What are the contraindications for Toradol (Ketorolac)?

Contraindications for Toradol (Ketorolac)

Ketorolac (Toradol) is contraindicated in patients with a history of peptic ulcer disease, gastrointestinal bleeding, renal impairment, pregnancy, labor and delivery, nursing mothers, and in those with hypersensitivity to aspirin or other NSAIDs. 1

Absolute Contraindications

• Gastrointestinal Conditions:

  • Active or history of peptic ulcer disease 2, 3
  • Gastrointestinal bleeding or perforation 1, 3
  • High risk for GI toxicities (age >60 years, history of significant alcohol use, hepatic dysfunction) 2

• Renal Conditions:

  • Moderate to severe renal impairment 1, 4
  • Advanced renal disease 4
  • Risk of renal failure (compromised fluid status, interstitial nephritis) 2

• Hematologic/Coagulation Disorders:

  • Compromised hemostasis 3
  • Bleeding disorders 3
  • Thrombocytopenia 2
  • Concurrent use of anticoagulants (significantly increases bleeding risk) 2

• Respiratory Conditions:

  • Aspirin/NSAID-induced asthma 2, 5
  • History of bronchospasm with NSAIDs 5

• Pregnancy and Lactation:

  • Pregnancy, especially third trimester (risk of premature closure of ductus arteriosus) 1
  • Labor and delivery (may inhibit uterine contractions, increase risk of uterine hemorrhage) 1
  • Nursing mothers (ketorolac passes into breast milk) 1

• Hypersensitivity:

  • Known hypersensitivity to ketorolac, aspirin, or other NSAIDs 1, 5
  • History of allergic-type reactions to NSAIDs 5

• Cardiovascular Conditions:

  • Cerebrovascular bleeding 2
  • History of cardiovascular disease or high risk for cardiovascular complications 2

Relative Contraindications/Use with Extreme Caution

• Elderly Patients:

  • Age ≥65 years (increased risk of adverse effects, slower clearance) 1, 6
  • Reduced dosage and careful monitoring required 1

• Duration Limitations:

  • Treatment should not exceed 5 days 2, 3
  • Prolonged use significantly increases risk of adverse events 3, 6

• Concomitant Medications:

  • Use with pentoxifylline (increased bleeding tendency) 1
  • Use with SSRIs (increased risk of GI bleeding) 1
  • Use with nondepolarizing muscle relaxants (risk of apnea) 1
  • Use with other nephrotoxic drugs (increased risk of renal toxicity) 2

• Other Conditions:

  • Hepatic dysfunction 1
  • Heart failure 2
  • Hypertension 2
  • Nasal polyps (associated with aspirin sensitivity) 5

Monitoring Requirements When Using Ketorolac

• Baseline and periodic monitoring of:
  • Blood pressure 2
  • BUN and creatinine 2
  • Liver function tests 2
  • Complete blood count 2
  • Fecal occult blood 2

Important Clinical Considerations

• Ketorolac has higher gastrotoxicity compared to other NSAIDs (5 times more gastrotoxic) 6
• Risk of adverse events increases significantly with high doses, prolonged therapy (>5 days), and in vulnerable patients 3
• Acute renal failure associated with ketorolac is usually reversible after discontinuation 3, 4
• When used in cancer patients, ketorolac should be limited to short-term use (maximum 5 days) 2
• COX-2 selective inhibitors may be a safer alternative for patients with high GI risk but without cardiovascular risk 2