What is the use of Toradol (Ketorolac)?

From the Guidelines

Toradol (ketorolac) should be used with caution for short-term management of moderate to severe acute pain, with a recommended dosage of 10mg orally every 4-6 hours, not to exceed 40mg daily, or 30mg IV/IM initially, followed by 15-30mg every 6 hours as needed, and limited to a maximum of 5 days due to increased risk of serious side effects with longer use. The use of Toradol is supported by the most recent study from 1, which highlights its efficacy in acute pain management. Key considerations for its use include:

• Avoiding its use in patients with kidney problems, history of stomach ulcers or bleeding, heart failure, or those taking blood thinners, as noted in 1 and 1.
• Patients should take it with food to reduce stomach irritation and maintain adequate hydration.
• Common side effects include stomach upset, dizziness, and drowsiness, as reported in 1.
• Unlike opioids, Toradol doesn't cause respiratory depression or addiction, making it valuable for acute pain management, particularly post-surgical pain or kidney stones, as discussed in 1. Some important points to consider when prescribing Toradol include:
• Monitoring for adverse effects, such as gastrointestinal upset, dizziness, and drowsiness.
• Limiting its use to a maximum of 5 days to minimize the risk of serious side effects.
• Considering alternative analgesics, such as ibuprofen, for patients who have found them effective and tolerated in the past, as suggested in 1.

From the FDA Drug Label

Carefully consider the potential benefits and risks of Ketorolac Tromethamine Tablets USP and other treatment options before deciding to use Ketorolac Tromethamine Tablets USP. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals Ketorolac Tromethamine Tablets USP are indicated for the short-term (≤ 5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting The total combined duration of use of Ketorolac Tromethamine Tablets USP and ketorolac tromethamine is not to exceed 5 days of use because of the potential of increasing the frequency and severity of adverse reactions associated with the recommended doses

• Ketorolac Tromethamine Tablets USP are used for the short-term management of moderately severe acute pain.
• The total combined duration of use is not to exceed 5 days.
• Patients should be switched to alternative analgesics as soon as possible. The recommended use of Toradol (Ketorolac Tromethamine Tablets USP) is for the short-term management of moderately severe acute pain, with a maximum duration of 5 days 2.

From the Research

Overview of Toradol

• Toradol, also known as ketorolac, is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term management of moderate to severe postoperative pain 3.
• It has analgesic, anti-inflammatory, and antipyretic properties, but does not bind to opioid receptors and is not a centrally acting agent 3.

Adverse Effects

• The use of ketorolac is associated with adverse effects such as gastrointestinal bleeding and perforation, platelet inhibition with altered haemostasis, and renal impairment 4.
• The risk of adverse events increases with high doses, prolonged therapy (>5 days), or in vulnerable patients (e.g., the elderly) 4.
• Acute renal failure has been reported after ketorolac treatment, but is usually reversible after discontinuation of the drug 4.
• Ketorolac may trigger allergic or hypersensitivity reactions, and careful patient selection is essential if use of ketorolac is considered 4.

Dosage and Administration

• 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 4.
• The recommended dose of ketorolac is 30-60 mg intramuscularly, with a maximum first-day dose of 150 mg and 120 mg on subsequent days up to a recommended maximum of 5 days 3.
• The lower dose range is recommended for elderly patients, patients weighing less than 50 kg, and patients with impaired kidney function 3.

Efficacy

• Ketorolac has been shown to be effective in reducing postoperative pain, with a large increase in the number of participants achieving at least 50% pain relief over four and six hours compared to placebo 5.
• The number needed to treat for one additional participant to benefit was 2.4 (95% CI 1.8 to 3.7) over four hours and 2.5 (95% CI 1.9 to 3.7) over six hours 5.
• Ketorolac probably results in a slight increase in total adverse event rates compared with placebo (74% versus 65%; 8 studies, 810 participants; RR 1.09,95% CI 1.00 to 1.19) 5.

Comparison with Other NSAIDs

• Ketorolac was compared to parecoxib and diclofenac in several studies, and there was no evidence of a difference between intravenous ketorolac and another NSAID in terms of pain relief over four and six hours 5.
• Ketorolac probably results in a slight increase in total adverse event rates compared with another NSAID (76% versus 68%, 5 studies, 516 participants; RR 1.11,95% CI 1.00 to 1.23) 5.

Risk of Gastrointestinal Bleeding

• Ketorolac has been associated with a higher risk of upper gastrointestinal tract bleeding compared to other NSAIDs, with a relative risk of 24.7 (95% CI 9.6-63.5) 6.
• The excess risk with ketorolac was observed with both oral and intramuscular administration and was already present during the first week of therapy 6.