Can Toradol (ketorolac) be administered after giving 324 mg of chewable aspirin (acetylsalicylic acid) in the emergency department?

From the Guidelines

It is not recommended to administer Toradol (ketorolac) to a patient who has recently received 324 mg of chewable aspirin in the emergency department. Both medications are nonsteroidal anti-inflammatory drugs (NSAIDs) that work through similar mechanisms by inhibiting cyclooxygenase enzymes and prostaglandin synthesis. Combining these medications increases the risk of adverse effects, particularly gastrointestinal bleeding, ulceration, and kidney injury, without providing significant additional pain relief. The combination can also increase bleeding risk due to their antiplatelet effects, as noted in a study from the American Heart Association 1. If additional pain management is needed after aspirin administration, consider alternative analgesics from different drug classes such as acetaminophen or, if necessary, opioid medications. Always evaluate the patient's complete medication history, kidney function, and risk factors for bleeding before administering any NSAID. In most clinical situations, it's best to wait at least 4-6 hours after aspirin before considering Toradol, though ideally, these medications should not be used together in the same treatment episode. Key considerations include:

• The potential for ibuprofen to interfere with aspirin's ability to irreversibly acetylate the platelet COX-1 enzyme, which could reduce the protective effect of aspirin on risk for atherothrombotic events 1
• The recommendation to take ibuprofen at least 30 minutes after aspirin ingestion, or at least 8 hours before aspirin ingestion to avoid any potential interaction 1
• The lack of data on concomitant use of ibuprofen and enteric-coated low dose aspirin, highlighting the need for caution when combining NSAIDs and aspirin 1

From the FDA Drug Label

Ketorolac tromethamine is contraindicated in patients currently receiving aspirin or NSAIDs because of the cumulative risks of inducing serious NSAID-related adverse events.

The administration of Toradol (ketorolac) is contraindicated in this scenario because the patient has already received 324 mg of aspirin, which is an NSAID. Giving Toradol in addition to aspirin would increase the risk of serious NSAID-related adverse events. 2 2

From the Research

Administration of Toradol after Aspirin

• The administration of toradol (ketorolac) after giving someone 324 mg of chewable aspirin in the emergency department can be considered based on the patient's condition and medical history.
• According to a study published in 2019 3, ketorolac can be used for pain management in prehospital settings, and its effectiveness is comparable to that of acetaminophen.
• Another study from 1990 4 compared the effectiveness of ketorolac, aspirin, and an acetaminophen-codeine combination in postoperative oral surgery pain, and found that ketorolac was significantly superior to aspirin for every measure of total and peak analgesia.
• However, it is essential to consider the potential interaction between ketorolac and aspirin, as some NSAIDs may interfere with the anti-platelet activity of aspirin 5.
• A study from 2013 5 found that ketorolac does not interfere with the anti-platelet activity of aspirin, whereas some other NSAIDs do.
• Additionally, a study from 2025 6 evaluated the effectiveness of ketorolac in managing acute pain in children in the emergency department and found that it showed variable effectiveness for different conditions.

Considerations for Administration

• Before administering toradol, it is crucial to consider the patient's medical history, current condition, and potential interactions with other medications, including aspirin.
• The patient's pain level and response to previous treatments should also be taken into account when deciding whether to administer toradol.
• It is also important to note that the effectiveness of ketorolac may vary depending on the specific condition being treated, as found in the study from 2025 6.
• The study from 2015 7 found that chewable aspirin may be faster than soluble aspirin at decreasing the amount of time to achieve platelet inhibition, which may be relevant when considering the administration of toradol after aspirin.