Can Toradol (ketorolac) be given in diverticulitis with large bowel perforation?

From the Guidelines

Toradol (ketorolac) should not be given in diverticulitis with large bowel perforation. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) like Toradol can increase the risk of bleeding and worsen the condition 1.

Alternative Analgesics

• Morphine sulfate is preferred for pain management in such cases.
• If Toradol is considered, a limited dose of 15-30 mg intravenously or intramuscularly every 6 hours, for a maximum duration of 5 days, may be used with caution, under close monitoring for signs of bleeding or perforation worsening 1.

Key Considerations

• The risk of bleeding and perforation worsening associated with NSAIDs like Toradol makes them a less desirable choice for patients with diverticulitis complicated by large bowel perforation.
• Close monitoring is essential if Toradol is used in these patients to promptly identify any adverse effects.
• The provided evidence does not directly address the use of Toradol in diverticulitis with large bowel perforation, but its guidance on NSAIDs and analgesics informs the decision to avoid Toradol in this context 1.

From the FDA Drug Label

Ketorolac tromethamine is contraindicated in patients with recent gastrointestinal bleeding or perforation 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.

Ketorolac (Toradol) is contraindicated in patients with large bowel perforation due to the risk of worsening the condition and causing further complications, such as bleeding or sepsis 2 2.

From the Research

Administration of Toradol (Ketorolac) in Diverticulitis with Large Bowel Perforation

• There is no direct evidence in the provided studies to suggest that Toradol (ketorolac) can be given in diverticulitis with large bowel perforation 3, 4, 5, 6, 7.
• The management of diverticulitis is typically based on the severity of symptoms and the presence of complications such as perforation or abscesses, with treatment options including antibiotics, bowel rest, and surgery 3.
• Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with strong analgesic activity, but its use in patients with diverticulitis and large bowel perforation is not specifically addressed in the provided studies 4, 5, 6, 7.
• The use of NSAIDs such as ketorolac in patients with gastrointestinal perforation or bleeding is generally contraindicated due to the risk of worsening the condition 4, 5.
• However, the provided studies do discuss the use of ketorolac in various other clinical settings, including postoperative pain management and acute pain relief in the emergency department 4, 5, 6, 7.

Considerations for Ketorolac Use

• The pharmacokinetics and pharmacodynamics of ketorolac are well established, with a rapid onset of action and a duration of effect that can last for several hours 4, 5.
• The recommended dosage of ketorolac varies depending on the clinical setting and the patient population, with a maximum daily dosage and duration of treatment that should not be exceeded 4, 5, 6, 7.
• The safety and efficacy of ketorolac have been evaluated in various studies, with a generally favorable profile but a risk of adverse events such as gastrointestinal bleeding and renal impairment 4, 5, 6, 7.