From the Research
It is recommended to wait at least 24 hours after receiving a ketorolac (Toradol) injection before taking any other NSAID medication, such as ibuprofen, naproxen, or aspirin, to minimize the risk of serious side effects. This waiting period is crucial because ketorolac is itself a potent NSAID, and combining it with other NSAIDs increases the risk of gastrointestinal bleeding, kidney problems, and cardiovascular complications. According to the most recent and highest quality study available, which is the 2021 Cochrane review 1, ketorolac has a slight increase in total adverse event rates compared to placebo, and its use may result in a higher risk of adverse events when combined with other NSAIDs.
Key Considerations
- The elimination half-life of ketorolac is approximately four to six hours, which increases in elderly patients and those with renal impairment, as reported in the 1990 study 2.
- The use of ketorolac in patients 65 years and older may require lower doses, as suggested by the 2023 study 3, which found that parenteral ketorolac doses of 15 mg IV or 30 mg IM did not demonstrate a greater need for rescue analgesia compared to doses of 30 mg IV or 60 mg IM.
- If pain control is needed during the 24-hour window after ketorolac administration, acetaminophen (Tylenol) is generally considered a safer alternative, as it works through a different mechanism and doesn't carry the same risks when used after ketorolac.
Important Factors to Consider
- Individual factors, such as kidney function, age, and other medications, may affect the recommended waiting period and should be discussed with a healthcare provider.
- The 2018 Cochrane review 4 and the 1997 study 5 provide additional information on the use of ketorolac in different populations and settings, but the 2021 Cochrane review 1 is the most recent and highest quality study available, and its findings should be prioritized.