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
Ketorolac
Diclofenac vs. Ketorolac Dosage
Diclofenac
Ketorolac
| 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 |
| 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
| 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
| 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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