolac is compounded to order and is not a standalone FDA-approved product.
Prescription Required
Yes, for every form. A licensed provider reviews your health history before ketorolac is prescribed.
Brand Names
Toradol is a familiar brand for injectable and oral ketorolac. Acular and Acuvail are ophthalmic brands. Topical versions are compounded, not branded products.
Where It Fits
A topical option a provider may consider for localized musculoskeletal pain, alongside, not automatically above, other NSAID choices.
How Topical Ketorolac Works
Like other NSAIDs, ketorolac calms inflammation by blocking the enzymes that produce it. Applied to the skin, more of the drug stays near the area you treat.
1
Inflammation produces pain signals
When tissue is injured or irritated, the body makes prostaglandins. These chemical messengers drive swelling, sensitize nerves, and turn up pain at the affected site.
2
Ketorolac blocks COX enzymes
Ketorolac inhibits the COX-1 and COX-2 enzymes that make prostaglandins. With fewer prostaglandins, the inflammatory signaling that keeps an area painful settles down.
3
Topical delivery concentrates the dose locally
Applied over a painful area, a topical NSAID is absorbed through the skin into nearby tissue. More medication stays near the application site, and less circulates through the whole body, than with an oral dose. How much penetrates depends on the formulation, the dose, the area treated, and how deep the painful structure sits.
4
Lower systemic exposure, not zero exposure
Because less drug reaches the bloodstream, topical use can lower systemic exposure compared with oral NSAIDs. It does not remove it. Some absorption still occurs, and NSAID-related effects remain possible, which is why a prescriber stays involved.
What Is Ketorolac Cream Used For?
Topical ketorolac is generally considered for localized musculoskeletal pain, where the painful tissue is close enough to the surface for a topical to reach useful concentrations.
Providers most often discuss topical NSAIDs for joint and soft-tissue pain that is focused in one area rather than spread throughout the body. Common examples include osteoarthritis of accessible joints such as the knee and hand, tendon-related pain like tennis elbow, and muscle or joint pain in the neck, shoulders, and back. For osteoarthritis of the knee and hand, the American College of Rheumatology guideline lists topical NSAIDs among recommended options.
Topical delivery tends to be a better fit when the source of pain is relatively superficial. Deeper or more widespread pain is less likely to respond to a cream alone, and may call for a different approach. If you are weighing how a topical compares with a tablet for your situation, our guide on topical versus oral NSAIDs walks through the trade-offs, and our arthritis overview covers joint-specific considerations.
Osteoarthritis (Knee, Hand)
Joints near the surface are a common reason providers consider a topical NSAID. Guidelines list topical NSAIDs among options for knee and hand osteoarthritis.
Tendon and Elbow Pain
Tennis elbow and similar tendon-related pain sit close to the skin, so a topical can reach the area, though it manages symptoms rather than rebuilding tendon.
Neck, Shoulder, and Back Tension
Muscle-related pain in superficial areas is a typical use case. Deeper spinal pain is less likely to respond to a cream by itself. The OTC topical NSAID label also excludes the back, which shapes the options for topical NSAIDs for back pain.
Jaw and Localized Joint Pain
Pain focused over one accessible joint or muscle group is where a topical NSAID is most often discussed as an option.
Does Ketorolac Cream Work? What the Evidence Shows
It helps to separate three different things: the evidence for topical NSAIDs as a category, what is known specifically about ketorolac, and what has not been established for any one compounded formula.
Level 1: Topical NSAIDs as a category
Good evidence, mostly from diclofenac and ketoprofen
The most established evidence is for the topical NSAID class as a whole, and most of it comes from topical diclofenac and ketoprofen. A 2016 Cochrane systematic review of topical NSAIDs for chronic musculoskeletal pain (39 trials, 10,631 participants) found that several topical NSAIDs provided useful pain relief for conditions like knee osteoarthritis (Derry et al., Cochrane 2016). On safety, a 2019 meta-analysis reported that topical NSAIDs may reduce gastrointestinal adverse effects compared with oral NSAIDs (Honvo et al., Drugs & Aging 2019), and a pharmacokinetic study found topical diclofenac produced lower systemic exposure than the same drug taken orally (Kienzler et al., 2010).
