Toradol (ketorolac tromethamine) is a potent nonsteroidal anti-inflammatory drug (NSAID) indicated for the short-term management of moderately severe acute pain that requires analgesia at the opioid level. As the only NSAID approved for both intramuscular and intravenous administration, it offers healthcare providers a valuable non-narcotic alternative for managing postoperative pain, renal colic, and musculoskeletal trauma. Its unique pharmacologic profile provides significant analgesic efficacy without the respiratory depression, sedation, or addiction potential associated with opioid medications. Appropriate patient selection and adherence to recommended dosing duration are critical to maximizing therapeutic benefits while minimizing risks.

Features

• Chemical name: (±)-5-Benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid compound with 2-amino-2-(hydroxymethyl)-1,3-propanediol
• Available formulations: 10 mg tablets, 15 mg/mL and 30 mg/mL injectable solutions
• Mechanism: Potent inhibitor of prostaglandin synthesis via cyclooxygenase (COX) inhibition
• Rapid onset of action: 30-60 minutes orally, 10 minutes parenterally
• Duration of analgesic effect: 4-6 hours per dose
• Hepatic metabolism primarily via glucuronidation and hydroxylation
• Renal excretion of unchanged drug and metabolites
• No known active metabolites
• Pregnancy category C (third trimester: category D)

Benefits

• Provides opioid-level analgesia without narcotic side effects or abuse potential
• Reduces or eliminates need for opioid medications in appropriate patients
• Demonstrated efficacy in postoperative pain, renal colic, and musculoskeletal trauma
• Multiple administration routes allow flexible treatment approaches
• Rapid onset enables quick pain control in acute settings
• Non-sedating nature permits clearer patient assessment and earlier mobilization

Common use

Toradol is primarily indicated for short-term management (up to 5 days) of moderately severe acute pain requiring analgesia at the opioid level. Common clinical applications include postoperative pain management following surgical procedures, particularly when early mobilization is desired. It is frequently employed for renal colic pain, where its combined analgesic and anti-inflammatory effects provide significant relief. Musculoskeletal injuries, including fractures, sprains, and strains, represent another common indication. In emergency departments, it serves as an effective alternative to opioids for acute pain crises. Some off-label uses include migraine headache treatment and pain management in patients with opioid contraindications.

Dosage and direction

Oral administration: For patients converting from parenteral therapy, the recommended dose is 20 mg as a first oral dose for patients who received 60 mg IM/IV, 30 mg IM, or 10 mg IV as a single dose, followed by 10 mg every 4 to 6 hours. Maximum daily oral dose should not exceed 40 mg. Total combined duration of parenteral and oral therapy should not exceed 5 days.

Parenteral administration: For single-dose treatment, 60 mg IM or 30 mg IV. For multiple-dose treatment, 30 mg IM or IV every 6 hours. Maximum daily parenteral dose is 120 mg, with a maximum treatment duration of 5 days. Dose reduction is required for patients weighing less than 50 kg, the elderly, and those with renal impairment.

Dosing should be individualized based on pain severity, patient response, and risk factors. The lowest effective dose should be used for the shortest duration possible.

Precautions

Toradol should be used with extreme caution in patients with a history of gastrointestinal bleeding or ulceration, as NSAIDs increase risk of serious GI adverse events. Renal function should be monitored, particularly in elderly patients, those with volume depletion, heart failure, hepatic dysfunction, or taking diuretics or ACE inhibitors. Hepatic function monitoring is advised during prolonged therapy. Cardiovascular thrombotic risk may increase with duration of use; patients with cardiovascular disease or risk factors should use with caution. May cause fluid retention and edema; use with caution in patients with fluid retention, heart failure, or hypertension. May cause serious skin adverse events without warning. May inhibit platelet aggregation; monitor patients with coagulation disorders.

Contraindications

Toradol is contraindicated in patients with known hypersensitivity to ketorolac tromethamine, aspirin, or other NSAIDs. It is contraindicated as prophylactic analgesic before major surgery and for intraoperative analgesia. Contraindicated in patients with active peptic ulcer disease, recent gastrointestinal bleeding or perforation, history of peptic ulcer disease or GI bleeding. Contraindicated in patients with advanced renal impairment or risk of renal failure due to volume depletion. Contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or high risk of bleeding. Contraindicated during labor and delivery, in nursing mothers, and in patients currently taking aspirin or other NSAIDs. Contraindicated before or during coronary artery bypass graft (CABG) surgery.

