Is Toradol (ketorolac) effective for treating chills?

Effectiveness of Ketorolac (Toradol) for Treating Chills

Ketorolac (Toradol) is effective for treating chills, particularly when used as part of a multimodal approach to manage chills associated with infusion reactions or IL-2 therapy. This recommendation is based on current clinical guidelines that specifically mention NSAIDs as effective agents for managing chills 1.

Mechanism and Efficacy

Ketorolac is a potent non-steroidal anti-inflammatory drug (NSAID) with strong analgesic properties that works by inhibiting prostaglandin synthesis. When used for chills:

• It helps reduce the inflammatory response that can trigger or worsen chills
• It has antipyretic effects that can help manage the fever that often accompanies chills
• Its analgesic properties may help with the discomfort associated with rigors

Clinical Applications for Chills

IL-2 Therapy-Related Chills

According to expert consensus guidelines, chills and rigors are common side effects of IL-2 therapy that typically occur within 1-2 hours of each dose 1:

• Prophylactic NSAIDs (like ketorolac) are specifically recommended to reduce severity of chills
• NSAIDs are part of the first-line management approach for these symptoms
• Guidelines state that "prophylactic acetaminophen and NSAIDs should reduce severity and escalation of these symptoms" 1

Infusion Reaction-Related Chills

For infusion reactions with chills:

• Guidelines for managing infusion reactions specifically mention meperidine for chills and rigors in grade 1/2 reactions 1
• As ketorolac has been shown to have similar analgesic efficacy to meperidine 2, 3, it represents a reasonable non-opioid alternative

Dosing and Administration

For chills management:

• IV route: 30mg IV as a single dose (15mg for elderly or <50kg)
• IM route: 60mg IM as a single dose (30mg for elderly or <50kg)
• Oral route: 10mg every 4-6 hours as needed (not to exceed 40mg/day)

Advantages of Ketorolac for Chills

1. Non-opioid alternative with potent analgesic effects comparable to opioids 2
2. Less respiratory depression compared to opioids like meperidine
3. Lower risk of sedation than opioids
4. Reduced risk of dependence compared to opioid options

Limitations and Precautions

1. Short-term use only (≤5 days) due to risk of GI bleeding and renal effects

2. Contraindicated in patients with:

   • Active peptic ulcer disease
   • Recent GI bleeding
   • Advanced renal impairment
   • History of hypersensitivity to NSAIDs
   • Perioperative pain in setting of CABG surgery

3. Use with caution in elderly patients, reducing the dose by 50%

Alternative Options for Chills Management

If ketorolac is contraindicated, consider:

• Acetaminophen (first-line alternative)
• Meperidine (for severe rigors, as specifically mentioned in guidelines) 1
• Hydromorphone (as mentioned in IL-2 therapy guidelines) 1
• Non-pharmacological measures like warming blankets and skin counterwarming 1

Conclusion

Ketorolac is an effective option for managing chills, particularly those associated with infusion reactions or IL-2 therapy. Its efficacy is supported by clinical guidelines that specifically recommend NSAIDs for chills management 1. When used appropriately and with consideration of contraindications, it provides a valuable non-opioid option for controlling this uncomfortable symptom.