Ketorolac (Toradol) and Kidney Damage
Yes, ketorolac (Toradol) can cause kidney damage and impaired renal function, especially in patients with risk factors for renal dysfunction. 1
Mechanism of Kidney Damage
Ketorolac, like other NSAIDs, affects kidney function through several mechanisms:
- Inhibits prostaglandin synthesis, which reduces renal blood flow 1
- Causes dose-dependent reduction in prostaglandin formation 1
- Can precipitate overt renal decompensation in susceptible patients 1
- May lead to acute renal failure, interstitial nephritis, and nephrotic syndrome 1
High-Risk Patients
Patients at greatest risk for ketorolac-induced kidney damage include:
- Elderly patients (age >60 years) 2
- Those with pre-existing renal impairment 1
- Patients with heart failure 1
- Those with liver dysfunction 1
- Patients taking diuretics and ACE inhibitors 1
- Patients with compromised fluid status or volume depletion 3
- Patients with cirrhosis 2
Clinical Evidence
Multiple case reports document ketorolac-induced renal failure:
- Acute renal failure in elderly patients following intramuscular ketorolac administration 3
- Irreversible renal failure in a sickle cell disease patient despite adequate hydration 4
- Acute renal failure and hyperkalemia in patients with predisposing conditions 5
Monitoring and Prevention
To minimize kidney damage risk:
- Monitor blood pressure, BUN, creatinine, and liver function tests at baseline and every 3 months 2, 6
- Discontinue ketorolac immediately if BUN or creatinine doubles or if hypertension develops/worsens 6
- Limit ketorolac use to a maximum of 5 days, even in healthy patients 6
- Avoid ketorolac in patients with advanced renal impairment 1
- Use with extreme caution in patients with any risk factors for renal dysfunction 3
Alternative Pain Management Options
For patients with renal impairment or risk factors:
- Opioid analgesics are safer and effective alternatives to NSAIDs 6
- Acetaminophen (without NSAIDs) may be appropriate for mild analgesia 6
- Methadone is suitable for patients with renal impairment due to its primary excretion through fecal routes 6
Clinical Implications
The renal effects of ketorolac are typically reversible upon discontinuation of the drug 1, but cases of irreversible renal damage have been reported 4. The risk-benefit ratio must be carefully assessed before administering ketorolac, especially in patients with any risk factors for renal dysfunction.
Healthcare providers should remain vigilant for early signs of renal impairment in patients receiving ketorolac and be prepared to discontinue the medication promptly if kidney function deteriorates.