Possible side effect

Gastrointestinal: Dyspepsia (13%), nausea (12%), gastrointestinal pain (13%), diarrhea (7%), constipation, flatulence, vomiting, stomatitis, gastrointestinal bleeding (1-2%), peptic ulceration (≤1%)

Central nervous system: Headache (17%), dizziness (7%), drowsiness (4-16%), sweating (4%)

Cardiovascular: Hypertension, palpitations, flushing, edema (≤3%)

Dermatological: Rash (4%), pruritus (3%), purpura (1%)

Renal: Elevated BUN and creatinine, renal failure (especially in volume-depleted patients)

Hematological: Prolonged bleeding time (antiplatelet effect), thrombocytopenia (rare)

Hepatic: Elevated liver enzymes (≤1%), hepatitis (rare)

Other: Injection site pain (2% with IM administration), tinnitus, visual disturbances

Drug interaction

Anticoagulants: Increased risk of bleeding with warfarin, heparin, LMWH Other NSAIDs: Increased risk of GI toxicity; contraindicated combination SSRIs/SNRIs: Increased risk of gastrointestinal bleeding ACE inhibitors/ARBs: Reduced antihypertensive effect, increased renal risk Diuretics: Reduced diuretic efficacy, increased nephrotoxicity risk Lithium: Increased lithium levels and toxicity risk Methotrexate: Increased methotrexate toxicity risk Cyclosporine: Increased nephrotoxicity risk Probenecid: Increased ketorolac levels Pentoxifylline: Increased bleeding risk Corticosteroids: Increased GI ulceration risk

Missed dose

If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed one. Given Toradol’s short-term use pattern and scheduled administration in clinical settings, missed doses are less common during supervised treatment. For outpatients prescribed oral Toradol, adherence to the prescribed schedule is important for maintaining consistent pain control.

Overdose

Symptoms of overdose may include nausea, vomiting, epigastric pain, gastrointestinal bleeding, metabolic acidosis, hypertension, acute renal failure, respiratory depression, coma, and seizures. Management is supportive and symptomatic. There is no specific antidote. Gastric lavage or activated charcoal may be considered if ingestion was recent. Forced diuresis, alkalinization of urine, hemodialysis, or hemoperfusion are unlikely to be beneficial due to high protein binding. Support blood pressure, maintain renal function, and monitor for gastrointestinal bleeding. Hemodialysis does not effectively remove ketorolac due to extensive protein binding.

Storage

Store at controlled room temperature 20°-25°C (68°-77°F). Protect from light. Keep in original container. Do not freeze. Keep out of reach of children. Discard any unused portion of the injectable solution after initial use. Oral tablets should be kept in a dry place. Do not use if discoloration or particulate matter is present in injectable solutions. Properly dispose of unused medication according to FDA guidelines.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Toradol is a prescription medication that should be used only under the supervision of a qualified healthcare professional. The prescribing physician should carefully consider the potential benefits and risks of Toradol therapy before prescription. Patients should follow their healthcare provider’s instructions precisely and report any adverse effects immediately. This summary is not exhaustive; please refer to the full prescribing information for complete details.

Reviews

“Toradol has been invaluable in our postoperative orthopedic patients, providing excellent analgesia without the sedation issues we see with opioids. It enables earlier mobilization and reduces opioid-related complications.” - Orthopedic Surgeon, 15 years experience

“In the emergency department, Toradol is our go-to for renal colic patients. The combination of analgesic and anti-inflammatory effects provides superior relief compared to opioids alone, with fewer side effects.” - Emergency Medicine Physician, 10 years experience

“While effective, I’m always cautious with Toradol due to its significant side effect profile. I reserve it for appropriate patients and never exceed the 5-day limit. Proper patient selection is crucial.” - Internal Medicine Specialist, 20 years experience

“The ability to transition from IV to oral therapy with the same medication simplifies pain management protocols and facilitates earlier discharge for surgical patients.” - Hospitalist, 8 years experience

“I’ve found Toradol particularly useful in patients with opioid intolerance or those at risk for respiratory depression. It fills an important niche in acute pain management.” - Anesthesiologist, 12 years experience