Ketorolac Oral, Intravenous, Injection, Intramuscular

kee-toe-ROLE-ak

Oral routeTablet
  • Warning
    • Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug (NSAID), is indicated for the short-term (up to 5 days in adults), management of moderately severe acute pain that requires analgesia at the opioid level and only as continuation treatment following IV or IM dosing of ketorolac tromethamine, if necessary. The total combined duration of use of oral and injectable ketorolac tromethamine should not exceed 5 days.
    • Ketorolac tromethamine is not indicated for use in pediatric patients and it is NOT indicated for minor or chronic painful conditions. Increasing the dose of oral ketorolac tromethamine beyond a daily maximum of 40 mg in adults will not provide better efficacy but will increase the risk of developing serious adverse events.
  • Gastrointestinal risk
    • Ketorolac tromethamine can cause peptic ulcers, gastrointestinal bleeding and/or perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Therefore ketorolac tromethamine is contraindicated in patients with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or perforation, and in patients with a history of peptic ulcer disease or gastrointestinal bleeding. Elderly patients are at greater risk for serious gastrointestinal events.
  • Cardiovascular risk
    • NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.
    • Ketorolac tromethamine is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
  • Renal risk
    • Ketorolac tromethamine is contraindicated in patients with advanced renal impairment and in patients at risk for renal failure due to volume depletion.
  • Risk of bleeding
    • Ketorolac tromethamine inhibits platelet function and is, therefore, contraindicated in patients with suspected or confirmed cerebrovascular bleeding, patients with hemorrhagic diathesis, incomplete hemostasis and those at high risk of bleeding.
  • Ketorolac tromethamine is contraindicated as prophylactic analgesic before any major surgery
  • Risk during labor and delivery
    • The use of ketorolac tromethamine in labor and delivery is contraindicated because it may adversely affect fetal circulation and inhibit uterine contractions. The use of ketorolac tromethamine is contraindicated in nursing mothers because of the potential adverse effects of prostaglandin-inhibiting drugs on neonates.
  • Concomitant use with NSAIDs
    • Ketorolac tromethamine is contraindicated in patients currently receiving aspirin or because of the cumulative risk of inducing serious NSAID-related side effects.
  • Special populations
    • Dosage should be adjusted for patients 65 years or older, for patients under 50 kilograms (110 pounds) of body weight and for patients with moderately elevated serum creatinine

For short term use only (up to 5 days in adults). Contraindicated in patients with peptic ulcer disease, recent GI bleeding or perforation, peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery, advanced renal impairment, risk of renal failure due to volume depletion, cerebrovascular bleeding, hemorrhagic diathesis, incomplete homeostasis, high-risk of bleeding, prophylactic analgesic before major surgery, labor and delivery use, nursing mothers, and concomitant aspirin or NSAID use. Use caution with elderly patients due to high risk of GI adverse events and in patients with cardiovascular disease or risk factors .

Intravenous routeSolution
  • Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug (NSAID), is indicated for the short-term (up to 5 days) management of moderately severe acute pain that requires analgesia at the opioid level. It is not indicated for minor or chronic painful conditions. Ketorolac tromethamine is a potent NSAID analgesic, and its administration carries many risks. The resulting NSAID-related adverse events can be serious in certain patients for whom ketorolac tromethamine is indicated, especially when the drug is used inappropriately. Increasing the dose of ketorolac tromethamine beyond the label recommendations will not provide better efficacy but will result in increasing the risk of developing serious adverse events.
  • Gastrointestinal effects
    • Ketorolac tromethamine can cause peptic ulcers, gastrointestinal bleeding and/or perforation. Therefore, ketorolac tromethamine is contraindicated in patients with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or perforation, and in patients with a history of peptic ulcer disease or gastrointestinal bleeding.
  • Renal effects
    • Ketorolac tromethamine is contraindicated in patients with advanced renal impairment and in patients at risk for renal failure due to volume depletion.
  • Risk of bleeding
    • Ketorolac tromethamine inhibits platelet function and is, therefore, contraindicated in patients with suspected or confirmed cerebrovascular bleeding, patients with hemorrhagic diathesis, incomplete hemostasis and those at high risk of bleeding.
    • Ketorolac tromethamine is contraindicated as prophylactic analgesic before any major surgery and is contraindicated intraoperatively when hemostasis is critical because of the increased risk of bleeding.
  • Hypersensitivity
    • Hypersensitivity reactions, ranging from bronchospasm to anaphylactic shock, have occurred and appropriate counteractive measures must be available when administering the first dose of ketorolac tromethamine injection. Ketorolac tromethamine is contraindicated in patients with previously demonstrated hypersensitivity to ketorolac tromethamine or allergic manifestations to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Intrathecal or epidural administration
    • Ketorolac tromethamine is contraindicated for intrathecal or epidural administration due to its alcohol content.
  • Labor, delivery and nursing
    • The use of ketorolac tromethamine in labor and delivery is contraindicated because it may adversely affect fetal circulation and inhibit uterine contractions.
    • The use of ketorolac tromethamine is contraindicated in nursing mothers because of the potential adverse effects of prostaglandin-inhibiting drugs on neonates.
  • Concomitant use with NSAIDs
    • Ketorolac tromethamine is contraindicated in patients currently receiving ASA or NSAIDs because of the cumulative risk of inducing serious NSAID-related side effects.
  • Dosage and administration
    • Ketorolac tromethamine tablets are indicated only as continuation therapy to ketorolac tromethamine IV/IM, and the combined duration of use of ketorolac tromethamine IV/IM and ketorolac tromethamine tablets is not to exceed 5 days, because of the increased risk of serious adverse events.
    • The recommended total daily dose of ketorolac tromethamine tablets (maximum 40 mg) is significantly lower than for ketorolac tromethamine IV/IM (maximum 120 mg).
  • Special populations
    • Dosage should be adjusted for patients 65 years or older, for patients under 50 kilograms (110 pounds) of body weight and for patients with moderately elevated serum creatinine. IV/IM doses of ketorolac tromethamine injection are not to exceed 60 mg (total dose per day) in these patients. Ketorolac tromethamine injection is indicated as a single dose therapy in pediatric patients; not to exceed 30 mg for IM administration and 15 mg for IV administration .

