From the FDA Drug Label
The principal route of elimination of ketorolac and its metabolites is renal. About 92% of a given dose is found in the urine, approximately 40% as metabolites and 60% as unchanged ketorolac Based on single-dose data only, the mean half-life of ketorolac tromethamine in renally impaired patients is between 6 and 19 hours and is dependent on the extent of the impairment. There is poor correlation between creatinine clearance and total ketorolac tromethamine clearance in the elderly and populations with renal impairment (r = 0. 5).
The FDA drug label does not answer the question.
From the Research
Yes, you can generally administer a single dose of ketorolac (Toradol) if the patient has a low creatinine level and normal glomerular filtration rate (GFR). Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that can be used for short-term management of moderate to severe acute pain. The standard single dose for adults is typically 15-30 mg IV/IM or 10 mg orally. However, even with normal renal function, it's essential to use the lowest effective dose for the shortest duration possible, ideally not exceeding 5 days of total use. While a single dose is likely safe with normal renal function, ketorolac can affect kidney function through inhibition of prostaglandins that help maintain renal blood flow, as noted in a study on NSAID nephrotoxicity 1. This is why renal function should be monitored if additional doses are considered.
Some key considerations and potential risks associated with ketorolac use include:
- Renal impairment: Ketorolac should be avoided in patients with advanced renal impairment, those at risk for renal failure due to volume depletion, or in elderly patients with marginal renal function 2, 1.
- Gastrointestinal risks: Active peptic ulcer disease, recent GI bleeding, and hypersensitivity to NSAIDs are contraindications for ketorolac use 2.
- Other risks: Cerebrovascular bleeding, hemorrhagic diathesis are also contraindications for ketorolac use 2.
A more recent study from 2017 highlights the potential long-term renal risks associated with ketorolac use, particularly in the context of live-donor nephrectomy, where it was found to be an independent risk factor for low GFR percentage one year post-surgery 3. Despite these considerations, for a patient with low creatinine and normal GFR, a single dose of ketorolac is likely to be safe when used judiciously and with appropriate monitoring, as supported by the findings of a study comparing ketorolac to meperidine for acute renal colic, which showed equivalent analgesia with fewer adverse effects for ketorolac 4.