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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)

DPP-4 Inhibitors Can Cause Severe Joint Pain, FDA Says
Source: Medscape Diabetes & Endocrinology Headlines [2015.08.28]
However, the pain associated with dipeptidyl peptidase-4 inhibitors for type 2 diabetes goes away once patients stop taking the medicine, according to the agency.
News Alerts

Group Offers Guidelines to Lessen Vaccination Pain
Source: Medscape Pediatrics Headlines [2015.08.28]
Clinicians can shuffle the order of vaccine injections, leverage the calming influence of parents and breast-feeding, and routinely apply topical anesthetic to ease vaccination pain for patients.
Medscape Medical News

DPP-4 Inhibitors Linked to Severe Joint Pain, FDA Warns
Source: MedPageToday.com - medical news plus CME for physicians [2015.08.28]
(MedPage Today) -- The agency has identified 33 cases since 2006

Low Back Pain and GI Symptoms on the Swiss Alps
Source: Medscape Gastroenterology Headlines [2015.08.26]
Dr Paget discusses a recent patient of his who presented with a 5-year history of recurrent severe low back pain and gastrointestinal symptoms.
Medscape Rheumatology

Is There Sex After Low Back Pain?
Source: Medscape Orthopaedics Headlines [2015.08.26]
For many people with low back pain, sex is excruciating. But the recommended position for the past 25 years--'side-lying' (ie, 'spooning')--is contraindicated by two new biomechanical studies.
Medscape Orthopedics

more news >>

Published Studies Related to Toradol (Ketorolac)

Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. [2014]
postoperatively, but concerns over postoperative bleeding have limited its use... CONCLUSIONS: This is the first meta-analysis of randomized controlled trials

Intramuscular ketorolac versus oral ibuprofen for pain relief in first-trimester surgical abortion: a randomized clinical trial. [2014]
ketorolac for pain management during first-trimester surgical abortion... CONCLUSIONS: Intramuscular ketorolac does not offer superior pain control

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...

more studies >>

Clinical Trials Related to Toradol (Ketorolac)

Ketorolac in Postoperative Infants: Pharmacokinetics and Safety [Completed]
Infants handle ketorolac differently than adults. Study of handling of this pain medication given to infants following surgery. Detailed analysis of how the drug is eliminated from age 2 months to 18 months. Compared morphine use in infants who received the drug to the group getting placebo. Safety testing for kidney and liver function, breathing measured by continuous oximetry, and any bleeding issues.

Pharmacokinetics of Intranasal Ketorolac in Children [Recruiting]
Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that is typically given to both adults and children by the intravenous (IV) or intramuscular (IM) route for analgesic purposes. Ketorolac can also be given by the intranasal (IN) route using a mucosal atomization device (MAD). We aim to study the pharmacokinetics of ketorolac when administered by the IN route using the MAD.

Intranasal Ketorolac Versus Intravenous Ketorolac for Treatment of Migraine Headaches in Children [Recruiting]
Ketorolac is an evidence-based, first-line acute migraine therapy that is commonly used in the pediatric population; however, it is typically administered by the intravenous (IV) or intramuscular (IM) routes, both of which require a painful and distressing needle stick to administer. The intranasal (IN) route is a painless and effective way of administering analgesics, including ketorolac: IN ketorolac has been shown to be an effective analgesic in adults for painful conditions, including acute migraine headaches. However, IN ketorolac has been understudied in children, and it is not known how effective it is compared to IV ketorolac, which is currently the most common way of administering ketorolac to children. If IN ketorolac is shown to be no less effective than IV ketorolac, IN ketorolac may be a viable and painless alternative to effectively treat acute migraine headaches in children. Therefore, our primary aim is to demonstrate that IN ketorolac is non-inferior to IV ketorolac for reducing pain in children with acute migraine headaches.

Pain Control for Intrauterine Device Placement: A Trial of Ketorolac Prior to Intrauterine Device Placement [Completed]
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.

Pain Outcomes of Intra-operative IV Tylenol and/or IV Toradol for Carpal Tunnel and Distal Radius Fracture Surgeries [Not yet recruiting]

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: 2015-08-28

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