Toradol® (ketorolac tromethamine) is a prescription medication that has been licensed for the short-term relief of moderate to severe pain. “Short-term” is defined as no longer than five days for adults. Children should not receive more than one dose of Toradol. The medication is most often used to treat pain following a procedure, but may also be used for such things as pain caused by kidney stones, back pain, or cancer pain. It belongs to a class of drugs called nonsteroidal anti-inflammatory drugs, or NSAIDs for short.
Ketorolac is a member of a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs) that is used for treating inflammation and pain. Other drugs in this class include ibuprofen and naproxen, but ketorolac is more effective than other NSAIDs in reducing pain from both inflammatory and non-inflammatory causes. Ketorolac reduces the production of prostaglandins, chemicals that cells of the immune system make that cause the redness, fever, and pain of inflammation and that also are believed to be important in the production of non-inflammatory pain. It does this by blocking the enzymes that cells use to make prostaglandins (cyclooxygenase 1 and 2). As a result, pain as well as inflammation and its signs and symptoms - redness, swelling, fever, and pain - are reduced. The FDA approved ketorolac in November 1989.
Blocking the effects of prostaglandins is what makes Toradol and other NSAIDs useful for reducing pain. In clinical studies, this medication was as effective as lower doses of narcotics at treating pain. When it was combined with narcotic pain medicines (such as morphine), it decreased the amount of narcotics needed. Also, pain relief was significantly better in those receiving Toradol and morphine compared to those receiving morphine alone.
Pain relief usually begins about 30 minutes after a person receives a dose of Toradol. The maximum effect occurs within two to three hours and lasts on average four to six hours.
Toradol is licensed for the short-term relief (defined as no more than five days) of moderate to severe pain. The most common use of Toradol is the relief of pain following a procedure. Some other Toradol uses include relieving back pain, cancer pain, and pain caused by kidney stones.
Ketorolac is used for the short-term treatment of moderate to severe pain. It is usually used before or after medical procedures or after surgery. Reducing pain helps you recover more comfortably so that you can return to your normal daily activities. This medication is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body's production of certain natural substances that cause inflammation. This effect helps to decrease swelling, pain, or fever. Ketorolac should not be used for mild or long-term painful conditions (such as arthritis).
As with any medication it really matters how do you get Toradol in order to get the best results from it. Because even the most effective medication can show mediocre results or even cause serious side effects if you don't manage to take it right. Toradol is not an exception and it is especially important to follow your doctor's guidelines since this drug is primarily used for pain relief during the recovery after treatment. Knowing how this period may be traumatizing and hard to carry through you should know how to maximize the efficiency of Toradol in order to get the best results from using this drug.
The main application of Toradol is primarily restricted to hospitals, clinics and emergency rooms where rapid pain relief is required. It's evident that you will be serviced by a professional healthcare provider that knows how to get the best out of this medication. Usually, Toradol is given in the form of intravenous injections during two days if necessary, which delivers the best painkiller effect. However, afterward the drug is delivered in oral tablets that are intended to be taken for not more than five days if you want to avoid any side effects associated with the use of Toradol.
Morphine has become the standard medication for managing severe acute pain during medical emergencies. This opioid analgesic is used for decades in the form of intravenous injections and is known for its high efficiency. However, morphine is also famous for its severe side effects that include nausea, vomiting, drowsiness, dizziness, inability to concentrate, respiratory depression and even hallucinations. Knowing this, doctors usually require prolonged care and monitoring of patients who were given morphine injections in order to control these undesired side effects. This adds up to the cost of care and restricts doctors from servicing other patients, which may be crucial in the conditions of an emergency room. So there's a reasonable question of whether there are any alternatives to morphine that are as affective yet with fewer side effects? A recent study has shown that Toradol can in fact replace morphine for relieving severe pain.
The study included two groups of patients with similar problems causing severe pain, with conditions including cancer, fractures and post-surgery syndrome. One group received traditional morphine injections, which provided the expected pain relief together with side-effects in some patients. The other group was given intravenous injections of Toradol with comparable concentration of active ingredients. The pain relief was reported to be delivered around the same time as in the case of morphine yet the side effects were less frequent and severe. The only serious side-effect associated with the use of Toradol is gastrointestinal bleeding, which is usually observed during a long term use of the drug. When used for less than five days the risk of this side effect with Toradol is very low. And while some may state that side-effects of morphine are not as serious as one would think, nearly all the patients participating in the study have rated Toradol higher than the opioid analgesic because they've received the necessary pain relief without being affected by any of the common side effects. This simple fact shows that Toradol may be a very viable alternative to morphine since it doesn't prolong the recovery process by delivering additional symptoms and provides the desired pain relief as rapidly as morphine does.