Level 2: What is known about ketorolac specifically
A potent NSAID, studied mostly in oral and injectable forms
Ketorolac itself is well characterized as a potent NSAID, but most of that evidence comes from its injectable and oral use for short-term pain, not from topical trials. As a rough sense of where it sits, StatPearls describes ketorolac as an option for acute moderate to severe pain and notes that giving it alongside opioids significantly decreases opioid requirements (StatPearls, Ketorolac). That characterization is drawn from oral, nasal, IV, and IM use. It does not carry over to a cream, where absorption and local concentrations work differently, and it does not mean a ketorolac cream outperforms a diclofenac gel applied to the skin.
Level 3: What is not established
No category result substitutes for testing one exact formula
There is not a large body of head-to-head trials testing a specific compounded topical ketorolac formula against topical diclofenac for these conditions. Because compounded formulas vary by pharmacy, base, and concentration, results from the topical NSAID category, and from oral ketorolac, are informative but are not the same as a clinical trial of the exact cream you are prescribed. The reasonable takeaway is that topical ketorolac is a plausible, provider-directed option, not a proven upgrade over established topical NSAIDs.
Ketorolac Cream vs. Oral and Injectable Ketorolac (Toradol)
The active ingredient is the same. What changes is where the medication goes. Oral and injectable ketorolac act throughout the body and are used for short courses; a topical version keeps more of the dose near the area you treat.
Topical Ketorolac (Compounded)
Applied to the skin over a painful area. More of the dose stays local, and systemic exposure is lower than with an oral dose.
- Concentrates medication near the application site
- Lower systemic exposure than oral, not zero
- Compounded to order, no standalone FDA approval
- Self-applied at home under a prescription
Oral and Injectable Ketorolac
Taken by mouth or given by injection. The drug circulates throughout the body, which is useful clinically but raises systemic exposure.
- FDA-approved for short-term moderate to severe pain
- Oral and injectable use is generally limited to about 5 days
- Full systemic exposure, with NSAID class risks
- Injectable forms are used in hospital and clinic settings
Because the oral and injectable forms are limited to short courses, some people and providers look to a topical option for more localized, longer-running symptoms. That is a reasonable rationale, but it is a clinical decision, not a guarantee of equal effect.
Ketorolac Cream vs. Diclofenac Gel (Voltaren)
Topical diclofenac, sold over the counter as Voltaren, is the most studied topical NSAID. Compounded topical ketorolac is a prescription alternative. The table compares both with oral and injectable ketorolac.
Diclofenac gel has the advantage of a large, direct topical evidence base and easy over-the-counter access, and it helps many people with localized joint pain. Compounded topical ketorolac is a prescription option a provider may consider, but there is no direct topical head-to-head evidence showing it is more effective than diclofenac gel for these conditions. The honest framing is that they are different tools, and which one fits depends on your history and a prescriber's judgment. Diclofenac is also not the only thing on the OTC shelf: a separate guide covers what is in every major OTC pain cream, ingredient by ingredient.
| Consideration | Compounded Topical Ketorolac | Oral / Injectable Ketorolac | OTC Topical Diclofenac (Voltaren) |
|---|---|---|---|
| Prescription status | Prescription, compounded to order | Prescription | Available over the counter (1%) |
| Typical form | Topical cream or gel | Tablet or injection | Topical gel |
| Where it is applied or given | On the skin over the painful area | Whole-body (oral or injected) | On the skin over the painful area |
| Evidence base | Limited direct topical data; relies on NSAID-class evidence | Established for short-term pain (oral/IV) | Largest direct topical NSAID evidence base |
| Systemic exposure | Lower than oral, not zero | Full systemic exposure | Lower than oral, not zero |
| Key safety considerations | NSAID class cautions; skin reactions possible | GI, kidney, cardiovascular risk; short courses only | NSAID class cautions; skin reactions possible |
| Appropriate role | Provider-directed option for localized pain | Short-term moderate to severe pain | Accessible first option for localized pain |
For a deeper comparison focused on diclofenac, see Voltaren vs. Ketro.
Ketorolac Cream Side Effects and Safety
Topical use can lower systemic exposure compared with oral NSAIDs, but absorption and side effects are still possible. The details depend on your formulation, dose, and health history.
What topical delivery can help with
- Concentrates more of the dose near the area you treat
- Lower systemic exposure than an equivalent oral NSAID
- May reduce gastrointestinal adverse effects compared with oral NSAIDs
- The most common local issue is mild skin irritation at the application site
NSAID cautions that still apply
- Gastrointestinal effects, including irritation or bleeding
- Kidney and cardiovascular considerations
- Bleeding risk, especially with blood thinners
- Allergy or asthma triggered by NSAIDs or aspirin
- Pregnancy, where NSAIDs may not be appropriate
- Interactions with other medications
How much risk applies in your case depends on the formulation, the dose, how large an area you treat, how often you use it, what else you take, and your overall health history. This page is general information, not individualized medical advice. Seek urgent care for signs of a serious allergic reaction, such as swelling of the face or throat, difficulty breathing, or a spreading rash. For anything else, a licensed provider should evaluate whether prescription ketorolac is appropriate for you.
