Ketorolac Tromethamine (Toradol)

Category:

• Analgesic

Description:

• Nonsteroidal anti-inflammatory drug (NSAID) analgesic

Indications:

• Moderately severe acute pain requiring analgesia at an opioid level (usually in a post-operative setting)  

Contraindications:

• Patients with active or history of peptic ulcer disease, gastrointestinal bleeding or perforation.

• Patients with advanced renal impairment or at risk of renal failure due to volume depletion.

• Labor and delivery.

• Prophylactic analgesia or intraoperative analgesia.

• Patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, and at high risk of bleeding.

• Patients currently on aspirin or other NSAIDs.

• Epidural or intrathecal injection.

• Concomitant use with probenecid.  

Precautions:

• Pregnancy Category C

• Ketorolac therapy should not continue over a duration of 5 days.  After days, switch to another appropriate analgesic agent.

• Ketorolac is an extremely potent NSAID and may experience cause potentially serious GI effects, including GI bleeding and ulceration, as well as kidney failure.

• Avoid use with anticoagulants (warfarin) due to increased bleeding times and potential for GI bleeding and decreased platelet aggregation.

• When administering as IV bolus, administer over a 15 second period.

• When administering as IM bolus, give slowly and deeply into muscle tissue.

• Analgesic effects begin in about 30 minutes and peak at 1-2 hours, with a duration of 2-6 hours.  

Adverse Reactions (Side Effects):

• GI effects: nausea (12%), dyspepsia (11%), GI pain (13%), diarrhea (7%)

• CNS effects: headache (17%), dizziness (7%), drowsiness (6%)

Dosage:

Administered as an oral tablet or injection (IM or IV)

May be used as a “one time” dose or as “prn” treatment

Single-Dose Treatment:

• IM (patients <65 years old): 60mg, one dose

• IM (patients >65 years old, with renal impairment or less than 50kg): 30mg, one dose

• IV (patients <65 years old): 60mg, one dose

• IV (patients >65 years old, with renal impairment or less than 50kg): 30mg, one dose

Multi-Dose Treatment:

• IM or IV (patients <65 years old): 30mg q6h (not to exceed 120mg per day)

• IM or IV (patients >65 years old, with renal impairment or less than 50kg): 15mg q6h (not to exceed 60mg per day)

Transition from IM/IV to oral:

• Patients <65 years old: 2 tablets (20mg) first dose, followed by 1 tablet (10mg) q4-6h (not to exceed 40mg per day)

• Patients >65 years old, with renal impairment or less than 50kg: 1 tablet (15mg) first dose, followed by 1 tablet (10mg) q4-6h (not to exceed 40mg per day)