From the Guidelines
Intravenous Toradol (Ketorolac) significantly increases the risk of ulcer development due to its inhibition of cyclooxygenase (COX)-1 and COX-2 enzymes 1.
Key Points
- The risk of ulcer development is dose- and duration-dependent, with higher doses and longer treatment durations increasing the likelihood of gastrointestinal complications 1.
- Patients receiving IV Toradol should be monitored closely for signs of gastrointestinal toxicity, particularly those with a history of peptic ulcer disease or bleeding disorders 1.
- Ketorolac has been linked to greater GI toxicity related to prolonged gastric and duodenal mucosal exposure due to its prominent enterohepatic circulation and significantly prolonged half-lives 1.
- The use of proton-pump inhibitors (PPIs) may help reduce the risk of gastrointestinal complications in patients receiving IV Toradol 1.
- It is essential to weigh the benefits and risks of using IV Toradol, especially in patients with a history of gastrointestinal issues or those taking concomitant medications that may increase the risk of gastrointestinal complications, such as corticosteroids, anticoagulants, or other NSAIDs 1.
From the FDA Drug Label
Gastrointestinal Effects – Risk of Ulceration, Bleeding and Perforation: Ketorolac tromethamine is contraindicated in patients with previously documented peptic ulcers and/or gastrointestinal (GI) bleeding Ketorolac tromethamine can cause serious GI adverse events including bleeding, ulceration and perforation, of the stomach, small intestine, or large intestine, which can be fatal. The incidence and severity of gastrointestinal complications increases with increasing dose of, and duration of treatment with ketorolac tromethamine
The effect of intravenous Toradol (Ketorolac) on cyclooxygenase is not directly stated in the provided drug labels. However, it is known that ketorolac tromethamine is an NSAID, which works by inhibiting cyclooxygenase enzymes. The effect of intravenous Toradol (Ketorolac) on ulcer development is an increased risk of ulceration, bleeding, and perforation of the stomach, small intestine, or large intestine, which can be fatal 2.
From the Research
Effect of Intravenous Toradol (Ketorolac) on Cyclooxygenase
- Ketorolac tromethamine, the active ingredient in Toradol, is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting prostaglandin synthesis, which is mediated by the enzyme cyclooxygenase 3.
- The inhibition of cyclooxygenase by ketorolac leads to a decrease in the production of prostaglandins, which are involved in the mediation of pain, inflammation, and fever.
Effect of Intravenous Toradol (Ketorolac) on Ulcer Development
- There is evidence to suggest that the use of ketorolac can increase the risk of gastrointestinal bleeding and peptic ulcer perforation, particularly with prolonged use or in high doses 4.
- However, other studies have found that the use of ketorolac does not significantly increase the risk of bleeding complications, such as hematoma formation, in certain patient populations, such as those undergoing implant-based breast reconstruction 5.
- The risk of ulcer development and gastrointestinal bleeding associated with ketorolac use may be related to its mechanism of action, which involves the inhibition of prostaglandin synthesis, and may be influenced by factors such as dose, duration of use, and individual patient characteristics.
Clinical Use of Intravenous Toradol (Ketorolac)
- Ketorolac is commonly used as an analgesic for the management of moderate to severe pain, particularly in the postoperative setting 6, 7, 3.
- The use of ketorolac has been shown to decrease the need for opioid analgesics and reduce the length of stay in the hospital or same-day surgery unit 6, 7.
- However, the use of ketorolac should be carefully considered in patients at risk for gastrointestinal bleeding or other complications, and its use should be monitored closely to minimize the risk of adverse effects.