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.
No, Toradol (ketorolac) is not safe to use in patients with impaired renal function undergoing dialysis, as it is contraindicated in patients with advanced renal impairment and should be used with caution in patients with impaired renal function. 1 1
From the Research
Toradol (ketorolac) should be avoided in patients with impaired renal function undergoing dialysis due to its potential to further worsen kidney function and increase the risk of adverse effects. This nonsteroidal anti-inflammatory drug (NSAID) is primarily eliminated by the kidneys, and impaired renal function leads to drug accumulation, increasing the risk of serious side effects including gastrointestinal bleeding, cardiovascular events, and further kidney injury 2. For dialysis patients requiring pain management, alternative analgesics such as certain opioids with less renal clearance (like fentanyl or hydromorphone), or low-dose gabapentinoids would be safer options. Although acetaminophen is often considered a safer alternative, recent studies suggest it may also have adverse renal effects, with a significant increase in the risk of renal impairment associated with its use 3. However, another study found that long-term use of acetaminophen does not appear to exacerbate renal function in a clinical setting 4. The pharmacokinetics of ketorolac are significantly altered in renal impairment, with the drug's half-life potentially increasing from 4-6 hours to over 10-20 hours in severe renal dysfunction, leading to dangerous drug accumulation even with standard dosing. If pain control is absolutely necessary and other options have failed, only very short-term use (1-2 days maximum) with significantly reduced dosing and close monitoring might be considered, but this approach still carries substantial risks and should generally be avoided 5, 6.