For short term use only (up to 5 days in adults). Contraindicated in patients with peptic ulcer disease, recent GI bleeding or perforation, peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery, advanced renal impairment, risk of renal failure due to volume depletion, cerebrovascular bleeding, hemorrhagic diathesis, incomplete homeostasis, high-risk of bleeding, prophylactic analgesic before major surgery, intra-operatively when hemostasis is critical, intrathecal/epidural use, labor and delivery use, nursing mothers, and concomitant aspirin or NSAID use. Use caution with elderly patients due to high risk of GI adverse events and in patients with cardiovascular disease or risk factors .

Intramuscular routeSolution
  • Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug (NSAID), is indicated for the short-term (up to 5 days) management of moderately severe acute pain that requires analgesia at the opioid level. It is not indicated for minor or chronic painful conditions. Ketorolac tromethamine is a potent NSAID analgesic, and its administration carries many risks. The resulting NSAID-related adverse events can be serious in certain patients for whom ketorolac tromethamine is indicated, especially when the drug is used inappropriately. Increasing the dose of ketorolac tromethamine beyond the label recommendations will not provide better efficacy but will result in increasing the risk of developing serious adverse events.
  • Gastrointestinal effects
    • Ketorolac tromethamine can cause peptic ulcers, gastrointestinal bleeding and/or perforation. Therefore, ketorolac tromethamine is contraindicated in patients with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or perforation, and in patients with a history of peptic ulcer disease or gastrointestinal bleeding.
  • Renal effects
    • Ketorolac tromethamine is contraindicated in patients with advanced renal impairment and in patients at risk for renal failure due to volume depletion.
  • Risk of bleeding
    • Ketorolac tromethamine inhibits platelet function and is, therefore, contraindicated in patients with suspected or confirmed cerebrovascular bleeding, patients with hemorrhagic diathesis, incomplete hemostasis and those at high risk of bleeding.
    • Ketorolac tromethamine is contraindicated as prophylactic analgesic before any major surgery and is contraindicated intraoperatively when hemostasis is critical because of the increased risk of bleeding.
  • Hypersensitivity
    • Hypersensitivity reactions, ranging from bronchospasm to anaphylactic shock, have occurred and appropriate counteractive measures must be available when administering the first dose of ketorolac tromethamine injection. Ketorolac tromethamine is contraindicated in patients with previously demonstrated hypersensitivity to ketorolac tromethamine or allergic manifestations to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Intrathecal or epidural administration
    • Ketorolac tromethamine is contraindicated for intrathecal or epidural administration due to its alcohol content.
  • Labor, delivery and nursing
    • The use of ketorolac tromethamine in labor and delivery is contraindicated because it may adversely affect fetal circulation and inhibit uterine contractions.
    • The use of ketorolac tromethamine is contraindicated in nursing mothers because of the potential adverse effects of prostaglandin-inhibiting drugs on neonates.
  • Concomitant use with NSAIDs
    • Ketorolac tromethamine is contraindicated in patients currently receiving ASA or NSAIDs because of the cumulative risk of inducing serious NSAID-related side effects.
  • Dosage and administration
    • Ketorolac tromethamine tablets are indicated only as continuation therapy to ketorolac tromethamine IV/IM, and the combined duration of use of ketorolac tromethamine IV/IM and ketorolac tromethamine tablets is not to exceed 5 days, because of the increased risk of serious adverse events.
    • The recommended total daily dose of ketorolac tromethamine tablets (maximum 40 mg) is significantly lower than for ketorolac tromethamine IV/IM (maximum 120 mg).
  • Special populations
    • Dosage should be adjusted for patients 65 years or older, for patients under 50 kilograms (110 pounds) of body weight and for patients with moderately elevated serum creatinine. IV/IM doses of ketorolac tromethamine injection are not to exceed 60 mg (total dose per day) in these patients. Ketorolac tromethamine injection is indicated as a single dose therapy in pediatric patients; not to exceed 30 mg for IM administration and 15 mg for IV administration .

