Diclofenac vs. Ketorolac

See how Diclofenac and Ketorolac compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Diclofenac is approved for ongoing conditions like arthritis, while ketorolac is limited to short-term, severe acute pain for no more than five days total.

  • Both carry boxed warnings for cardiovascular and gastrointestinal risks, but ketorolac also carries a boxed warning for kidney failure with prolonged use.

  • Ketorolac can be given by injection for fast, opioid-level pain relief, while diclofenac is typically taken as an oral tablet for longer-term symptom control.

Diclofenac vs. Ketorolac Drug Summary

Diclofenac

Diclofenac is an NSAID prescribed for ongoing pain and inflammation from osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, as well as short-term acute pain and menstrual cramps. It comes as a delayed-release oral tablet, usually taken two to three times a day depending on the dose.

Ketorolac

Ketorolac is an NSAID used for short-term treatment of moderately severe acute pain strong enough to otherwise require an opioid. It is given as an IV or IM injection in hospitals, or sometimes as an oral tablet or nasal spray, for no more than five total days.

Diclofenac vs. Ketorolac Side Effects

Diclofenac

Most common
Gastrointestinal symptoms (up to 20%)
Headache (up to 7%)
Dizziness (up to 3%)
Elevated liver enzymes (up to 2%)

Ketorolac

Most common
Abdominal pain (>10%)
Dyspepsia (>10%)
Nausea (>10%)
Headache (>10%)

Diclofenac vs. Ketorolac Dosage

Diclofenac

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50 mg two-three x daily At the start
Maximum dose 150 mg/day maximum If needed
Dose changes 3 increases As tolerated

Ketorolac

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 30 mg IV/IM every 6 hrs Days 1-5
Maximum dose 10 mg every 4-6 hrs PRN If needed
Dose changes 3 increases As tolerated

Diclofenac vs. Ketorolac Indications

Diclofenac

Diclofenac is FDA-approved for chronic inflammatory conditions such as osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. It is also approved for mild to moderate acute pain and menstrual cramps (primary dysmenorrhea).

  • Osteoarthritis pain and inflammation

  • Rheumatoid arthritis pain and inflammation

  • Ankylosing spondylitis

  • Mild to moderate acute pain

  • Primary dysmenorrhea

Ketorolac

Ketorolac is FDA-approved only for short-term management of moderately severe acute pain that would otherwise require an opioid. Treatment with ketorolac, in any combination of forms, cannot exceed five total days.

  • Moderately severe acute pain (opioid-level)

  • Often used after surgery or injury

  • Given as IV/IM injection, oral tablet, or nasal spray

  • Maximum 5 days of combined use

  • Not for chronic or minor pain

Diclofenac vs. Ketorolac Pros and Cons

Diclofenac

Diclofenac's approval for chronic conditions makes it a long-term option for arthritis pain, but that same long-term use raises cumulative risk of GI and cardiovascular complications. It is widely available in multiple forms, including an over-the-counter topical gel.

Pros

  • Approved for long-term chronic conditions like osteoarthritis and rheumatoid arthritis

  • Available in oral, topical, ophthalmic, and injectable forms

  • Topical gel version available over-the-counter for mild joint pain

  • Flexible oral dosing from once to three times daily

Cons

  • Long-term use raises cumulative cardiovascular and GI risk

  • Risk of severe liver toxicity requires periodic monitoring

  • Not approved for use in pediatric patients

  • Extended use increases risk of stomach ulcers and bleeding

Ketorolac

Ketorolac delivers strong, opioid-level pain relief, which makes it useful for short bursts of severe pain, especially after surgery or injury. Its potency comes with a strict five-day limit and kidney-related warnings not typically seen with routine NSAID use.

Pros

  • Potent analgesia comparable to opioids without opioid-related sedation

  • Available as IV/IM injection for rapid pain relief in hospitals

  • Useful opioid-sparing option after surgery or trauma

  • Nasal spray option avoids the need for an injection

Cons

  • Strict 5-day maximum use limit across all forms combined

  • Contraindicated in patients with advanced kidney disease

  • Not approved for chronic or minor pain conditions

  • Cannot be used before major surgery or during CABG procedures

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