What Should You Not Take With Ketorolac?
Ketorolac is an NSAID, and the sharpest rule is about other NSAIDs. What follows comes from the FDA labeling for prescription ketorolac tablets and from the Drug Facts label of an over-the-counter topical NSAID. It is a starting point for a conversation with your prescriber and pharmacist, not a substitute for one.
NSAID plus NSAID
Can you take ketorolac with ibuprofen?
Not unless a prescriber has told you to. Ibuprofen is an NSAID and so is ketorolac, so taking both stacks the same mechanism rather than adding a second one. The FDA label for ketorolac tromethamine tablets states that ketorolac "is contraindicated in patients currently receiving aspirin or NSAIDs because of the cumulative risks of inducing serious NSAID-related adverse events" (DailyMed). MedlinePlus says the same thing in patient language: "Do not take aspirin or other NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) while you are taking ketorolac" (MedlinePlus). Naproxen, aspirin, diclofenac, and celecoxib all sit in the same class. If you are already taking one, say so before ketorolac is prescribed in any form.
A different drug class
Can you take ketorolac with Tylenol (acetaminophen)?
This one goes to your prescriber or pharmacist, and here is why the answer is not simply yes. Acetaminophen is not an NSAID. MedlinePlus puts it "in a class of medications called analgesics (pain relievers) and antipyretics (fever reducers)", which is a different pathway from COX inhibition. In the FDA label for ketorolac tablets, acetaminophen appears once, in a protein-binding finding that therapeutic concentrations of it "did not alter ketorolac tromethamine protein binding", and it is not among the drugs the label singles out for a clinically significant interaction. Those are aspirin and other NSAIDs, anticoagulants, probenecid, pentoxifylline, ACE inhibitors and ARBs, lithium, methotrexate, antiepileptics, and diuretics. That is a statement about what the label does and does not say, not clearance for your situation. Acetaminophen is also an ingredient inside a long list of combination products, and MedlinePlus tells patients not to "take more than one product that contains acetaminophen at a time" and not to exceed 4000 mg a day from all sources.
Topical does not exempt you
Does any of this change if the ketorolac is a cream?
Not enough to skip the conversation. Topical NSAIDs as a class produce lower systemic exposure than the same drug taken by mouth, studied most directly with diclofenac (Kienzler et al., 2010). Equivalent published data for compounded topical ketorolac do not exist, so there is no figure to put on how much of the systemic picture changes for a cream, and interaction questions are about what reaches the bloodstream. The clearest illustration is on an over-the-counter topical NSAID. The Drug Facts label for Voltaren Arthritis Pain, a 1% diclofenac gel, carries a stomach bleeding warning stating that the chance is "higher if you" among other things "take other drugs containing prescription or nonprescription NSAIDs (aspirin, ibuprofen, naproxen, or others)" (DailyMed). Compounded topical ketorolac has no standardized Drug Facts label of its own, because it is prepared to order rather than mass-manufactured. That is exactly why the prescriber who reviews your history is the one to answer this.
| What you are already taking | What the ketorolac labeling says | Source |
|---|---|---|
| Aspirin or another NSAID (ibuprofen, naproxen, diclofenac) | Contraindicated, on the cumulative risk of serious NSAID-related adverse events | FDA label, StatPearls |
| Probenecid | Concomitant use is contraindicated | FDA label |
| Pentoxifylline | Concomitant use is contraindicated; an increased tendency to bleeding is reported | FDA label |
| Warfarin, heparin, or another anticoagulant | Should be done "extremely cautiously", with close monitoring | FDA label |
| An ACE inhibitor or an angiotensin II receptor blocker | May increase the risk of renal impairment, particularly in volume-depleted patients | FDA label |
| Lithium | Watch carefully for signs of lithium toxicity | FDA label |
| Methotrexate | NSAIDs may enhance methotrexate toxicity; the label advises caution | FDA label |
| An SSRI antidepressant | May increase the risk of bleeding | StatPearls |
| Phenytoin or carbamazepine | Sporadic cases of seizures reported with concomitant use | FDA label |
| Furosemide or a thiazide diuretic | Ketorolac can reduce the natriuretic effect | FDA label |
| Acetaminophen (Tylenol) | Not among the drugs the label flags for a clinically significant interaction. The separate caution is to stay under 4000 mg of acetaminophen a day from all products | FDA label, MedlinePlus |
Every row above describes systemic ketorolac, the oral and injectable forms that have been studied and approved. Topical NSAIDs as a class produce lower systemic exposure than the same drug taken by mouth, studied most directly with diclofenac (Kienzler et al., 2010). Equivalent published data for compounded topical ketorolac do not exist. What can be said about a compounded cream is that the active ingredient is the same one this list describes, which makes the list the right agenda for a conversation rather than a risk score. Bring your full medication list, including anything you buy over the counter, to the provider who reviews your prescription. If something is unclear after it is dispensed, the pharmacist who filled it can walk you through it.
