From the Guidelines
Toradol (Ketorolac) is not recommended for use in patients with impaired renal function, including those on dialysis, due to its potential to worsen kidney function and cause acute kidney injury. The use of nonsteroidal anti-inflammatory drugs (NSAIDs), including Toradol, is generally discouraged in patients with preexisting kidney insufficiency or diminished kidney blood flow, as they may exacerbate renal dysfunction 1. In patients with compromised renal function, the inhibition of prostaglandin synthesis by NSAIDs like Toradol can lead to a decrease in renal blood flow and glomerular filtration rate, further compromising kidney function.
For pain management in dialysis patients, alternative options such as acetaminophen, low-dose opiates, or short courses of oral or intra-articular corticosteroids for acute inflammatory noninfectious arthritis are recommended 1. These alternatives can help mitigate the risk of nephrotoxicity associated with NSAIDs like Toradol. It is crucial to prioritize the preservation of residual kidney function in dialysis patients and avoid potential insults to the kidneys, including the use of nephrotoxic agents like NSAIDs.
Key considerations for managing pain in patients with impaired renal function include:
- Avoiding NSAIDs, including Toradol, due to their nephrotoxic potential
- Using conventional analgesia like acetaminophen for noninflammatory pain
- Considering low-dose opiates, with careful monitoring for side effects like constipation
- Utilizing short courses of oral or intra-articular corticosteroids for acute inflammatory conditions
- Prioritizing the preservation of residual kidney function and minimizing exposure to nephrotoxic agents.
From the FDA Drug Label
Ketorolac tromethamine is contraindicated in patients with serum creatinine concentrations indicating advanced renal impairment Ketorolac tromethamine should be used with caution in patients with impaired renal function or a history of kidney disease because it is a potent inhibitor of prostaglandin synthesis Because patients with underlying renal insufficiency are at increased risk of developing acute renal decompensation or failure, the risks and benefits should be assessed prior to giving ketorolac tromethamine to these patients.
Ketorolac (Toradol) is not safe for use in patients with advanced renal impairment. For patients with impaired renal function, ketorolac should be used with caution and the risks and benefits should be assessed prior to administration 2. In patients with impaired renal function or a history of kidney disease, ketorolac should be used with caution due to its potent inhibition of prostaglandin synthesis 2. Dialysis patients with advanced renal impairment should not use ketorolac 2.
From the Research
Safety of Toradol in Dialysis Patients
- The use of Toradol (Ketorolac) in patients with impaired renal function is a concern due to its potential nephrotoxic effects 3, 4.
- Studies have shown that Toradol can cause acute renal failure or hyperkalemia in patients with pre-existing renal conditions 3, 4.
- The mechanism of action of Toradol, which involves the inhibition of cyclooxygenase (COX), can lead to a decrease in prostaglandin synthesis, resulting in renal vasoconstriction and decreased renal function 5, 6.
- Patients with end-stage kidney disease (ESKD) may be at higher risk for Toradol-induced nephrotoxicity due to their reliance on prostaglandin-mediated vasodilatory effects to maintain renal function 7, 5.
- The use of Toradol in dialysis patients should be approached with caution, and alternative analgesic options should be considered to minimize the risk of nephrotoxicity 7, 4.
- Further studies are needed to quantify the risk of Toradol use in dialysis-dependent patients and to determine the safety of its use in this population 7.