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Toradol (Ketorolac Tromethamine) - Summary

 
 



WARNING

TORADOL, a nonsteroidal anti-inflammatory drug (NSAID), 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. It is NOT indicated for minor or chronic painful conditions. TORADOL is a potent NSAID analgesic, and its administration carries many risks. The resulting NSAID-related adverse events can be serious in certain patients for whom TORADOL is indicated, especially when the drug is used inappropriately. Increasing the dose of TORADOL beyond the label recommendations will not provide better efficacy but will result in increasing the risk of developing serious adverse events.

GASTROINTESTINAL EFFECTS

- TORADOL can cause peptic ulcers, gastrointestinal bleeding and/or perforation. Therefore, TORADOL is CONTRAINDICATED in patients with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or perforation, and in patients with a history of peptic ulcer disease or gastrointestinal bleeding.

RENAL EFFECTS

- TORADOL is CONTRAINDICATED in patients with advanced renal impairment and in patients at risk for renal failure due to volume depletion (see WARNINGS).

RISK OF BLEEDING

- TORADOL inhibits platelet function and is, therefore, CONTRAINDICATED in patients with suspected or confirmed cerebrovascular bleeding, patients with hemorrhagic diathesis, incomplete hemostasis and those at high risk of bleeding (see WARNINGS and PRECAUTIONS).

- TORADOL is CONTRAINDICATED as prophylactic analgesic before any major surgery and is CONTRAINDICATED intraoperatively when hemostasis is critical because of the increased risk of bleeding.

HYPERSENSITIVITY

- Hypersensitivity reactions, ranging from bronchospasm to anaphylactic shock, have occurred and appropriate counteractive measures must be available when administering the first dose of TORADOLIV/IM(see CONTRAINDICATIONS and WARNINGS). TORADOL is CONTRAINDICATED in patients with previously demonstrated hypersensitivity to ketorolac tromethamine or allergic manifestations to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).

INTRATHECAL OR EPIDURAL ADMINISTRATION

- TORADOL is CONTRAINDICATED for intrathecal or epidural administration due to its alcohol content.

LABOR, DELIVERY AND NURSING

- The use of TORADOL in labor and delivery is CONTRAINDICATED because it may adversely affect fetal circulation and inhibit uterine contractions.

- The use of TORADOL is CONTRAINDICATED in nursing mothers because of the potential adverse effects of prostaglandin-inhibiting drugs on neonates.

CONCOMITANT USE WITH NSAIDs

- TORADOL is CONTRAINDICATED in patients currently receiving ASA or NSAIDs because of the cumulative risk of inducing serious NSAID-related side effects.

DOSAGE AND ADMINISTRATION

TORADOLORAL

- TORADOLORALis indicated only as continuation therapy to TORADOL IV/IM, and the combined duration of use of TORADOL IV/IMand TORADOL ORALis not to exceed 5 days because of the increased risk of serious adverse events.

- The recommended total daily dose of TORADOL ORAL(maximum 40 mg) is significantly lower than for TORADOL IV/IM(maximum 120 mg) (see DOSAGE AND ADMINISTRATION and Transition from TORADOL IV/IMto TORADOL ORAL).

SPECIAL POPULATIONS

- Dosage should be adjusted for patients 65 years or older, for patients under 50 kg (110 lbs) of body weight (see DOSAGE AND ADMINISTRATION) and for patients with moderately elevated serum creatinine (see WARNINGS). Doses of TORADOL IV/IMare not to exceed 60 mg (total dose per day) in these patients. TORADOL IV/IMis indicated as a single dose therapy in pediatric patients (see DOSAGE AND ADMINISTRATION); not to exceed 30 mg for IM administration and 15 mg for IV administration.

 

TORADOL SUMMARY

TORADOL (ketorolac tromethamine) is a member of the pyrrolo-pyrrole group of nonsteroidal anti-inflammatory drugs (NSAIDs).

TORADOL is indicated for the short-term (<=5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting.
See all Toradol indications & dosage >>

NEWS HIGHLIGHTS

Media Articles Related to Toradol (Ketorolac)

American Academy of Pain Management (AAPM) 25th Annual Clinical Meeting
Source: Medscape Family Medicine Headlines [2014.09.17]
Read clinically focused news coverage of key developments from AAPM 2014.
Medscape Neurology

Morphine-epilepsy drug combo can result in less pain, lower opioid doses
Source: Epilepsy News From Medical News Today [2014.09.17]
Adding a common epilepsy drug to a morphine regimen can result in better pain control with fewer side effects.

