What are the contraindications for Toradol (ketorolac)?

Contraindications for Toradol (Ketorolac)

Ketorolac (Toradol) is absolutely contraindicated in patients with advanced renal impairment, active peptic ulcer disease, recent GI bleeding/perforation, history of peptic ulcer disease, and in patients at risk for renal failure due to volume depletion. 1

Absolute Contraindications

• Hypersensitivity reactions: Previous hypersensitivity to ketorolac, aspirin, or other NSAIDs (including patients who have experienced asthma, urticaria, or allergic-type reactions after taking these medications) 1

• Gastrointestinal conditions:

  • Active peptic ulcer disease
  • Recent gastrointestinal bleeding or perforation
  • History of peptic ulcer disease or GI bleeding 1

• Renal impairment:

  • Advanced renal impairment
  • Patients at risk for renal failure due to volume depletion 1

• Bleeding risk:

  • Suspected or confirmed cerebrovascular bleeding
  • Hemorrhagic diathesis
  • Incomplete hemostasis
  • High risk of bleeding (due to platelet function inhibition) 1

• Perioperative settings:

  • As prophylactic analgesic before any major surgery
  • For perioperative pain in coronary artery bypass graft (CABG) surgery 1

• Pregnancy and labor:

  • During labor and delivery (may adversely affect fetal circulation and inhibit uterine contractions, increasing risk of uterine hemorrhage) 1

• Medication interactions:

  • Concomitant use with aspirin or other NSAIDs (cumulative risk of adverse events)
  • Concomitant use with probenecid
  • Concomitant use with pentoxifylline 1

High-Risk Populations (Use with Extreme Caution)

• Elderly patients: Higher risk of serious GI and renal adverse events 2, 3
• Patients on anticoagulants: Increased bleeding risk
• Patients with cardiovascular disease: Risk of cardiovascular events
• Patients with liver disease: Impaired metabolism of the drug

Important Usage Limitations

• Duration: Treatment should not exceed 5 days, even in healthy patients 4, 2
• Dosing: Use lowest effective dose; reduced dosing for elderly, those weighing <50kg, or with impaired kidney function 5
• Monitoring: If used in patients with any degree of renal impairment, monitor blood pressure, BUN, creatinine, and liver function tests at baseline and every 3 months 4
• Discontinuation criteria: Stop immediately if BUN or creatinine doubles or if hypertension develops or worsens 4

Risk Factors for Adverse Events

The risk of serious adverse events significantly increases with:

• High doses
• Prolonged therapy (>5 days)
• Advanced age
• History of GI disorders 2, 6

Alternative Options for High-Risk Patients

For patients with contraindications to ketorolac, consider:

• Opioid analgesics (safer alternatives for patients with renal impairment) 4
• Acetaminophen for mild pain
• Methadone for cancer pain in patients with renal impairment (primarily excreted through fecal routes) 4

Understanding these contraindications is crucial as ketorolac has been associated with a significantly higher risk of GI complications (RR 24.7) compared to other NSAIDs, even with short-term use 6.