For short term use only (up to 5 days in adults). Contraindicated in patients with peptic ulcer disease, recent GI bleeding or perforation, peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery, advanced renal impairment, risk of renal failure due to volume depletion, cerebrovascular bleeding, hemorrhagic diathesis, incomplete homeostasis, high-risk of bleeding, prophylactic analgesic before major surgery, intra-operatively when hemostasis is critical, intrathecal/epidural use, labor and delivery use, nursing mothers, and concomitant aspirin or NSAID use. Use caution with elderly patients due to high risk of GI adverse events and in patients with cardiovascular disease or risk factors .

Commonly used brand name(s):

In the U.S.

  • Toradol
  • Toradol IV/IM

Available Dosage Forms:

  • Solution
  • Tablet
  • Injectable

Therapeutic Class: Analgesic

Pharmacologic Class: NSAID

Chemical Class: Acetic Acid (class)

Uses For ketorolac

Ketorolac is used to relieve moderately severe pain, usually pain that occurs after an operation or other painful procedure. It belongs to the group of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs). Ketorolac is not a narcotic and is not habit-forming. It will not cause physical or mental dependence, as narcotics can. However, ketorolac is sometimes used together with a narcotic to provide better pain relief than either medicine used alone.

Ketorolac has side effects that can be very dangerous. The risk of having a serious side effect increases with the dose of ketorolac and with the length of treatment. Therefore, ketorolac should not be used for more than 5 days. Before using ketorolac, you should discuss with your doctor the good that ketorolac can do as well as the risks of using it.

Ketorolac is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, ketorolac is used in certain patients with the following medical conditions:

  • Pain after surgery in children

Before Using ketorolac

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For ketorolac, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to ketorolac or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies on ketorolac have been done only in adult patients, and there is no specific information comparing use of ketorolac in children up to 16 years of age with use in other age groups.

Geriatric

Stomach or intestinal problems, swelling of the face, feet, or lower legs, or sudden decrease in the amount of urine may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of ketorolac. Also, elderly people are more likely than younger adults to get very sick if the medicine causes stomach problems. Studies in older adults have shown that ketorolac stays in the body longer than it does in younger people. Your doctor will consider this when deciding on how much ketorolac should be given for each dose and how often it should be given.

Interactions with Medicines

Using ketorolac with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Aceclofenac
  • Acemetacin
  • Alclofenac
  • Apazone
  • Aspirin
  • Benoxaprofen
  • Bufexamac
  • Carprofen
  • Clometacin
  • Clonixin
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyrone
  • Droxicam
  • Etodolac
  • Etofenamate
  • Felbinac
  • Fenbufen
  • Fenoprofen
  • Fentiazac
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Ibuprofen
  • Indomethacin
  • Indoprofen
  • Isoxicam
  • Ketoprofen
  • Lornoxicam
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Nabumetone
  • Naproxen
  • Niflumic Acid
  • Nimesulide
  • Oxaprozin
  • Oxyphenbutazone
  • Phenylbutazone
  • Pirazolac
  • Piroxicam
  • Pirprofen
  • Propyphenazone
  • Proquazone
  • Sulindac
  • Suprofen
  • Tenidap
  • Tenoxicam
  • Tiaprofenic Acid
  • Tolmetin
  • Zomepirac

Using ketorolac with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Ardeparin
  • Beta Glucan
  • Certoparin
  • Dalteparin
  • Danaparoid
  • Enoxaparin
  • Ginkgo
  • Methotrexate
  • Nadroparin
  • Parnaparin
  • Pemetrexed
  • Reviparin
  • Tacrolimus
  • Tinzaparin

