Can Toradol (ketorolac) increase blood pressure?

Ketorolac Can Increase Blood Pressure

Yes, ketorolac (Toradol) can lead to increased blood pressure, as it is a nonsteroidal anti-inflammatory drug (NSAID) that can worsen pre-existing hypertension or cause new-onset hypertension. 1

Mechanism of Blood Pressure Elevation

Ketorolac affects blood pressure through several mechanisms:

• Inhibition of prostaglandin synthesis, which reduces vasodilation
• Sodium and fluid retention
• Interference with the effectiveness of antihypertensive medications, particularly:
  • Thiazide diuretics
  • Loop diuretics
  • ACE inhibitors
  • Angiotensin receptor blockers

Clinical Significance

The FDA drug label for ketorolac explicitly states that NSAIDs, including ketorolac, can:

1. Lead to onset of new hypertension
2. Worsen pre-existing hypertension
3. Contribute to increased incidence of cardiovascular events 1

Risk Factors for BP Elevation

Certain patient populations are at higher risk for ketorolac-induced blood pressure elevation:

• Patients with pre-existing hypertension
• Elderly patients
• Those with renal impairment
• Patients taking antihypertensive medications, especially diuretics 2, 1

Monitoring Recommendations

For patients receiving ketorolac:

• Measure baseline blood pressure before initiating treatment
• Monitor blood pressure closely during the initiation of treatment
• Continue monitoring throughout the course of therapy 1

Clinical Management

If blood pressure elevation occurs:

1. Consider discontinuing ketorolac if clinically appropriate
2. Adjust antihypertensive therapy as needed
3. Consider alternative analgesics with less impact on blood pressure

Precautions

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifically identifies NSAIDs as medications that can elevate blood pressure 2. The drug label for ketorolac explicitly warns that it should be used "only very cautiously in patients with cardiac decompensation, hypertension or similar conditions" 1.

Alternative Analgesics

For patients with uncontrolled hypertension or high cardiovascular risk who require pain management:

• Acetaminophen may be preferred for mild to moderate pain
• For more severe pain, consider opioid analgesics with close monitoring
• If an NSAID is necessary, use the lowest effective dose for the shortest duration possible

Remember that the blood pressure effects of ketorolac can contribute to increased cardiovascular risk, so careful consideration of risks versus benefits is essential, particularly in patients with pre-existing cardiovascular disease or risk factors.