Ketorolac vs. Indomethacin
See how Ketorolac and Indomethacin compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Ketorolac is a short-term NSAID capped at 5 days total use for moderately severe acute pain that would otherwise need opioid-level relief.
Indomethacin is used for longer-term management of chronic inflammatory conditions like rheumatoid arthritis, osteoarthritis, and gout flares.
Both drugs carry FDA boxed warnings or serious warnings for cardiovascular, gastrointestinal, and kidney risks common to NSAIDs.
Ketorolac vs. Indomethacin Drug Summary
Ketorolac
Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) approved for short-term treatment of moderately severe acute pain that would otherwise require opioid-level analgesia. It is given as an IV/IM injection, oral tablet, nasal spray, or ophthalmic solution, but total treatment across all forms cannot exceed 5 days.
Indomethacin
Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used for longer-term management of chronic conditions such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis, plus flares of gout and bursitis. It is typically taken as an oral capsule two to three times a day, with the dose adjusted to the lowest amount that controls symptoms.
Ketorolac vs. Indomethacin Side Effects
Ketorolac
Indomethacin
Ketorolac vs. Indomethacin Dosage
Ketorolac
Indomethacin
| 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 |
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg 2-3 times daily | At the start |
| Maximum dose | 50 mg 3 times daily | 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 |
Indomethacin
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg 2-3 times daily | At the start |
| Maximum dose | 50 mg 3 times daily | If needed |
| Dose changes | 3 increases | As tolerated |
Ketorolac vs. Indomethacin Indications
Ketorolac
Ketorolac is FDA-approved only for short-term management of moderately severe acute pain, such as after surgery, that needs opioid-level relief. It is not approved for minor pain, chronic conditions, children, or as a preventive pain reliever before major surgery.
Moderately severe acute pain requiring opioid-level analgesia
Short-term postoperative pain (5-day total limit, all routes combined)
Transition from injectable to oral therapy only, never oral alone
Not approved for children, chronic pain, or labor and delivery
Indomethacin
Indomethacin is FDA-approved for long-term treatment of moderate to severe rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. It is also approved for acute painful shoulder from bursitis or tendinitis and for acute gouty arthritis flares.
Moderate to severe rheumatoid arthritis, including acute flares
Ankylosing spondylitis
Osteoarthritis
Acute painful shoulder (bursitis or tendinitis)
Ketorolac vs. Indomethacin Pros and Cons
Ketorolac
Ketorolac delivers analgesia comparable to morphine without opioid-related sedation or dependence risk, useful for short bursts of severe pain. Its strict 5-day cap and boxed warnings mean it is reserved for brief, closely monitored use rather than ongoing pain control.
Pros
Opioid-level pain relief without opioid sedation or dependence risk
Available as IV/IM, oral, and nasal spray for flexible administration
Fast onset useful for acute postoperative or emergency pain
Cons
Cannot be used for more than 5 days total across all forms
Boxed warnings for heart attack, stroke, GI bleeding, and kidney failure
Contraindicated before major surgery, in labor, and in advanced kidney disease
Not approved for children or chronic pain conditions
Indomethacin
Indomethacin is one of the more potent NSAIDs for controlling inflammation in chronic arthritis and acute gout flares, and it can be used for extended periods when needed. That potency comes with a higher rate of headache and dizziness than many other NSAIDs, especially in older adults.
Pros
Approved for long-term control of chronic inflammatory arthritis
Effective first-line option for acute gout flares
Available in capsule, suspension, and suppository forms for flexible dosing
Cons
Higher rates of headache and dizziness than many other NSAIDs
Requires dosing 2-3 times daily rather than a single daily dose
Not indicated for severe acute pain needing opioid-level analgesia
Long-term use still carries cumulative GI, cardiovascular, and kidney risk
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