Using ketorolac with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acetohexamide
  • Alacepril
  • Amiloride
  • Azosemide
  • Bemetizide
  • Benazepril
  • Bendroflumethiazide
  • Benzthiazide
  • Bumetanide
  • Buthiazide
  • Candesartan Cilexetil
  • Canrenoate
  • Captopril
  • Chlorothiazide
  • Chlorpropamide
  • Chlorthalidone
  • Cilazapril
  • Citalopram
  • Clopamide
  • Clopidogrel
  • Clovoxamine
  • Cyclopenthiazide
  • Cyclosporine
  • Cyclothiazide
  • Delapril
  • Desvenlafaxine
  • Duloxetine
  • Enalaprilat
  • Enalapril Maleate
  • Eprosartan
  • Escitalopram
  • Ethacrynic Acid
  • Femoxetine
  • Flesinoxan
  • Fluoxetine
  • Fluvoxamine
  • Fosinopril
  • Furosemide
  • Gliclazide
  • Glimepiride
  • Glipizide
  • Gliquidone
  • Glyburide
  • Hydrochlorothiazide
  • Hydroflumethiazide
  • Imidapril
  • Indapamide
  • Irbesartan
  • Lisinopril
  • Lithium
  • Losartan
  • Methyclothiazide
  • Metolazone
  • Milnacipran
  • Moexipril
  • Nefazodone
  • Olmesartan Medoxomil
  • Paroxetine
  • Pentopril
  • Perindopril
  • Piretanide
  • Polythiazide
  • Probenecid
  • Quinapril
  • Quinethazone
  • Ramipril
  • Sertraline
  • Spirapril
  • Spironolactone
  • Tasosartan
  • Telmisartan
  • Temocapril
  • Tolazamide
  • Tolbutamide
  • Torsemide
  • Trandolapril
  • Triamterene
  • Trichlormethiazide
  • Valsartan
  • Venlafaxine
  • Xipamide
  • Zimeldine
  • Zofenopril

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of ketorolac. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse or
  • Diabetes mellitus (sugar diabetes) or
  • Edema (swelling of face, fingers, feet or lower legs caused by too much fluid in the body) or
  • Kidney disease or
  • Liver disease (severe) or
  • Systemic lupus erythematosus (SLE)—The chance of serious side effects may be increased
  • Asthma or
  • Heart disease or
  • High blood pressure—Ketorolac may make your condition worse.
  • Bleeding in the brain (history of) or
  • Hemophilia or other bleeding problems—Ketorolac may increase the chance of serious bleeding
  • Bleeding from the stomach or intestines (history of) or
  • Colitis, stomach ulcer, or other stomach or intestinal problems (or history of)—Ketorolac may make stomach or intestinal problems worse. Also, bleeding from the stomach or intestines is more likely to occur during ketorolac treatment in people with these conditions

Proper Use of ketorolac

For patients taking ketorolac tablets:

  • To lessen stomach upset, ketorolac tablets should be taken with food (a meal or a snack) or with an antacid.
  • Take ketorolac with a full glass of water. Also, do not lie down for about 15 to 30 minutes after taking it. This helps to prevent irritation that may lead to trouble in swallowing.

For patients using ketorolac injection:

  • Medicines given by injection are sometimes used at home. If you will be using ketorolac at home, your health care professional will teach you how the injections are to be given. You will also have a chance to practice giving injections. Be certain that you understand exactly how the medicine is to be injected.

For safe and effective use of ketorolac, do not use more of it, do not use it more often, and do not use it for more than 5 days. Using too much of ketorolac increases the chance of unwanted effects, especially in elderly patients.

Ketorolac should be used only when it is ordered by your doctor for treating certain kinds of pain. Because of the risk of serious side effects, do not save any leftover ketorolac for use in the future, and do not share it with other people.

Dosing

The dose of ketorolac will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of ketorolac. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For pain:
      • Adults (patients 16 years of age and older)—One 10-milligram (mg) tablet four times a day, four to six hours apart. Some people may be directed to take two tablets for the first dose only.
      • Children up to 16 years of age—Use and dose must be determined by your doctor.
  • For injection dosage form:
    • For pain:
      • Adults (patients 16 years of age and older)—15 or 30 mg, injected into a muscle or a vein four times a day, at least 6 hours apart. This amount of medicine may be contained in 1 mL or in one-half (0.5) mL of the injection, depending on the strength. Some people who do not need more than one injection may receive one dose of 60 mg, injected into a muscle.
      • Children up to 16 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of ketorolac, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Do not refrigerate. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using ketorolac