NASHVILLE, TN -- March 5, 2001 -- Women with gynecologic malignancies who are treated with the non-steroidal anti-inflammatory ketorolac consume less morphine while they are in hospital, are able to resume normal eating habits sooner, and they have shorter hospital stays than women not using ketorolac.
Researchers reported these findings March 4 at the 32nd annual meeting of the Society for Gynecologic Oncology.
Thirty-five of the patients in this study had cervical cancer, 46 had endometrial cancer and six had uterine sarcomas. Three-quarters of the patients had stage 1-2 disease and one-quarter were stage 3-4. The mean age of the women in the study group was 52, and their hospital charts were compared with charts for three women who said they did not use ketorolac during this time period.
Over the course of treating their malignancies, the women who used ketorolac had a mean morphine consumption of 76.2 units, as compared with 105.8 units for those who did not use ketorolac. It's interesting to note that their pain scores were no different, despite this 28 percent reduction in morphine usage.
There were also significantly fewer cases of fever in the study group (5.7 percent versus 19 percent) compared with the non-ketorolac group.
“Our study revealed a decreased incidence of post-operative fever,” said principal investigator Dr. Laura Berghahn, of the department of obstetrics and gynecology, biostatistics and medical informatics. “Prostaglandins might play a large role in post-op fever, and the inhibition of cyclo-oxygenase by ketorolac may prevent the often unnecessary work-up and treatment for post-op fever.”
A significant finding was that the women who used ketorolac were able to resume their normal eating habits sooner than those who did not -- 2.8 versus 4.0 days. They were also able to return to a standard diet sooner, possibly because their lower morphine consumption meant fewer gastrointestinal side effects, such as nausea and vomiting, Dr. Berghahn said.
The women were also discharged from hospital approximately half a day sooner than controls, she added, although any data dealing with length of hospital stay will be confounded by the fact that there has been a trend across the United States toward shorter hospital stays.
The study had some limitations, Dr. Berghahn said. Researchers did not control the amount of ketorolac the women took. Patients in the study were asked if they had ever used the NSAID while their disease was being treated. Also, this was a retrospective study and subject to patient bias -- those who were feeling well at the time they responded to the questionnaire were more likely to respond with positive answers.
Perhaps more important, the study did not address the issue of gastrointestinal side effects, including bleeding ulcers and gastric perforations, which are well known with virtually all NSAIDs, Dr. Berghahn said.
The homogeneity of the study population was noteworthy, however, because all of the patients were treated at the same institution, by the same surgeon and with the same nursing team.
Despite the seeming benefit of ketorolac, the rate of post-operative infections and hospital re-admission was not different between the two groups.
For short term use only (up to 5 days in adults). Not for use in pediatric patients and not indicated for minor or chronic pain. Contraindicated in patients with peptic ulcer disease, recent GI bleeding or perforation, perioperative pain in the setting of coronary artery bypass graft (CABG) surgery, advanced renal impairment, risk of renal failure due to volume depletion, cerebrovascular bleeding, hemorrhagic diathesis, incomplete homeostasis, high-risk of bleeding, prophylactic analgesic before major surgery and concomitant aspirin or NSAID use. Use caution with elderly patients due to high risk of GI adverse events and in patients with cardiovascular disease or risk factors. Adjust dosages for elderly patients, patients under 50 kg, and patients with moderately elevated serum creatinine.
For short term use only (up to 5 days in adults). Not for use in pediatric patients and not indicated for minor or chronic pain. Contraindicated in patients with peptic ulcer disease, recent GI bleeding or perforation, perioperative pain in the setting of coronary artery bypass graft (CABG) surgery, advanced renal impairment, risk of renal failure due to volume depletion, cerebrovascular bleeding, hemorrhagic diathesis, incomplete homeostasis, high-risk of bleeding, prophylactic analgesic before major surgery, previously demonstrated hypersensitivity reactions, intrathecal or epidural administration and concomitant aspirin or NSAID use. Use caution with elderly patients due to high risk of GI adverse events and in patients with cardiovascular disease or risk factors. Adjust dosages for elderly patients, patients under 50 kg, and patients with moderately elevated serum creatinine.
You must not use Toradol during pregnancy or if you are trying to become pregnant due to possible harm to the unborn baby and interference with normal labor/delivery.
Tell your doctor before using Toradol if you are breast-feeding. It is not known whether using Toradol during breastfeeding is dangerous. Ketorolac (Toradol) is excreted into breast milk in small amounts after oral dosing with 10 mg four times daily. Ketorolac is considered compatible with breast-feeding by the The American Academy of Pediatrics. However, the manufacturer considers the use of ketorolac contraindicated in nursing mothers because of the potential adverse effects of prostaglandin-inhibiting drugs on neonates.
