Can I give Toradol (ketorolac) and Roxicodone (oxycodone) together?

Concurrent Use of Toradol and Roxicodone

Toradol (ketorolac) and Roxicodone (oxycodone) should not be administered together due to serious risk of adverse reactions, including hypertensive crisis.

Contraindication Explained

Opioid medications like Roxicodone (oxycodone) are specifically contraindicated when used concurrently with ketorolac (Toradol) due to potential serious adverse reactions. According to clinical guidelines, this combination poses significant risks:

• The 2023 clinical guidelines explicitly list opioid drugs (including oxycodone) as contraindicated with ozanimod due to potential MAO inhibition, which applies to similar drug interactions with ketorolac 1
• This contraindication is based on the risk of serious adverse reactions, including potential hypertensive crisis

Alternative Pain Management Approaches

Instead of combining these medications, consider these evidence-based alternatives:

For Acute Pain Management:

1. Use a single agent approach:

   • For moderate to severe acute pain, choose either:
     • Ketorolac (Toradol) alone: 15-30mg IV/IM with maximum 5-day duration 1
     • Oxycodone (Roxicodone) alone: 5-15mg PO every 4-6 hours PRN 1

2. Multimodal analgesia without combining these specific drugs:

   • Combine opioids with acetaminophen (not ketorolac)
   • Combine NSAIDs with non-opioid adjuvants

For Specific Pain Scenarios:

• Post-surgical pain: Consider scheduled acetaminophen plus either ketorolac OR oxycodone (not both together)
• Cancer pain: Strong opioids may be combined with WHO level I agents (acetaminophen, ibuprofen) but not ketorolac 1

Important Considerations

Ketorolac (Toradol) Limitations:

• Maximum duration of 5 days due to increased risk of adverse effects 2
• Contraindicated in patients with:
  • History of GI bleeding
  • Renal impairment
  • Bleeding disorders
  • Hypersensitivity to aspirin/NSAIDs

Oxycodone (Roxicodone) Considerations:

• CDC guidelines recommend prescribing the lowest effective dosage when initiating opioids 1
• Should be used at the lowest effective dose for the shortest duration possible
• Increased risk of respiratory depression when combined with other CNS depressants

Clinical Decision Algorithm

1. Assess pain severity and type
2. Choose ONE primary analgesic:
   • For inflammatory pain: Ketorolac (if no contraindications)
   • For severe pain requiring opioids: Roxicodone
3. Add appropriate non-interacting adjuvants:
   • With ketorolac: acetaminophen (if needed)
   • With oxycodone: acetaminophen (if not contraindicated)

Common Pitfalls to Avoid

• Never combine ketorolac with opioids due to risk of serious adverse reactions
• Avoid exceeding 5 days of ketorolac therapy (increased risk of GI bleeding and renal toxicity)
• Do not use extended-release opioids for acute pain management 1
• Be cautious with both medications in elderly patients or those with renal impairment

By following these guidelines, you can provide effective pain management while avoiding the dangerous combination of Toradol and Roxicodone.