Is ketoralac (toradol) safe to use in a patient with impaired renal function, specifically an estimated glomerular filtration rate (eGFR) of 63 and elevated creatinine level of 1.09?

From the Guidelines

Ketorolac should be avoided in patients with an eGFR of 63 and creatinine of 1.09 due to the risk of worsening renal function, as prolonged therapy is not recommended in people with GFR < 60 ml/min/1.73 m2 1. When considering the use of ketorolac in a patient with mild renal impairment, it is crucial to weigh the potential benefits against the risks.

• The patient's eGFR of 63 indicates some degree of kidney dysfunction, making them more susceptible to NSAID-induced kidney injury.
• According to the guidelines, NSAIDs, including ketorolac, should be avoided in people with GFR < 30 ml/min/1.73 m2 and prolonged therapy is not recommended in people with GFR < 60 ml/min/1.73 m2 1.
• Alternative analgesics, such as acetaminophen, should be considered first, especially if pain management is needed for longer periods.
• If ketorolac is deemed necessary, close monitoring of renal function, urine output, and signs of fluid retention is essential during treatment.
• The total daily dose should not exceed 60 mg parenterally or 40 mg orally, and the maximum duration of treatment should not exceed 5 days.
• Ensuring adequate hydration is also crucial to minimize the risk of kidney injury. It is essential to prioritize the patient's renal function and consider alternative pain management options to minimize the risk of worsening kidney function 1.

From the FDA Drug Label

Ketorolac tromethamine should be used with caution in patients with impaired renal function (see DOSAGE AND ADMINISTRATION) and such patients should be followed closely. Ketorolac tromethamine is contraindicated in patients with serum creatinine concentrations indicating advanced renal impairment (see CONTRAINDICATIONS). 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.

The patient's eGFR of 63 and creatinine of 1.09 indicate impaired renal function, but not advanced renal impairment.

• Key consideration: Ketorolac should be used with caution in patients with impaired renal function.
• Recommendation: The risks and benefits of using ketorolac tromethamine should be assessed prior to administration in this patient, and the patient should be closely monitored 2.

From the Research

Ketoralac Safety with Impaired Renal Function

The safety of ketoralac (toradol) in patients with impaired renal function, specifically an estimated glomerular filtration rate (eGFR) of 63 and elevated creatinine level of 1.09, can be assessed based on available evidence.

Renal Function and NSAID Use

• Guidelines recommend avoiding NSAIDs in patients with eGFR < 30 mL/min/1.73 m2, and long-lasting therapy is not recommended in people with chronic kidney disease 3.
• Patients with impaired renal function are at risk of NSAID nephrotoxicity, and close attention to urine output and parameters of renal function must be maintained when administering ketorolac 4.

Ketoralac and Renal Impairment

• Ketorolac is excreted almost entirely by the kidney, and either elderly patients or patients with underlying renal insufficiency must have an adjustment of the dosing interval, or this medication should be avoided in such patients altogether 4.
• There is no specific guidance on the use of ketorolac in patients with an eGFR of 63 and creatinine level of 1.09, but the available evidence suggests that caution should be exercised when using NSAIDs in patients with impaired renal function.

Considerations for Safe Use

• The decision to use ketorolac in a patient with impaired renal function should be based on a careful assessment of the potential benefits and risks, and alternative treatments should be considered if possible.
• Close monitoring of renal function and urine output is necessary when using ketorolac in patients with impaired renal function 4.
• The use of ketorolac in patients with renal impairment should be guided by the principles of safe prescribing, including careful dose selection and monitoring for adverse effects 3, 4.