As with any medicine, there are possible side effects with Toradol® (ketorolac tromethamine); however, not everyone who takes Toradol will experience side effects. In fact, most people tolerate Toradol well. When people do develop side effects, in many cases they are minor, meaning they require no treatment or are easily treated by you or your healthcare provider. However, there are some less common but serious side effects that can occur.
The risk of side effects with Toradol seems to vary depending on a number of factors, including:
Your age
Your general health
The amount of Toradol taken
Other medical conditions you may have
Other medicines you may be taking.
(The side effects discussed below are not a complete list of side effects reported with Toradol. Your healthcare provider can discuss a more complete list with you.)
Toradol has been studied extensively in clinical trials, with many people having been evaluated. In these studies, side effects are always documented and compared to side effects that occur in a similar group of people not taking the medicine. Based on these studies, the most common Toradol side effects include:
Headache
Abdominal pain (or stomach pain)
Nausea
Heartburn or indigestion
Diarrhea
Dizziness
Drowsiness
Swelling.
Other side effects with Toradol occurring in more than 1 percent of people include but are not limited to:
High blood pressure (hypertension)
Itching
Unexplained rash
Gas
Constipation
Vomiting
Sweating
Pain at the injection site.
As with any drug, there is the potential for serious side effects with Toradol. These serious side effects include but are not limited to:
Allergic reactions such as swelling of the face or body, blisters, unexplained skin rash, wheezing, or difficultly breathing
Stomach or intestinal problems, including bleeding, ulcers, or a hole (known as a perforation)
Liver damage, which can cause nausea, fatigue, yellowing of the skin or whites of the eyes, and excessive tiredness
Kidney problems, including kidney failure
Fluid retention or unexplained weight gain
Congestive heart failure.
Because Toradol can increase the risk of major or life-threatening bleeding, contact your doctor immediately if you notice any unusual bleeding or have any of the following symptoms:
Bloody nose
Black, tarry stools
Blood in the urine or stools
Vomiting blood
Red or purple spots on the skin.
During clinical studies, there were also some side effects that occurred rarely in people taking Toradol. These side effects occurred in less than 1 percent of people. It is often difficult to tell whether these side effects are the result of the medication or something else. These possible rare Toradol side effects include but are not limited to:
Weight gain
Fainting (syncope)
Changes in appetite
Rectal bleeding
Hallucination
Unusual thinking
Dry mouth
Breathing problems
Problems with vision, including blurred vision
Ringing in the ears (tinnitus)
Allergic reaction
Hepatitis
Asthma.
Do not use this medication if you:
are allergic to ketorolac or any ingredients of this medication
are allergic to ASA or other anti-inflammatory medications (e.g., ibuprofen, naproxen, diclofenac) or have had allergic symptoms (e.g., runny nose, nasal polyps, asthma, itchy skin rash) caused by these medications
are currently taking other NSAIDs (e.g., ibuprofen, naproxen, diclofenac)
are scheduled for surgery in the immediate future or have just had surgery
are taking probenecid
have a stomach or intestinal ulcer or a history of recurring ulcers
have an inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease)
have bleeding disorders or bleeding in the brain
have just had coronary artery bypass graft (CABG) surgery
have nasal polyps
have or have had bleeding or perforation (holes or tears) in the stomach or intestines
have reduced liver function or liver disease
have reduced kidney function or are at risk of kidney failure
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, and any other significant facts about your health. These factors may affect how you should use this medication.
Allergic reactions: If you have had a reaction to acetylsalicylic acid (ASA) or other NSAIDs (e.g., ibuprofen, ketoprofen, diclofenac) that included a runny nose, itchy skin rash, nasal polyps, or shortness of breath and wheezing, you should not take this medication. If you experience symptoms of a severe allergic reaction (e.g., hives; difficulty breathing, wheezing; swelling of the face, tongue, or throat), get immediate medical attention.
Bladder symptoms: This medication can cause bladder symptoms such as frequent or painful urination and blood in urine. If you develop these symptoms, stop taking this medication and contact your doctor immediately.
Drowsiness and dizziness: This medication can cause drowsiness or dizziness. Do not drive or operate machinery until you are sure that this medication does not affect your ability to do these safely
Fluid and electrolyte balance: This medication can cause fluid retention. If you have heart failure, high blood pressure, or other medical conditions that increase your risk of fluid retention (e.g., kidney problems), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Ketorolac may also cause high blood potassium levels. If you are a senior; have diabetes or kidney failure; or are taking beta-blockers (e.g., metoprolol, atenolol), angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril, enalapril), or some diuretics (e.g., triamterene, amiloride), you are more at risk of high blood potassium.
