From the FDA Drug Label
Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion With the use of ketorolac tromethamine, there have been reports of acute renal failure, interstitial nephritis and nephrotic syndrome Ketorolac tromethamine is contraindicated in patients with serum creatinine concentrations indicating advanced renal impairment
The relationship between Toradol (ketorolac) and pyelonephritis is not directly addressed in the label. However, renal toxicity and renal injury are potential risks associated with long-term administration of NSAIDs, including ketorolac tromethamine.
- Key points:
- Renal prostaglandins play a role in maintaining renal perfusion
- Ketorolac tromethamine can cause renal toxicity
- Reports of acute renal failure, interstitial nephritis, and nephrotic syndrome have been associated with ketorolac tromethamine use
- Ketorolac tromethamine is contraindicated in patients with advanced renal impairment 1
From the Research
Relationship between Toradol (Ketorolac) and Pyelonephritis
There is no direct evidence in the provided studies that establishes a relationship between Toradol (ketorolac) and pyelonephritis. However, the studies do discuss the potential renal effects of ketorolac:
- Acute renal failure has been reported after ketorolac treatment, but it is usually reversible after discontinuation of the drug 2.
- Ketorolac may trigger allergic or hypersensitivity reactions, and careful patient selection is essential if use of ketorolac is considered 2.
- The risk of acute renal failure associated with ketorolac is similar to that associated with opioids when used for less than 5 days, but may be elevated when used for more than 5 days 3.
- Ketorolac is excreted almost entirely by the kidney, and elderly patients or patients with underlying renal insufficiency may require adjustment of the dosing interval or avoidance of the medication altogether 4.
Key Points
- Ketorolac can cause renal impairment, including acute renal failure 2, 4, 3.
- The risk of renal failure increases with high doses, prolonged therapy, or in vulnerable patients 2, 3.
- Ketorolac should be prescribed at the lowest dosage necessary to control pain, and the duration of therapy should be limited to as few days as possible 2.