Taking certain other medicines together with ketorolac may increase the chance of unwanted effects. The risk will depend on how much of each medicine you take every day, and on how long you take the medicines together. Therefore, do not take acetaminophen (e.g., Tylenol) together with ketorolac for more than a few days, unless otherwise directed by your medical doctor or dentist. Also, do not take any of the following medicines together with ketorolac, unless your medical doctor or dentist has directed you to do so and is following your progress:

  • Aspirin or other salicylates
  • Diclofenac (e.g., Voltaren)
  • Diflunisal (e.g., Dolobid)
  • Etodolac (e.g., Lodine)
  • Fenoprofen (e.g., Nalfon)
  • Floctafenine (e.g., Idarac)
  • Flurbiprofen (e.g., Ansaid)
  • Ibuprofen (e.g., Motrin)
  • Indomethacin (e.g., Indocin)
  • Ketoprofen (e.g., Orudis)
  • Meclofenamate (e.g., Meclomen)
  • Mefenamic acid (e.g., Ponstel)
  • Nabumetone (e.g., Relafen)
  • Naproxen (e.g., Naprosyn)
  • Oxaprozin (e.g., Daypro)
  • Phenylbutazone (e.g., Butazolidin)
  • Piroxicam (e.g., Feldene)
  • Sulindac (e.g., Clinoril)
  • Tenoxicam (e.g., Mobiflex)
  • Tiaprofenic acid (e.g., Surgam)
  • Tolmetin (e.g., Tolectin)
  • Zomepirac (e.g., Zomax)

Ketorolac may cause some people to become dizzy or drowsy. If either of these side effects occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert.

Serious side effects can occur during treatment with ketorolac. Sometimes serious side effects can occur without any warning. However, possible warning signs often occur, including swelling of the face, fingers, feet, and/or lower legs; severe stomach pain, black, tarry stools, and/or vomiting of blood or material that looks like coffee grounds; unusual weight gain; and/or skin rash. Also, signs of serious heart problems could occur such as chest pain, tightness in chest, fast or irregular heartbeat, or unusual flushing or warmth of skin. Stop taking ketorolac and check with your doctor immediately if you notice any of these warning signs.

ketorolac Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Stop taking ketorolac and get emergency help immediately if any of the following effects occur:

Rare
  • Bleeding from the rectum or bloody or black, tarry stools
  • bleeding or crusting sores on lips
  • blue lips and fingernails
  • chest pain
  • convulsions
  • fainting
  • shortness of breath, fast, irregular, noisy, or troubled breathing, tightness in chest, and/or wheezing
  • vomiting of blood or material that looks like coffee grounds

Check with your doctor as soon as possible if any of the following side effects occur:

More common
  • Swelling of face, fingers, lower legs, ankles, and/or feet
  • weight gain (unusual)
Less common
  • Bruising (not at place of injection)
  • high blood pressure
  • skin rash or itching
  • small, red spots on skin
  • sores, ulcers, or white spots on lips or in mouth
Rare
  • Abdominal or stomach pain, cramping, or burning (severe)
  • bloody or cloudy urine
  • blurred vision of other vision change
  • burning, red, tender, thick, scaly, or peeling skin
  • cough or hoarseness
  • dark urine
  • decrease in amount of urine (sudden)
  • fever with severe headache, drowsiness, confusion, and stiff neck or back
  • fever with or without chills or sore throat
  • general feeling of illness
  • hallucinations (seeing, hearing, or feeling things that are not there)
  • hearing loss
  • hives
  • increase in amount of urine or urinating often
  • light-colored stools
  • loss of appetite
  • low blood pressure
  • mood changes or unusual behavior
  • muscle cramps or pain
  • nausea, heartburn, and/or indigestion (severe and continuing)
  • nosebleeds
  • pain in lower back and/or side
  • pain, tenderness, and/or swelling in the upper abdominal area
  • painful or difficult urination
  • pale skin
  • puffiness or swelling of the eyelids or around the eyes
  • ringing or buzzing in ears
  • runny nose
  • severe restlessness
  • swollen and/or painful glands
  • swollen tongue
  • thirst (continuing)
  • unusual tiredness or weakness
  • yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Abdominal or stomach pain (mild or moderate)
  • bruising at place of injection
  • diarrhea
  • dizziness
  • drowsiness
  • headache
  • indigestion
  • nausea
Less common or rare
  • Bloating or gas
  • burning or pain at place of injection
  • constipation
  • feeling of fullness in abdominal or stomach area
  • increased sweating
  • vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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