Infection: This medication may mask the signs of infection (e.g., fever). If you notice other symptoms of infection (e.g., painful or frequent urination, sore throat, cough) contact your doctor.
Kidney function: This medication can affect kidney function. You have a higher risk of developing kidney problems if you are a senior, take diuretics (water pills; e.g., hydrochlorothiazide, furosemide), or already have kidney disease, liver disease, or heart failure. Your doctor may monitor your kidney function with blood tests if you take this medication.
Liver problems: This medication may affect your liver function or cause liver problems. If you experience symptoms of liver problems (e.g., nausea, vomiting, feeling tired, yellowing of the skin or eyes) contact your doctor immediately. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Long-term use: Long-term use of ketorolac (beyond 5 to 7 days for the tablets, or 2 days for the injection) is not recommended as the risk of side effects increases with the length of treatment.
Ulcers and bleeding in the stomach and intestines: This medication may cause stomach ulcers and bleeding from the stomach. These complications can occur at any time and are sometimes severe.
If you have had a stomach or intestinal ulcer, diverticulosis, Crohn's disease or ulcerative colitis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you experience symptoms of an ulcer or other stomach problems (e.g., stomach or abdominal pain, black stools, blood or coffee grind-like vomit, weakness) contact your doctor immediately or get immediate medical attention.
Children: The safety and effectiveness of using this medication have not been established for children less than 16 years of age.
Seniors: Seniors have a higher risk of side effects with this medication. If you are a senior, your doctor will closely monitor you for side effects and may prescribe a lower dose than usually recommended.
There may be an interaction between ketorolac and any of the following:
alcohol
anticoagulants (e.g., heparin, warfarin)
ASA
blood pressure medications (e.g., atenolol, ramipril, amlodipine)
carbamazepine
cholestyramine
colestipol
corticosteroids (e.g., prednisone)
cyclosporine
diuretics (water pills; e.g., spironolactone, furosemide, hydrochlorothiazide)
herbal products that affect blood clotting (e.g., cat's claw, chamomile, fenugreek, evening primrose, feverfew, garlic, ginger, ginseng, turmeric)
lithium
methotrexate
other NSAIDs (e.g., naproxen, diclofenac)
pemetrexed
phenytoin
potassium supplements
probenecid
SSRIs (e.g., paroxetine, citalopram, escitalopram)
warfarin
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
stop taking one of the medications,
change one of the medications to another,
change how you are taking one or both of the medications, or
leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or other can affect the action of many medications, you should let your prescriber know if you use them.
Condition: Pain, 1/5/2012 8:42:01 AM
Reviewer: bobsmom, 55-64 Female on Treatment for 6 months to less than 1 year (Patient)
Comment: post op pain and MIGRAINE relief. Works good
Review by Anonymous: User Rating: 10
Toradol (ketorolac) for Pain: This is an amazing drug that doesn't have the same problems for which narcotic meds are known.
Condition: Pain, 12/6/2010 5:55:33 PM
Reviewer: 25-34 Female on Treatment for less than 1 month (Patient)
Comment: I received a shot of Toradol for pain related to endometriosis. I woke up the next day barely able to move my neck. My neck has only gotten worse and my doctor said it's a very rare side effect. I've had the shot twice before and never experienced this. Very painful and the shot was NOT worth it.
Review by Anonymous: User Rating: 10
Toradol (ketorolac) for Pain: I had a severe toothache that hurt so bad I couldn't even think. Over the years I have had morphine, Lortab, Tylox, you name it; nothing I tried completely killed the pain. Toradol did.
Condition: Pain, 2/5/2009 9:27:22 PM
Reviewer: bpmoe, 55-64 Female on Treatment for less than 1 month (Patient)
Comment: Had crick in neck, got 1 injection its been 3 days now and cant controll blood pressure. way too high.Dr says kidneys may be damaged. Will never take again. not worth it.
Condition: Pain, 12/6/2010 4:12:41 PM
Reviewer: scoombs, 45-54 Female on Treatment for less than 1 month (Patient)
Comment: I took this for extreme sinus pain and eneded up in the hospital with severe chest pains, numb lips and hands....
Review by Anonymous: User Rating: 9.0
Toradol (ketorolac) for Pain: I was given Toradol via IV in the ER to relieve pain from kidney stone attack and it worked wonders for me! It made the pain go away completely within about 20 minutes and didn't make me feel doped up or sick to my stomach. I also didn't experience any side effects from it.