Deaths From Narcotic Painkillers Quadrupled in Past Decade: CDC
Source: MedicineNet Chronic Pain Specialty [2014.09.17]
Title: Deaths From Narcotic Painkillers Quadrupled in Past Decade: CDC
Category: Health News
Created: 9/16/2014 4:36:00 PM
Last Editorial Review: 9/17/2014 12:00:00 AM

Back-Related Leg Pain: Spine Manipulation Helps
Source: Medscape Orthopaedics Headlines [2014.09.16]
Spine manipulation plus exercise and home advice provided more short-term relief for patients with back-related leg pain than exercise and home advice alone, according to a recent study.
Medscape Medical News

Chiropractic care and exercise provide short-term relief of back-related leg pain
Source: Complementary Medicine / Alternative Medicine News From Medical News Today [2014.09.15]
In the short term, patients who received chiropractic care coupled with home exercise and advice reported greater reductions in back-related leg pain (BRLP) than those who received home exercise...

more news >>

Published Studies Related to Toradol (Ketorolac)

Prophylactic nepafenac and ketorolac versus placebo in preventing postoperative macular edema after uneventful phacoemulsification. [2012]
randomized clinical trial... CONCLUSIONS: One month after uneventful phacoemulsification, there was no

The effect of perioperative ketorolac on pain control in pregnancy termination. [2011.11.29]
BACKGROUND: The study was conducted to evaluate the effect of perioperative ketorolac on pain associated with first-trimester aspiration abortion... CONCLUSION: Perioperative ketorolac has the same effect on postoperative pain as determined by VAS as placebo. The use of ketorolac at the 30-mg dose cannot be recommended for better pain control for patients undergoing first-trimester pregnancy termination by suction curettage. The only positive effect of the use of ketorolac compared to placebo was a reduction in the use of acetaminophen. Ketorolac use does not appear to change blood loss in the operating room or through postoperative day 1 compared to placebo. Copyright (c) 2011 Elsevier Inc. All rights reserved.

A randomized, controlled trial validates a peripheral supra-additive antihyperalgesic effect of a paracetamol-ketorolac combination. [2011.11]
The combination of paracetamol with non-steroidal anti-inflammatory drugs (NSAIDs) is widely used; however, the nature and mechanism of their interaction are still debated. A double-blind, pharmacokinetic/pharmacodynamic, randomized, cross-over, placebo-controlled study was carried out in human healthy volunteers...

Preemptive analgesic effectiveness of oral ketorolac plus local tramadol after impacted mandibular third molar surgery. [2011.09.01]
OBJECTIVE: The aim of this study was to compare preemptive analgesia of oral ketorolac plus submucous local placebo with oral ketorolac plus submucous local tramadol after impacted mandibular third molar surgery... CONCLUSIONS: Preemptive use of oral ketorolac plus submucous local tramadol is an alternative treatment for acute pain after surgical removal of an impacted mandibular third molar.

A double-blind placebo-controlled comparison of a novel formulation of intravenous diclofenac and ketorolac for postoperative third molar extraction pain. [2011.06]
Dyloject is a novel formulation of diclofenac intended for intravenous (IV) administration...

more studies >>

Clinical Trials Related to Toradol (Ketorolac)

An Efficacy and Safety Trial of Intranasal Ketorolac in Emergency Department Patients for the Treatment of Acute Pain [Not yet recruiting]
The purpose of this study is to determine the effectiveness, the safety, and the tolerability of intranasal ketorolac (Sprix) in relieving acute pain in adults ages 18-64 who come to the ED seeking care. Considering all ED visits, pain is the most common chief complaint. Giving intranasal ketorolac (Sprix) after stomach and dental surgeries has been shown to be safe and effective, but no studies have investigated the use of intranasal ketorolac (Sprix) for the treatment of acute pain in the ED.

Ketorolac (Sprix) has several advantages over other drugs commonly given for pain, including opioids. Ketorolac (Sprix) is non-addicting and has fewer side effects than opioids. The administration of ketorolac (Sprix) by other methods, such as IV, intramuscular shot, and oral pill form, has been shown to be safe and effective in treating acute pain.

This study is being done to find out if giving ketorolac (Sprix) as a single dose nasal spray will have the same benefit in decreasing patient's pain.

Use of Ketorolac in Management of Post-Operative Pain After Heart Surgery [Completed]
This study evaluates the safety and efficacy of ketorolac for post-operative pain management after heart surgery. Ketorolac appears to provide enhanced pain relief while also decreasing the requirements for morphine during the (immediate) 24-hour post-operative period.