Who Should Ask a Provider Before Using Ketorolac?
Ketorolac is prescription-only for a reason: a clinician can weigh your history before you start. It is especially worth a careful conversation if any of the following apply.
- A history of stomach ulcers, gastrointestinal bleeding, or reflux
- Kidney disease, or risk factors for reduced kidney function
- Heart disease, high blood pressure, or prior cardiovascular events
- A known NSAID or aspirin allergy, or aspirin-sensitive asthma
- Use of blood thinners or other medications that affect bleeding
- Pregnancy or trying to become pregnant, where NSAIDs may not be appropriate
- Broken or infected skin over the area you would treat
None of these automatically rule out a topical NSAID, but they are the kind of details a prescriber needs in order to decide whether ketorolac, another medication, or a non-drug approach makes more sense for you.
How Ketro RX Pain Gel Is Prescribed
Ketro RX Pain Gel is one way to access compounded topical ketorolac. Here is what the process actually involves.
Prescription Topical NSAID
RX Pain Gel
Ketro RX Pain Gel contains prescription ketorolac in a compounded topical formulation, developed by the same compounding team that works with professional sports organizations, including the Boston Red Sox. It is intended for localized application when a provider decides it is appropriate.
- Prescription required for every order
- A licensed provider reviews your questionnaire and history
- A US compounding pharmacy prepares approved prescriptions
- Approved prescriptions are shipped to you
- Lower systemic exposure than an oral NSAID, not zero exposure
Because it is compounded, the exact formulation is prepared for you rather than taken off a shelf. As with any NSAID, whether it is a good fit depends on the prescriber's review. If you want the science behind topical delivery in more depth, see how topical relief works.
Frequently Asked Questions
References
- Derry S, Conaghan P, Da Silva JAP, Wiffen PJ, Moore RA. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews. 2016. PubMed 27103611
- Derry S, Wiffen PJ, Kalso EA, et al. Topical analgesics for acute and chronic pain in adults, an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017. PubMed 28497473
- Honvo G, Leclercq V, Geerinck A, et al. Safety of topical non-steroidal anti-inflammatory drugs in osteoarthritis. Drugs & Aging. 2019. PubMed 31073923 / PMC6509095
- Kienzler JL, Gold M, Nollevaux F. Systemic bioavailability of topical diclofenac sodium gel 1% versus oral diclofenac sodium in healthy volunteers. J Clin Pharmacol. 2010. PubMed 19841157
- Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology. 2020. doi:10.1002/art.41142
- Reinhart JM, et al. Ketorolac. StatPearls. NCBI Bookshelf. NBK545172
- Ketorolac Tromethamine tablet, film coated. Prescribing information. DailyMed, US National Library of Medicine. DailyMed label
- Ketorolac. MedlinePlus, US National Library of Medicine. medlineplus.gov/druginfo/meds/a693001
- Acetaminophen. MedlinePlus, US National Library of Medicine. medlineplus.gov/druginfo/meds/a681004
- Voltaren Arthritis Pain (diclofenac sodium topical gel 1%). Drug Facts label. DailyMed, US National Library of Medicine. DailyMed label
Ketro RX Pain Gel is compounded topical ketorolac, prescribed after a licensed provider reviews your history.
This content is for general information and does not constitute medical advice. Consult a licensed healthcare provider before starting any new treatment. Ketorolac requires a prescription, and a provider reviews your health information before prescribing. Compounded topical ketorolac is not an FDA-approved drug product. Individual results vary.
Ketro RX Pain Gel
Compounded prescription topical ketorolac