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Licensed to fill prescriptions for patients in RI, MA, CT, NJ, NH, FL, ME and PA. New York patients are served on a limited basis while nonresident registration is pending.
Prepared to a prescriber's order for one patient. Not FDA-approved.
Ketorolac is a potent non-steroidal anti-inflammatory pain medicine that compounding pharmacies prepare as sterile injections, nasal sprays, eye drops and topical preparations by prescription.
Ketorolac tromethamine is a non-steroidal anti-inflammatory drug (NSAID) with strong pain-relieving activity and no sedative effect. It blocks cyclooxygenase-1 and -2, lowering production of prostaglandins, prostacyclin and thromboxane, the chemical messengers behind pain and inflammation; the S-enantiomer carries the activity. Manufactured products include ketorolac tromethamine tablets (for example Mylan) and injection (for example Hospira), FDA-approved for short-term management of moderately severe acute pain that requires opioid-level analgesia, usually after surgery, with tablets used only to continue injectable therapy; Sprix nasal spray (Zyla), approved for short-term management of moderate to moderately severe pain in adults that requires opioid-level analgesia; and Acular ophthalmic solution (Allergan), approved for ocular itching from seasonal allergic conjunctivitis and for inflammation after cataract surgery. Prescribers may order ketorolac compounded as a preservative-free injection, a nasal or ophthalmic preparation in another strength or vehicle, or a topical form. Compounded preparations are not FDA-approved and require a prescription.
Ketorolac carries an extensive FDA boxed warning. It is for short-term use only, as the label limits, in adults with moderately severe acute pain, never for minor or long-term pain or for children. It can cause stomach or intestinal bleeding, ulcers or perforation without warning, and NSAIDs raise the risk of heart attack and stroke. The boxed warning lists contraindications: active or past peptic ulcer or GI bleeding, coronary bypass surgery, advanced kidney disease or dehydration that threatens kidney function, any bleeding risk or incomplete hemostasis, use before major surgery, labor and delivery, and taking aspirin or any other NSAID at the same time. Do not use it if aspirin or NSAIDs have caused asthma, hives or allergic reactions, or with probenecid or pentoxifylline. Warfarin and heparin, SSRIs, oral steroids, ACE inhibitors, diuretics, lithium and methotrexate all interact; review your list with your prescriber or pharmacist. Doses are reduced for people 65 and older, with low body weight, or with raised creatinine. Avoid in pregnancy from about 20 weeks, and from 30 weeks on it can close the fetal ductus arteriosus. Milk levels are low, but the oral label advises caution and MedlinePlus says not to breastfeed while taking it. Stop and get emergency help for black or bloody stools, vomiting blood, chest pain, one-sided weakness, slurred speech, swelling, rash or trouble breathing.
Ketorolac is a racemic NSAID whose analgesic activity resides in the S-enantiomer; it inhibits COX-1 and COX-2 and platelet function. Oral bioavailability is 100 percent, plasma protein binding about 99 percent, racemate half-life 5 to 6 hours (S-enantiomer about 2.5 hours, longer in the elderly and in renal impairment), hepatic hydroxylation and conjugation, and about 92 percent urinary excretion, roughly 60 percent unchanged. Probenecid raises AUC about threefold and doubles half-life. Labeled indications are given above by product; the oral label limits combined parenteral and oral therapy to a short course and states that higher doses add risk without added benefit. StatPearls lists off-label use for pediatric acute pain, emergency department musculoskeletal pain, migraine and sickle cell crises, pain from bone-metastatic cancer and patients with opioid use disorder. The injection's boxed warning contraindicates intrathecal or epidural administration because of its alcohol content. The 2020 NASEM report on compounded topical pain creams found "limited evidence to support the use of compounded topical pain creams" and did not evaluate ketorolac specifically. Dosing and route are per prescriber. Monitoring: CBC for occult GI bleeding, renal function and urine output, liver enzymes, and INR with anticoagulants. Ketorolac is not a controlled substance.
Wash your hands. Apply the amount on your label to clean, dry skin and spread it in a thin layer. For a metered pump, your label states the number of presses. For a dosing syringe, push the plunger to the mark. Let the gel dry before covering with clothing. Wash your hands afterward and keep the site from touching other people until it has dried. Do not apply to broken skin unless told to.
A gel can have a nonaqueous or a water-based base, and USP <795> sets its default beyond-use date by water content, not by the word gel. A nonaqueous gel usually carries a beyond-use date of up to 180 days at room temperature or refrigerated. A water-based gel carries up to 35 days with a preservative, or 14 days refrigerated without one. Your label states which applies. Keep the container closed, away from heat and open flame if it contains alcohol, out of reach of children, and discard after the beyond-use date on your label.
This formulation is compounded by Bayview Pharmacy on a prescriber's order for an individual patient. It is not an FDA-approved drug product, and the FDA has not evaluated it for safety, effectiveness, or manufacturing quality.
A valid prescription is required. Availability depends on Bayview's licensure in your state. This page is general information, not medical advice. Discuss your situation with a licensed healthcare provider.
Search by NCPDP 4106882, or by name and ZIP: Bayview Pharmacy, Warwick, RI 02886. Select it as the destination pharmacy and save it as a favorite. Click any value to copy it.
Compounded preparations have no NDC, so this formula will not appear in your EHR's drug search. Use your system's compound, non-formulary, or free-text prescription entry and name the preparation exactly as written in step 3. If your EHR forces you to pick a listed drug, pick the closest entry for the active ingredient and put the full formula in the prescription body (the Sig or directions field), not in Notes to Pharmacy.
Compounded preparations have no NDC and will not appear in your drug search. For EPCS to validate, select a drug entry your EHR recognizes as controlled, usually the bulk powder entry for the active ingredient (for example Ketamine (bulk) powder, not a branded product), then put the full formula from step 3 in the prescription body. A free-text entry that does not validate as controlled will be rejected by your EPCS module.
Quantity and directions are starting points for this dose form, not treatment recommendations. Dosing remains the prescriber's responsibility.
Transmit from your EHR. For this non-controlled preparation we also accept fax to (401) 284-4506 and phoned orders at (401) 284-4505. Order forms are on the formulation pages and in the prescriber portal.
Transmit with two-factor authentication through your EPCS-enabled EHR. No order form is offered for this preparation; e-prescribing guides for our controlled preparations are on the formulation pages.
Licensed to dispense in RI, MA, CT, NJ, NH, FL, ME, and PA; New York is served on a limited basis while nonresident registration is pending. Compounded preparations are not FDA-approved. A valid prescription is required. Full guide, including steps by EHR: How to e-prescribe to Bayview. Questions about this formula: call (401) 284-4505.
Apply topically to affected area(s)
