Toradol (ketorolac tromethamine) is a highly effective nonsteroidal anti-inflammatory drug (NSAID) indicated for the short-term management of moderately severe acute pain. It is particularly valuable in clinical settings where potent analgesia is required but opioid use is undesirable or contraindicated. As a non-narcotic agent, Toradol provides significant pain control through its powerful anti-inflammatory and analgesic properties, making it a first-line option in postoperative care, renal colic, and musculoskeletal trauma. Its injectable and oral formulations offer flexibility in administration across various healthcare environments, from emergency departments to inpatient units.

Features

• Contains ketorolac tromethamine as the active pharmaceutical ingredient
• Available in multiple formulations: intramuscular/intravenous injection (15 mg/mL, 30 mg/mL) and oral tablets (10 mg)
• Potent cyclooxygenase (COX-1 and COX-2) inhibitor with strong anti-inflammatory and analgesic effects
• Rapid onset of action: analgesic effects typically begin within 30 minutes of intramuscular administration
• Duration of analgesic effect ranges from 4-6 hours per dose
• Not classified as a controlled substance despite its potent analgesic properties
• White to off-white crystalline powder with good solubility in water

Benefits

• Provides potent analgesia equivalent to moderate opioid doses without narcotic side effects
• Reduces inflammation at the site of injury, addressing the underlying cause of pain
• Minimizes risk of respiratory depression compared to opioid alternatives
• Avoids the potential for opioid dependence and abuse in pain management
• Enables faster recovery in postoperative settings by facilitating early mobilization
• Offers flexible administration routes for tailored pain management protocols

Common use

Toradol is primarily employed for the short-term management of moderately severe acute pain that requires analgesia at the opioid level. Its most frequent applications include postoperative pain management following surgical procedures, particularly in orthopedic, abdominal, and dental surgeries. Emergency departments commonly utilize Toradol for acute musculoskeletal injuries, renal colic, and migraine headaches. It serves as an effective alternative to opioids in patients with respiratory compromise or those at risk of opioid dependence. The medication is typically administered for a maximum of 5 days due to increasing risk of adverse effects with prolonged use.

Dosage and direction

For intramuscular administration: The recommended single dose is 30 mg or 60 mg for patients under 65 years with normal renal function. For intravenous use: A 15 mg or 30 mg dose may be administered. Subsequent dosing: 15 mg or 30 mg every 6 hours, not to exceed 60 mg daily in patients under 65, or 30 mg daily in patients over 65 or those with impaired renal function. Oral tablets: 10 mg every 4-6 hours as needed for pain relief, not to exceed 40 mg daily. The total duration of Toradol therapy (combined injectable and oral) should not exceed 5 days. Always use the lowest effective dose for the shortest duration possible.

Precautions

Toradol carries a significant risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation, which can occur at any time without warning symptoms. The risk increases with longer duration of use and higher doses. Patients with a history of peptic ulcer disease or gastrointestinal bleeding should use Toradol with extreme caution. Renal toxicity may occur, particularly in patients with pre-existing renal impairment, dehydration, heart failure, or those taking diuretics or ACE inhibitors. Hepatic function should be monitored during therapy. Toradol may inhibit platelet aggregation and prolong bleeding time. Use with caution in patients with coagulation disorders or those taking anticoagulants. Elderly patients are at increased risk for adverse reactions.

Contraindications

Toradol is contraindicated in patients with known hypersensitivity to ketorolac tromethamine, aspirin, or other NSAIDs. It must not be used in patients with active peptic ulcer disease, recent gastrointestinal bleeding or perforation, or history of peptic ulcer disease or gastrointestinal bleeding. Contraindications include patients with advanced renal impairment or risk of renal failure due to volume depletion. The medication is prohibited in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or high risk of bleeding. Toradol is contraindicated as prophylactic analgesic before major surgery and intraoperatively. It must not be used concurrently with other NSAIDs, including aspirin. Contraindicated during labor and delivery, and in nursing mothers.

