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

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

Indomethacin

Most common
Dyspepsia (up to 9%)
Headache (up to 16%)
Nausea (up to 9%)
Dizziness (up to 9%)

Ketorolac vs. Indomethacin Dosage

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

Indomethacin

Dosage
Dosage Table
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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