I. Class

  1. NSAID in the Acetic acid class (Pyrrolo-pyrrole)

II. Precautions

  1. Do not use longer than 5 days
  2. Do not repeat 2 Toradol courses back to back

III. Indications

  1. Analgesia for moderate to severe acute pain
  2. Alternative to Narcotic Analgesic

IV. Contraindications

  1. Peptic Ulcer Disease
  2. Renal Insufficiency
  3. Acute or chronic bleeding risk
  4. Hypersensitivity to Aspirin or other NSAID

V. Dosing: Indications for using lower dose

  1. Age over 65 years
  2. Renal Impairment
  3. Weight under 50 kg (110 pounds)

VI. Dosing: Intramuscular dose

  1. Regular dose
    1. Single dose: 60 mg IM
    2. Repeated dose: 30 mg IM every 6 hours prn (<5 days)
    3. Maximum: 120 mg per day
  2. Low dose
    1. Single dose: 30 mg IM
    2. Repeated dose: 15 mg IM every 6 hours prn (<5 days)
    3. Maximum: 60 mg per day

VII. Dosing: Intravenous dose

  1. Regular dose: 30 mg IV every 6 hours prn (<5 days)
  2. Low dose: 15 mg IV every 6 hours prn <(5 days)

VIII. Dosing: Oral dose (continuation of parenteral dosing)

  1. Maximum: 40 mg per day
  2. Regular dose
    1. First dose: 20 mg PO (two 10 mg tablets)
    2. Subsequent dosing: 10 mg PO q4-6 hours prn
  3. Low dose
    1. Dose: 10 mg PO q4-6 hours prn

X. Efficacy

  1. Equivalents to Toradol 60 mg IM
    1. Morphine 12 mg IM
    2. Most NSAIDS (and similar onset of action to IM injection)
      1. Ibuprofen 800 mg orally
      2. Naprosyn 500 mg orally
  2. Advantages over Morphine in ER with blunt limb trauma
    1. Toradol has longer duration
    2. Toradol less adverse effects
    3. Toradol IV more effective than Morphine IV
  3. References
    1. Rainer (2000) BMJ 321:1247-51 [PubMed] (or open in [QxMD Read])

Images: Related links to external sites (from Google)

Cost: Medications

Ketorolac Tromethamine (on 2/9/2012 at DrugStore.com)
Ketorolac Tromethamine 10mg Tablets #30 for $24.99 ($0.83/unit)
Ketorolac Tromethamine 0.4% Solution 5ml Bottle #1 for $76.00 ($76.00/unit)

Ontology: Ketorolac (C0073631)

Definition (NCI) A synthetic pyrrolizine carboxylic acid derivative with anti-inflammatory, analgesic, and antipyretic activities. Ketorolac non-selective inhibits the enzymes cyclooxygenase 1 (COX-1) and COX-2. The inhibition of COX-2, up-regulated at sites of inflammation, prevents conversion of arachidonic acid to pro-inflammatory prostaglandins. The inhibition of COX-1 by this agent prevents the normal steady-state production of prostaglandins that play housekeeping roles in the protection of the gastrointestinal tract, the regulation of renal blood flow, and platelet aggregation. As a result, the inhibition of COX-1 may be associated with gastrointestinal toxicity, nephrotoxicity, and the inhibition of platelet aggregation.
Definition (MSH) A pyrrolizine carboxylic acid derivative structurally related to INDOMETHACIN. It is an NSAID and is used principally for its analgesic activity. (From Martindale The Extra Pharmacopoeia, 31st ed)
Definition (PDQ) A synthetic pyrrolizine carboxylic acid derivative with anti-inflammatory, analgesic and antipyretic properties. Ketorolac, a non-selective inhibitor of the cyclo-oxygenase (COX) enzyme, prevents the synthesis of prostaglandins and thromboxanes from arachidonic acid. COX enzymes exist in two isoforms; inhibition of the COX-2 enzyme produces the anti-inflammatory and analgesic whereas, inhibition of the COX-1 enzyme is associated with gastrointestinal side effects, nephrotoxicity and platelet de-aggregatory effects. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40569&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40569&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1219" NCI Thesaurus)
Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D020910
SnomedCT 108512006, 372501008, 363609006
English ketorolac, Ketorolac, 1H-Pyrrolizine-1-carboxylic acid, 5-benzoyl-2,3-dihydro, KETOROLAC, Ketorolac [Chemical/Ingredient], Ketorolac (product), Ketorolac (substance), Ketorolac product (substance), Ketorolac product
Swedish Ketorolak
Czech ketorolak
Spanish Ketorolac product, Ketorolac product (substance), ketorolac (producto), cetorolaco, ketorolaco (producto), ketorolac, ketorolac (sustancia), ketorolaco (sustancia), ketorolaco, Ketorolaco
Finnish Ketorolaakki
Russian KETOROLAK, КЕТОРОЛАК
Polish Ketorolak
French Kétorolac
German Ketorolac
Italian Ketorolac
Portuguese Cetorolaco

Ontology: Toradol (C0146226)

Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D020911
English Toradol, toradol