Can you take Toradol (ketorolac) with a history of seizures?

Ketorolac Use in Patients with Seizure Disorders

Ketorolac (Toradol) should be used with extreme caution in patients with a history of seizures due to potential increased risk of seizure activity.

Risk Assessment

The FDA drug label for ketorolac specifically mentions that "sporadic cases of seizures have been reported during concomitant use of ketorolac tromethamine and antiepileptic drugs (phenytoin, carbamazepine)" 1. This indicates a potential interaction that could affect seizure threshold or control in patients with seizure disorders.

Multiple guidelines from the CDC and other health authorities highlight concerns about medications that may lower seizure threshold or interact with antiepileptic medications:

• Medications like amantadine and rimantadine have been documented to increase seizure risk in patients with seizure disorders 2
• While ketorolac is not as extensively studied in this population, the documented interaction with antiepileptic drugs raises significant concerns

Recommendations for Clinical Practice

If ketorolac must be used in a patient with seizure history:

1. Ensure seizures are well-controlled on current antiepileptic medication regimen
2. Use the lowest effective dose of ketorolac for the shortest duration possible
3. Monitor closely for any signs of increased seizure activity, especially during the first 24-48 hours of treatment
4. Consider alternative pain management options with better established safety profiles in seizure disorders:
   • Acetaminophen (first-line for mild to moderate pain)
   • Tramadol (with caution, as it may also reduce seizure threshold) 2
   • Non-pharmacological pain management strategies

Alternative Analgesics

For patients with seizure disorders requiring pain management:

• Acetaminophen is generally considered safe and is recommended as a first-line agent for minor musculoskeletal trauma 2
• If an anxiolytic is needed, buspirone has been shown to be safe in patients with seizure disorders as it does not lower the seizure threshold 3
• For moderate to severe pain requiring opioids, close monitoring is essential as respiratory depression risks may be heightened in patients with poorly controlled seizures

Important Precautions

• Avoid concurrent use of ketorolac with other medications that may lower seizure threshold
• Be particularly cautious when combining ketorolac with antiepileptic drugs like phenytoin or carbamazepine 1
• Ensure patients and caregivers are educated about potential warning signs of seizure activity
• Have an emergency plan in place should breakthrough seizures occur

Conclusion

While ketorolac is an effective analgesic for moderate to severe pain 4, 5, its use in patients with seizure disorders carries additional risks that must be carefully weighed against potential benefits. Alternative analgesics with better established safety profiles in this population should be considered first-line options whenever possible.