Possible side effect

Common adverse reactions include gastrointestinal effects: nausea (12%), dyspepsia (12%), gastrointestinal pain (13%), and vomiting. Central nervous system effects: headache (17%), dizziness (7%), and drowsiness. Injection site pain occurs in approximately 2% of patients receiving IM administration. Serious side effects include gastrointestinal bleeding, ulceration, and perforation; renal impairment and renal failure; hepatotoxicity; hypertension; heart failure; and anaphylactoid reactions. Rare but serious adverse events include Stevens-Johnson syndrome, toxic epidermal necrolysis, and aseptic meningitis. Platelet aggregation inhibition may lead to prolonged bleeding time and increased risk of hemorrhage.

Drug interaction

Toradol exhibits significant interactions with multiple medication classes. Concurrent use with other NSAIDs, including aspirin, increases the risk of serious gastrointestinal adverse events. When used with anticoagulants such as warfarin, heparin, or direct oral anticoagulants, Toradol significantly increases the risk of bleeding complications. Concomitant administration with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may elevate bleeding risk. Toradol may reduce the antihypertensive effect of ACE inhibitors, angiotensin II receptor blockers, and beta-blockers. Diuretics may enhance the nephrotoxicity of Toradol. Concurrent use with methotrexate may increase methotrexate plasma levels and toxicity. Probeneci d may decrease Toradol clearance, increasing the risk of adverse effects.

Missed dose

As Toradol is typically prescribed for acute pain management on an as-needed basis, missed doses are generally not a concern for scheduled administration. If Toradol is being administered on a fixed schedule for short-term pain control and a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In this case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should never double the dose to make up for a missed administration. For postoperative pain management in clinical settings, healthcare providers should follow established protocols for analgesic administration.

Overdose

Toradol overdose may manifest as symptoms including lethargy, drowsiness, nausea, vomiting, and epigastric pain. More severe overdose may result in gastrointestinal bleeding, renal failure, hypertension, respiratory depression, and coma. There is no specific antidote for ketorolac overdose. Management involves supportive care and symptomatic treatment. Gastric lavage or activated charcoal may be considered if ingestion occurred within the previous 4 hours. Forced diuresis, alkalinization of urine, hemodialysis, or hemoperfusion are unlikely to be beneficial due to Toradol’s high protein binding and extensive metabolism. Hemodialysis does not significantly remove ketorolac from circulation. Monitor for signs of gastrointestinal bleeding and renal impairment.

Storage

Store Toradol injection vials and prefilled syringes at controlled room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Protect from light. Do not freeze. The oral tablets should be stored at 20°C to 25°C (68°F to 77°F) in a tight, light-resistant container. Keep all medications out of reach of children and pets. Do not use Toradol if discoloration or particulate matter is visible in the injection solution. Discard any unused portion of the injection solution, as it contains no preservatives. Do not transfer the injection solution to other containers for storage.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Toradol is a prescription medication that should only be used under the supervision of a qualified healthcare professional. The prescribing physician should carefully evaluate the patient’s medical history, current medications, and risk factors before initiating therapy. Patients should follow their healthcare provider’s instructions precisely and report any adverse effects immediately. This document does not contain all possible information about Toradol and should not be used as a substitute for professional medical advice, diagnosis, or treatment.

Reviews

Clinical studies demonstrate that Toradol provides effective analgesia in approximately 70-80% of patients with moderate to severe acute pain. In postoperative settings, Toradol has shown equivalent efficacy to meperidine and morphine at standard doses while causing significantly less respiratory depression. Emergency medicine specialists report high satisfaction with Toradol’s efficacy in renal colic, with pain reduction scores comparable to opioid medications. Orthopedic surgeons value Toradol’s anti-inflammatory properties in musculoskeletal trauma management. However, many clinicians emphasize the importance of strict adherence to the 5-day maximum duration due to the significant risk of adverse effects with prolonged use. The medication receives particular praise for its role in opioid-sparing pain management protocols.