From the Guidelines
I strongly advise against mixing dexamethasone and toradol in the same syringe due to potential physical or chemical incompatibility. These medications have different chemical properties that may lead to precipitation, reduced efficacy of one or both medications, or other adverse reactions when combined 1.
Key Considerations
- Dexamethasone is a corticosteroid with anti-inflammatory properties, while toradol (ketorolac) is a non-steroidal anti-inflammatory drug (NSAID) that works through different mechanisms.
- The use of toradol should be closely monitored because overuse may lead to rebound headaches, as noted in the management of acute migraine headaches 1.
- Each medication should be administered separately according to its specific guidelines, with appropriate flushing between injections if given through the same line.
Administration Protocols
- If you need to administer both medications, consult with a pharmacist about proper administration protocols for your specific formulations, as compatibility can sometimes depend on specific concentrations, preservatives, and other factors in the particular products being used.
- Healthcare providers should prioritize the safe and effective administration of these medications to minimize potential adverse effects and ensure optimal patient outcomes.
From the FDA Drug Label
Ketorolac tromethamine injection should not be mixed in a small volume (e.g., in a syringe) with morphine sulfate, meperidine hydrochloride, promethazine hydrochloride or hydroxyzine hydrochloride; this will result in precipitation of ketorolac from solution. The FDA drug label does not answer the question about mixing dexamethasone and toradol (ketorolac) in the same syringe, as it only discusses mixing with other specific medications. 2
From the Research
Mixing Dexamethasone and Toradol in the Same Syringe
- There are no direct studies on mixing dexamethasone and toradol (ketorolac tromethamine) in the same syringe.
- However, studies have compared the efficacy of dexamethasone and ketorolac tromethamine in reducing pain and inflammation in various medical procedures 3, 4, 5.
- These studies suggest that both dexamethasone and ketorolac tromethamine are effective in reducing pain and inflammation, but their efficacy may vary depending on the specific medical procedure and patient population 3, 4, 5.
- One study found that dexamethasone was superior to ketorolac tromethamine in reducing pain, swelling, and trismus after mandibular third molar removal 4.
- Another study found that dexamethasone and ketorolac tromethamine had similar efficacy in reducing pain and edema after third molar extractions, but dexamethasone had a better effect on limiting mouth opening 5.
- A study on postoperative pain management with ketorolac in facial plastic surgery patients found that intraoperative locally injected ketorolac was effective in reducing postoperative analgesic requirements 6.
- However, none of these studies provide information on the safety or efficacy of mixing dexamethasone and toradol in the same syringe.