From the Guidelines
Toradol (ketorolac tromethamine) is not recommended as a first-line abortive therapy for migraines due to its significant risks and side effects, despite being available in oral form in Canada. The most recent and highest quality study 1 suggests that NSAIDs, such as ibuprofen or naproxen, or combination medications containing acetaminophen, aspirin, and caffeine are preferred as first-line abortive treatments for migraines due to their better safety profile for repeated use.
Key Points to Consider
- The oral form of Toradol is typically limited to a maximum 5-day course due to significant risks of gastrointestinal bleeding, kidney damage, and cardiovascular events with prolonged use 1.
- Patients with kidney disease, history of peptic ulcers, bleeding disorders, or those taking anticoagulants should avoid ketorolac entirely 1.
- Triptans, such as sumatriptan, are also a viable option for migraine treatment, and the choice of a specific NSAID or triptan should be based on individualized decision making, taking into consideration patient preferences and factors such as route of administration and cost 1.
- Ketorolac is more commonly used in emergency settings as an injection for severe, refractory migraines rather than as a regular oral treatment.
Alternative Treatment Options
- NSAIDs, such as ibuprofen or naproxen, are recommended for mild to moderate migraine attacks 1.
- Combination medications containing acetaminophen, aspirin, and caffeine are also effective for migraine treatment 1.
- Triptans, such as sumatriptan, are a viable option for moderate to severe migraine attacks 1.
Important Considerations
- Patients should be aware of the potential risks and side effects associated with ketorolac, including gastrointestinal bleeding, kidney damage, and cardiovascular events 1.
- The medication's significant side effect profile makes it unsuitable for regular migraine management, especially since migraines are typically a chronic, recurring condition requiring safer options for repeated use.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Carefully consider the potential benefits and risks of ketorolac tromethamine tablets and other treatment options before deciding to use ketorolac tromethamine tablets. INDICATIONS AND USAGE Carefully consider the potential benefits and risks of Ketorolac Tromethamine Tablets USP and other treatment options before deciding to use Ketorolac Tromethamine Tablets USP. Acute Pain in Adult Patients Ketorolac Tromethamine Tablets USP are indicated for the short-term (≤ 5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting
The answer to whether toradol PO is available in Canada and recommended for migraines abortive therapy cannot be determined from the provided information, as migraine abortive therapy is not mentioned in the drug labels.
- The labels discuss the use of ketorolac tromethamine tablets for acute pain in adult patients.
- They do not provide information on the availability of the drug in Canada or its use for migraine abortive therapy 2 2.
From the Research
Availability of Toradol PO in Canada
- There is no direct evidence in the provided studies regarding the availability of Toradol PO in Canada.
- However, Toradol is another name for Ketorolac, which is mentioned in several studies as a treatment for acute migraine 3, 4.
Recommendation for Migraines Abortive Therapy
- Ketorolac, the active ingredient in Toradol, has been shown to be effective in the acute treatment of migraine headaches 3, 4.
- A study comparing ketorolac nasal spray to sumatriptan nasal spray and placebo found that ketorolac was superior to placebo and non-inferior to sumatriptan for 2-hour pain relief and 24-hour sustained pain relief 3.
- Another study found that parenteral ketorolac was an effective alternative agent for the relief of acute migraine headache in the emergency department, with similar pain relief to meperidine and more effective than sumatriptan 4.
- The use of NSAIDs, including ketorolac, is recommended as a treatment strategy for acute migraine, particularly for patients with mild to moderate attacks or for those who do not respond well to triptans 5.