Condition: Pain, 11/19/2010 1:00:59 PM
Reviewer: jettsmama, 25-34 Female on Treatment for less than 1 month (Patient)
Comment: I was prescribed this to help with an infection due to a bad tooth. I had the tooth pulled and the infection remained and caused a bad headache and pressure. This medication didn't do a lot for the pain - I still have to take Ibuprofen or something else with it. It also caused some stomach pain.
Condition: Pain, 9/4/2010 8:23:04 PM
Reviewer: 45-54 Female on Treatment for less than 1 month (Patient)
Comment: I went to the ER with headache and dizziness..ongoing for several days. After 4 hours of waiting and a CT scan later.. I was giving this in an injection. Absolutely NO RELIEF!!!
Review by Anonymous: User Rating: 10
Toradol (ketorolac) for Postoperative Pain: Where has this drug been my entire life? I had rectal surgery and used Toradol for the post-op pain. Wonderful!! Got rid of the pain and no narcotic effect. Was clear-headed and could function. No side-effects for me.
Condition: Pain, 6/8/2010 11:10:54 AM
Reviewer: Gretchen, 25-34 Female on Treatment for 2 to less than 5 years (Patient)
Comment: Take this when I feel a migraine coming on and don't want to take my expensive migraine medication. This makes me feel better without all of the side effects of other pain medications. I only use my other migraine medication if I didn't take the Toradol soon enough to stop the headache.
Review by Anonymous: User Rating: 8.0
Toradol (ketorolac) for Pain: 3 days ago I had a root canal treatment done. 24 hours later I felt like Mt. St. Helens was going to erupt in my jaw. They gave me Vicodin, no help. Antibiotics, no help. Stepped up to Dilaudid no help. Then Toradol it really took off the edge. With a Dilaudid the pain is very manageable for the first 4 hours of the 6 hour span till next dosage. The other two hours are still quite miserable. Many years ago I had a hysterectomy, they could not give me enough narcotics to control my pain, Demerol, morphine, fentanyl, then they gave me Toradol and it was an answer to prayers, with a narcotic added to it.
Condition: Pain, 2/27/2009 12:12:45 AM
Reviewer: RN as a patient, 45-54 Female on Treatment for less than 1 month (Patient)
Comment: I rarely experience side effects, however ...I took this med for the first time before going to bed. Woke up a few hours later with severe stomach cramping, extreme nausea and diarrhea, too dizzy to stand. And so weak from the violent side effects I was unable to work the following day. This medication can also cause serious liver damage.
Review by Anonymous: User Rating: 1.0
Toradol (ketorolac) for Pain: I was given an injection of Toradol for a severe headache in the ER. I was told I had to have the injection in the posterior as it would be sore the next day. All I can say was it was like having a shot of liquid pain. Was given a prescription for the tablets and they haven't done anything.
Review by Anonymous: User Rating: 10
Toradol (ketorolac) for Pain: I have been in total agony with a pain that felt like I was going to be giving birth to an elephant, plus pains in each side of the abdomen and pain coming out in my lower back and rib pain. The pain made my moods and emotions full of anger, sobbing, outbursts, I felt non-human. Just no control of myself. I tried Dilaudid, and Tylenol 3's nothing worked and while in emergency I was treated with several drugs, the pain remained. Finally Dilaudid with a shot of Toradol and it took the pain, what a relief. I felt human again, I felt focused and I could see life...
Condition: Pain, 6/27/2008 4:34:17 PM
Reviewer: Elly, 55-64 Female on Treatment for 1 to less than 2 years (Patient)
Comment: My orthopedic physician gives me toradol injections and they are extremely effect, however the oral medication has no effect whatsoever. There are no physicians in the town where I live who have toradol medication available. This is the most effect treament for me in between epidurals. I have rhuematoid, osteo, fibromyalgia, rhuematic fever, sjogren syndrom and number other health problems. The injections are one of the most effective treatments I have. I have very weak kidneys and this does not appear to affect them. The last three surguies I have had my kidneys completely shut down. I am now trying to delay other surguries as long as possible and toradol is a great help.
Review by Anonymous: User Rating: 10
Toradol (ketorolac) for Pain: I had excruciating pain in my left arm. They gave me a shot of morphine which did not relieve it at all. They then decided to give me Toradol through an IV site. It was the only thing that took the pain away. It's excellent.
Review by rkr...: User Rating: 9.0
Toradol (ketorolac) for Pain: It is the only thing that has helped me for the past 15 years for migraine and tension headaches. Did not feel great side effects.