From the FDA Drug Label
Ketorolac tromethamine is contraindicated in patients with serum creatinine concentrations indicating advanced renal impairment Ketorolac tromethamine should be used with caution in patients with impaired renal function or a history of kidney disease The increase in volume of distribution of ketorolac tromethamine implies an increase in unbound fraction In patients with renal disease, the AUC ∞ of each enantiomer increased by approximately 100% compared with healthy volunteers.
The appropriate level of renal function for administration of Toradol (Ketorolac) is not explicitly defined in terms of a specific creatinine concentration or clearance value, but ketorolac tromethamine is contraindicated in patients with serum creatinine concentrations indicating advanced renal impairment.
- Patients with impaired renal function or a history of kidney disease should be treated with caution.
- The drug should not be used in patients with advanced renal impairment.
- Renal function should be carefully monitored in patients receiving ketorolac tromethamine, especially in those with pre-existing renal disease 1.
From the Research
Toradol (ketorolac) should only be given to patients with normal kidney function, defined as a creatinine clearance of 60 mL/min or higher, and used with caution in those with mild impairment (creatinine clearance 30-59 mL/min), as it can increase the risk of acute kidney injury, particularly in patients with pre-existing kidney disease, dehydration, heart failure, or those taking other nephrotoxic medications, as reported in a case study 2.
Key Considerations
- The maximum recommended duration of treatment is 5 days, with typical dosing of 10 mg orally every 4-6 hours or 30 mg IV/IM initially, followed by 15-30 mg every 6 hours, not exceeding 120 mg daily.
- Kidney function should be monitored during treatment, especially in at-risk patients, as ketorolac can reduce renal blood flow and potentially cause acute kidney injury, as seen in a study on patients undergoing donor nephrectomy 3.
- Maintaining adequate hydration during treatment is essential to minimize kidney-related risks, and the dose should be reduced in elderly patients and those with borderline renal function, as suggested by a study on ketorolac use in neonates and infants post-cardiac surgery 4.
Renal Function Guidelines
- Normal kidney function: creatinine clearance ≥ 60 mL/min
- Mild impairment: creatinine clearance 30-59 mL/min (use with caution)
- Moderate to severe impairment: creatinine clearance < 30 mL/min (contraindicated)
Additional Safety Measures
- Monitor urine output and parameters of renal function closely, especially in patients with risk factors for NSAID nephrotoxicity, as recommended by a study on NSAID nephrotoxicity 5.
- Avoid using ketorolac in patients with conditions that predispose to NSAID nephrotoxicity, such as dehydration, heart failure, or those taking other nephrotoxic medications, as reported in a study on ketorolac-induced acute renal failure and hyperkalemia 2.