Ketorolac – Toradol

The following information is NOT meant to be used to treat yourself or patients

Generic name = Ketorolac

Trade name = Toradol
Class = anti-inflammatory
MOA

• Blocks cyclooxygenase (COX-1 & COX-2) and thus production of prostaglandins
• In vitro, ketorolac is the most COX-1 predominant NSAID (click here)

Advantages

• When used IM or IV, it is the go-to NSAID for acute relief of severe pain

Dosing

• Availability:  10-mg pills; 15, 30, 60-mg vials
• Typically given as a one-time IM/IV dose of 60-mg or 30-mg, or multi-dosed as 30-mg IM/IV q6h or 15-mg q6h
• If given as PO route, 10-mg PO q6h
• Max dose: Do not exceed 120-mg IV/IM per day, or 40-mg PO per day
• Max of 5 consecutive days
• Renal insufficiency dosing:  15-mg IV/IM q6h; do not exceed >60-mg/day
  
• Advanced renal impairment:  contraindicated

Note:

• COX-1 normally produces prostaglandins that are gastroprotective.  Thus, blocking it can lead to gastric ulcers/bleeds
• Take with food or 8-oz of water
• May increase risk of cardiovascular thrombotic events, MI, and stroke
  • Avoid in patients with cardiac history
• Absolute contraindication: ASA allergy

Clinical Pearl

• Robaxin 200mg IM and Toradol 60mg IM (separate sites) is a great acute pain treatment