Patient Instructions for Back Spasms: Toradol (Ketorolac) and Flexeril (Cyclobenzaprine)
Critical Medication Safety Information
Take Toradol and Flexeril exactly as prescribed, and never combine Toradol with other pain medications like ibuprofen, Advil, Motrin, or Aleve, as this significantly increases your risk of stomach bleeding, kidney damage, and heart problems. 1
Toradol (Ketorolac) - Important Safety Rules
Toradol is for SHORT-TERM USE ONLY - maximum 5 days total. 2
- Do NOT take Toradol if you have taken ibuprofen (Advil, Motrin) or naproxen (Aleve) in the past 6-8 hours - you must wait for complete clearance to avoid dangerous side effects 1
- Take with food or milk to reduce stomach upset 3
- Stop immediately and call your doctor if you experience:
Flexeril (Cyclobenzaprine) - What to Expect
Flexeril works best in the first 4 days of treatment and is most effective when combined with rest and physical therapy. 4
Common side effects (these are normal):
DO NOT drive, operate machinery, or perform tasks requiring alertness until you know how this medication affects you 6
DO NOT drink alcohol - it will make drowsiness much worse 6
Take at bedtime if drowsiness is bothersome during the day 5
Dangerous Drug Combinations to AVOID with Flexeril
Never combine Flexeril with these medications without telling your doctor: 6
- Antidepressants (SSRIs like Prozac, Zoloft; SNRIs like Cymbalta; or older antidepressants)
- Tramadol (Ultram)
- MAO inhibitors
- Sleeping pills or anxiety medications
These combinations can cause serotonin syndrome - a life-threatening condition with symptoms of confusion, rapid heart rate, high fever, and muscle rigidity. 6
Pain Management Strategy
Using Both Medications Together
The combination of Flexeril (muscle relaxant) and Toradol (anti-inflammatory) works better than either medication alone for back spasms. 7
- Flexeril reduces muscle spasm and improves range of motion 8, 4
- Toradol reduces inflammation and pain 3
- Together they address both the muscle spasm and underlying inflammation 7
Alternative Pain Relief During Toradol Treatment
You CAN safely take regular Tylenol (acetaminophen) 650mg every 6 hours while on Toradol - these medications work differently and do not increase each other's risks 1
- Maximum Tylenol dose: 3000-4000mg per day (about 6 regular-strength tablets) 1
- You can alternate Tylenol and Toradol every 3 hours for better pain coverage 1
When to Contact Your Doctor Immediately
Call your doctor or go to the emergency room if you experience: 3
- No bowel movement for 3 days
- Difficulty waking up or extreme confusion
- New or worsening pain despite medication
- Any signs of bleeding (black stools, vomiting blood, easy bruising)
- Yellowing of skin or eyes (liver problems with Flexeril) 6
- Severe allergic reaction (rash, swelling, difficulty breathing)
Higher Risk Patients - Extra Precautions Needed
You are at higher risk for complications if you: 3, 9
- Are age 60 or older
- Have heart disease, high blood pressure, or history of heart attack/stroke
- Have kidney disease
- Have history of stomach ulcers or bleeding
- Take blood thinners (warfarin, aspirin, Plavix)
- Drink 2 or more alcoholic beverages daily
If any of these apply to you, your doctor may need to adjust your treatment plan or monitor you more closely. 3
Medication Storage and Handling
- Store medications in a secure location away from children 3
- Do not share your medications with others 3
- Take only the prescribed dose - do not adjust on your own 3
- Keep a written list of all your medications and bring it to every doctor visit 3
Expected Timeline for Improvement
Most patients experience significant improvement within 3-4 days of starting treatment. 4
- Pain relief from Toradol typically begins within 1-2 hours 1
- Muscle relaxation from Flexeril is most noticeable in the first week 4
- If you see no improvement after 4-5 days, contact your doctor - you may need a different treatment approach 3
After Completing Your Medication Course
Plan to transition to safer long-term options after 5 days: 2