Ketorolac (Toradol) Can Cause Stomach Pain Under the Ribs
Yes, ketorolac (Toradol) is very likely the cause of your bad stomach pain under the ribs, as it is known to cause serious gastrointestinal side effects including gastric irritation, ulceration, and bleeding. 1
Mechanism of Gastrointestinal Toxicity
Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting cyclooxygenase (COX) enzymes. This inhibition:
- Blocks production of protective prostaglandins in the stomach lining
- Reduces the gastric mucosal protective barrier
- Increases stomach acid exposure to the unprotected lining
- Can lead to inflammation, erosions, and ulcers 2
Risk Factors for Ketorolac-Induced Stomach Pain
Your risk of experiencing stomach pain with ketorolac increases with:
- Duration of use (even short-term use can cause problems)
- Higher doses
- History of previous peptic ulcer
- Advanced age
- Concomitant use of other NSAIDs, aspirin, corticosteroids, or anticoagulants 2
Severity of Ketorolac's GI Effects
Ketorolac has been specifically identified as having greater gastrointestinal toxicity compared to many other NSAIDs:
- In case-control studies, ketorolac showed a distinctly elevated risk of gastroduodenal lesions (OR = 4.2) 3
- For ulcers specifically, ketorolac had an adjusted relative risk of 9.8 3
- Ketorolac has prominent enterohepatic circulation and can cause prolonged gastric and duodenal mucosal exposure 2
Warning Signs to Watch For
The FDA black box warning for ketorolac specifically mentions serious gastrointestinal adverse events including:
- Inflammation
- Bleeding
- Ulceration
- Perforation 1
Importantly, only one in five patients who develop serious upper GI adverse events on NSAID therapy is symptomatic, meaning your pain could indicate a significant problem 1.
What to Do Now
- Stop taking the ketorolac immediately
- Contact your healthcare provider about your symptoms
- Watch for warning signs of serious complications:
- Black or tarry stools
- Vomiting blood or material that looks like coffee grounds
- Severe or worsening abdominal pain
- Dizziness, lightheadedness, or fainting
Alternative Pain Management Options
If you still need pain relief, discuss these alternatives with your doctor:
- Acetaminophen (if liver function is normal)
- Lower-risk NSAIDs (if appropriate): ibuprofen or nabumetone have better GI safety profiles 2
- Opioid analgesics for short-term use if severe pain persists
- Combination therapy with gastroprotective agents if NSAIDs must be continued 4
Prevention for Future Use
If ketorolac must be used again in the future:
- Limit treatment to no more than 5 days (maximum duration recommended) 4
- Wait at least 7 days before starting another course 4
- Consider prophylactic use of proton pump inhibitors
- Monitor for early signs of GI toxicity 1
Remember that ketorolac's gastrointestinal risks are significant and can occur even with short-term use. Your stomach pain should be taken seriously as it may indicate damage to your gastric or duodenal lining.