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 Research
Effect of Intravenous Toradol on Cyclooxygenase
- Toradol, also known as ketorolac, is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting the enzyme cyclooxygenase (COX) 2.
- The inhibition of COX by Toradol reduces the production of prostaglandins, which are mediators of pain and inflammation 2.
Ulcer Development
- The use of NSAIDs, including Toradol, has been associated with an increased risk of peptic ulcers and gastrointestinal bleeding 3, 4.
- A case report published in the Journal of the National Medical Association found that a patient developed a perforated gastric ulcer after receiving multiple doses of intramuscular ketorolac tromethamine 3.
- However, another study found that the use of ketorolac did not increase the risk of hematoma formation in patients undergoing implant-based breast reconstruction 5.
Administration and Dosage
- Toradol can be administered intramuscularly or intravenously, with peak plasma levels reached in 45 to 50 minutes after intramuscular administration 2.
- The recommended dosage of Toradol varies depending on the patient's condition, with a maximum daily dose of 150 mg on the first day and 120 mg on subsequent days 2.
- A study published in the AANA journal found that intraoperative administration of ketorolac tromethamine reduced the length of stay in a same day surgery unit by an average of 30 minutes 6.