Toradol Does Not Lower Heart Rate
Toradol (ketorolac) is not indicated for, and does not effectively lower heart rate in cases of tachycardia. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, anti-inflammatory, and antipyretic properties that works by inhibiting prostaglandin synthesis—it has no direct cardiac chronotropic effects 1, 2.
Mechanism and Cardiovascular Effects
Ketorolac does not act on cardiac conduction pathways or receptors that control heart rate 1. Unlike medications used for rate control in tachyarrhythmias (beta blockers, calcium channel blockers, digoxin, or amiodarone), ketorolac:
- Does not bind to opioid receptors and is not a centrally acting agent 1
- Has no significant effect on cardiac output, stroke volume, or mean arterial pressure when given as intravenous injections 3
- Does not affect AV nodal conduction or refractoriness, which are the primary mechanisms for controlling ventricular rate in tachycardia 4
Appropriate Medications for Heart Rate Control
For acute tachycardia management, established guidelines recommend:
For Supraventricular Tachycardia (SVT):
- Beta blockers (metoprolol, esmolol, propranolol) as first-line agents 4
- Nondihydropyridine calcium channel blockers (diltiazem, verapamil) for rate control 4
- Amiodarone for rate control when other measures are unsuccessful or contraindicated 4
- Digoxin for rate control, though with slower onset of action 4
For Atrial Fibrillation/Flutter:
- Beta blockers remain the most common first-line agents 4
- Diltiazem or verapamil for rate control in hemodynamically stable patients 4
- Intravenous amiodarone can be useful when other measures fail 4
Clinical Caveat
The only cardiovascular consideration with ketorolac is that NSAIDs may induce hypertension and increase systemic vascular resistance through prostaglandin inhibition, but this does not translate to heart rate reduction 3. In fact, ketorolac produces fewer hemodynamic effects than morphine, with no significant changes in cardiac indices 3.
Ketorolac should be reserved exclusively for its approved indication: short-term management of moderate to severe pain (maximum 5 days), not for any cardiac rate control purpose 2, 5.