Is Toradol (ketorolac) contraindicated in a patient with a history of lumbar stenosis, chronic insomnia, shortness of breath (SOB) on exertion, complete right bundle branch block, erectile dysfunction, chronic pain, positive hepatitis C antibody test, gingivitis, dental decay, bipolar disorder, hyperglycemia, trigger finger, varicose veins with pain, paresthesias, and hyperlipidemia?

Toradol IM is Contraindicated in This Patient

Based on the patient's positive hepatitis C antibody test indicating potential hepatic dysfunction, this represents an absolute contraindication to ketorolac (Toradol) administration. 1, 2

Absolute Contraindications Present in This Patient

Hepatic Dysfunction

• Hepatitis C positivity creates high risk for GI toxicities and hepatic complications, which is explicitly listed as a contraindication for ketorolac use 1
• The FDA label emphasizes that ketorolac can cause serious gastrointestinal bleeding and perforation, risks that are substantially elevated in patients with hepatic dysfunction 2
• Hepatic impairment compromises the metabolism and clearance of ketorolac, increasing drug accumulation and toxicity risk 3

Cardiovascular Risk Factors

• The patient's complete right bundle branch block and shortness of breath on exertion suggest underlying cardiovascular disease, which is an absolute contraindication 1, 2
• The FDA black box warning specifically states that NSAIDs cause increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke 2
• History of cardiovascular disease or high risk for cardiovascular complications explicitly contraindicates ketorolac use 1

High-Risk Conditions Requiring Avoidance

Chronic Pain Management

• Ketorolac is contraindicated for chronic painful conditions and is only indicated for short-term (≤5 days) management of acute pain 2
• This patient has documented chronic pain, making ketorolac inappropriate regardless of other factors 2
• The FDA label explicitly states ketorolac "is NOT indicated for minor or chronic painful conditions" 2

Renal Concerns

• While not explicitly documented, the patient's multiple comorbidities (hepatitis C, hyperlipidemia, cardiovascular disease) place them at risk for compromised renal function 1, 2
• Ketorolac is contraindicated in patients at risk for renal failure due to volume depletion 2
• Even a single dose of ketorolac has caused acute renal failure in vulnerable patients 4

Additional Risk Factors

Age and Comorbidity Burden

• Patients with multiple comorbidities require dose reduction or complete avoidance of ketorolac 1, 5
• The extensive medical history (15+ conditions) indicates a vulnerable patient at high risk for adverse events 3

Gastrointestinal Risk

• Hepatic dysfunction significantly increases risk of GI bleeding and perforation 1
• Ketorolac has one of the highest risks of gastrointestinal toxicity among all NSAIDs 1

Clinical Pitfalls to Avoid

Do not rationalize ketorolac use based on:

• The absence of documented active peptic ulcer disease (hepatic dysfunction alone is sufficient contraindication) 1
• The patient's chronic pain needs (this actually strengthens the contraindication) 2
• Perceived need for non-opioid analgesia (safer alternatives exist) 6

Safer Alternative Approaches

For acute pain management in this patient, consider: 6

• Low-dose oral opioids (generally well tolerated and safe in cardiovascular disease) 6
• Acetaminophen up to 4g daily (monitor for blood pressure effects) 6
• Topical agents (lidocaine, capsaicin) for localized pain 6
• Opioids without active metabolites (methadone, buprenorphine, fentanyl) if renal concerns develop 6