What is this medication?
Analgesic, Nonsteroidal Anti-inflammatory Drug (NSAID)
Ketorolac/Toradol is indicated for moderately severe acute pain (may be used for conditions not listed)
“ALERT: US Boxed Warning
Ketorolac is indicated for the short-term (up to 5 days in adults) management of moderately severe acute pain that requires analgesia at the opioid level. Oral ketorolac is only indicated as continuation treatment following IV or IM dosing of ketorolac, if necessary. The total combined duration of use of ketorolac tablets and injection should not exceed 5 days. The recommended total daily dose of ketorolac tablets (maximum 40 mg) is significantly lower than for ketorolac injection (maximum 120 mg).
Ketorolac is not indicated for use in pediatric patients and is not indicated for minor or chronic painful conditions. Increasing the dose of ketorolac beyond labeled recommendations will not provide better efficacy but will increase the risk of developing serious adverse events.
Cardiovascular thrombotic events:
Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.
Ketorolac is contraindicated in the setting of coronary artery bypass graft surgery.
Ketorolac can cause peptic ulcers, GI bleeding, and/or perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Therefore, ketorolac is contraindicated in patients with active peptic ulcer disease, recent GI bleeding or perforation, and a history of peptic ulcer disease or GI bleeding. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.
Intrathecal or epidural administration:
Ketorolac is contraindicated for intrathecal or epidural administration due to its alcohol content.
Hypersensitivity reactions, ranging from bronchospasm to anaphylactic shock, have occurred and appropriate counteractive measures must be available when administering the first dose of ketorolac injection. Ketorolac is contraindicated in patients with previously demonstrated hypersensitivity to ketorolac or allergic manifestations to aspirin or other NSAIDs.
Ketorolac is contraindicated in patients with advanced renal impairment and in patients at risk for renal failure due to volume depletion.
Risk of bleeding:
Ketorolac inhibits platelet function and is, therefore, contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, and those at high risk of bleeding.
Ketorolac is contraindicated as a prophylactic analgesic before any major surgery.
Risk during labor and delivery:
The use of ketorolac in labor and delivery is contraindicated because it may adversely affect fetal circulation and inhibit uterine contractions.
Concomitant use with nonsteroidal anti-inflammatory drugs:
Ketorolac is contraindicated in patients currently receiving aspirin or NSAIDs because of the cumulative risks of inducing serious NSAID-related adverse events.
Dosage should be adjusted for patients ≥65 years of age, for patients <50 kg (110 lbs) of body weight, and for patients with moderately elevated serum creatinine. Doses of ketorolac injection are not to exceed 60 mg (total dose per day) in these patients.”
How does this medication work?
Ketorolac/Toradol reversibly inhibits cyclooxygenase 1 and 2 (COX 1 and 2) which decreases prostaglandin production (inflammatory mediators). Has anti-inflammatory, analgesic, and antipyretic properties (fever reducing).
How should I take this medication?
Oral: 10mg orally every 4-6 hours to a maximum of 40mg/day. This medication is intended for short term use (i.e. 5 days or less)
How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature, take with food, milk or antacids to reduce adverse gastrointestinal effects, swallow whole unless otherwise directed
You Need to Avoid: Regular alcohol consumption can increase the risk of an intestinal bleed. Do not mix with ibuprofen, ASA or other over the counter NSAIDs due to increased risk of adverse effects.
What should I watch for while using this medication?
Before starting Ketorolac/Toradol make sure your physician is aware of any allergies or medications you currently take, if you have asthma, have had bariatric surgery, a history of ulcer, a bleeding disorder, drink alcohol regularly, liver disease, kidney disease, are pregnant or breastfeeding
Note that all NSAIDs can increase risk of heart attack and stroke, as well as can cause gastrointestinal inflammation, ulceration, and bleeding. Caution should be used in the elderly, those with cardiovascular disease and a history of gastrointestinal ulceration or bleeding.
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Headache, gastrointestinal pain, dyspepsia (indigestion), nausea
Note this is not a complete list of side effects, only common ones.
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