Disposition of Intravenous Ketorolac [Not yet recruiting]
The purpose of this study is:

- to document ketorolac disposition (concentration/time profile, protein binding,

metabolism) and its covariates following intravenous (iv) administration of ketorolac right after caesarean section and to compare those observations (n=32) with non-pregnant state (n=8) (intra-subject PK comparison)

- to document biochemical tolerance of ketorolac

- to evaluate if optimalisation of ketorolac dose regimen during pregnancy and labor are

appropriated and needed

- to quantify the neonatal exposure to ketorolac through excretion in the breast milk

Pain Control for Intrauterine Device Placement: A Trial of Ketorolac Prior to Intrauterine Device Placement [Recruiting]
Intrauterine device (IUD) placement can be painful for patients during and after the procedure. Fear of pain from IUD insertion can be a barrier to obtaining this highly effective long acting reversible contraception. Currently there are no proven effective methods for reduction of pain during and after placement of modern IUDs (Mirena IUD and Paragard IUD). Ketorolac has not been studied in regards to decreasing pain during and after IUD insertion although it is used by some providers for this purpose. It is a strong NSAID that is indicated for the treatment of moderate acute pain. In the intramuscular form it has an analgesia onset of action at 30min, thus may be a plausible option for pain management in the office setting compared to oral NSAIDs, which have a longer time to onset of analgesia and have not been proven to be effective in reducing pain associated with IUD placement. The primary aim of this study is to determine whether ketorolac (Toradol) decreases pain associated with intrauterine device placement compared to placebo. We hypothesize that administration of ketorolac 30mg intramuscularly at least 30 minutes prior to IUD insertion will decrease pain scores by at least 20mm on a visual analog scale at various time points during IUD insertion when compared to placebo of normal saline injection.

Study of Whether 15 mg Dose of Ketorolac IV is as Effective as a 30 mg Dose. [Recruiting]
The primary aim of this study is to show the non-inferiority of 15 mg intraoperative dose of ketorolac as compared to the standard 30 mg ketorolac by looking at the VAS scores 4 hours after an adult spine surgery.

more trials >>

Reports of Suspected Toradol (Ketorolac) Side Effects

Drug Hypersensitivity (10)Hypersensitivity (8)Blood Pressure Increased (8)Haemorrhage (7)Muscle Spasms (7)Haematemesis (6)Migraine (6)Hiatus Hernia (5)Injection Site Pain (5)Status Epilepticus (5)more >>


PATIENT REVIEWS / RATINGS / COMMENTS

Based on a total of 3 ratings/reviews, Toradol has an overall score of 4. The effectiveness score is 6 and the side effect score is 4.67. The scores are on ten point scale: 10 - best, 1 - worst.
 

Toradol review by 50 year old female patient

  Rating
Overall rating:  
Effectiveness:   Considerably Effective
Side effects:   Moderate Side Effects
  
Treatment Info
Condition / reason:   pain after dental surgery
Dosage & duration:   10 mg taken every 4 - 6 hrs for the period of 3 days
Other conditions:   none
Other drugs taken:   Levaquin 500 mg
  
Reported Results
Benefits:   Pain, (which was not controlled by Acetaminophen w/Codeine #3), was reduced to a manageable state with Ketorolac.
Side effects:   Constipation and loss of appetite, which were of little consequence, but the NAUSEA was problematic. Pepto-bismol tablets were used to try to control the nausea.
Comments:   Three dental implants were being implanted into the front, lower jawbone to anchor a bridge replacing 4 lower incisors and 2 lower canine teeth.

 

Toradol review by medical professional caring for 40 year old female patient

  Rating
Overall rating:  
Effectiveness:   Ineffective
Side effects:   Extremely Severe Side Effects
  
Treatment Info
Condition / reason:   for back pain
Dosage & duration:   one amp. (dosage frequency: once) for the period of once
Other conditions:   NO
Other drugs taken:   morphina
  
Reported Results
Benefits:   None. She did an anaphylaxis schock and she did not receive any benefit .
Side effects:   Shock anaphylactic
Comments:   It was used for back pain . She did a severe reaction ( anaphylactic schock). We did the right treatment . We use adrenaline and IV solutions inmediately, we have to transport the patient to the more big hospital in our city and she was at intense care unit by 5 days. She is outside now , but she got as aftermath an Asthma and she is using Inhalator.

 

Toradol review by medical professional caring for 40 year old female patient

  Rating
Overall rating:  
Effectiveness:   Ineffective
Side effects:   Extremely Severe Side Effects
  
Treatment Info
Condition / reason:   for back pain
Dosage & duration:   one amp. (dosage frequency: once) for the period of once
Other conditions:   NO
Other drugs taken:   morphina
  
Reported Results
Benefits:   None. She did an anaphylaxis schock and she did not receive any benefit .
Side effects:   Shock anaphylactic
Comments:   It was used for back pain . She did a severe reaction ( anaphylactic schock). We did the right treatment . We use adrenaline and IV solutions inmediately, we have to transport the patient to the more big hospital in our city and she was at intense care unit by 5 days. She is outside now , but she got as aftermath an Asthma and she is using Inhalator.

See all Toradol reviews / ratings >>

Page last updated: 2014-09-17

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