Analgesic
Ketorolac
search
Ketorolac
, Toradol, SPRIX
Class
NSAID
in the Acetic acid class (Pyrrolo-pyrrole)
Non-selective
NSAID
that inhibits both COX-1 and COX-2, reducing
Prostaglandin
synthesis
Antiinflammatory activity is via COX-2 enzyme inhibition
Precautions
See
NSAID
s
Do not use longer than 5 days
Do not repeat two Toradol courses back to back
Indications
Analgesia for moderate to severe acute pain
Alternative to
Narcotic Analgesic
Contraindications
Peptic Ulcer Disease
Renal Insufficiency
Acute or chronic bleeding risk
Hypersensitivity
to
Aspirin
or other
NSAID
Age <2 years old
Dosing
Indications for using lower dose
Age over 65 years
Renal
Impairment
Weight under 50 kg (110 pounds)
Dosing
Intramuscular dose
Regular dose
Single dose: 60 mg IM
Repeated dose: 30 mg IM every 6 hours prn (<5 days)
Maximum: 120 mg per day
Low dose
Single dose: 30 mg IM
Repeated dose: 15 mg IM every 6 hours prn (<5 days)
Maximum: 60 mg per day
Dosing
Intravenous dose
Regular dose: 30 mg IV every 6 hours prn (<5 days)
Low dose: 15 mg IV every 6 hours prn <(5 days)
Very low dose: 10 mg IV every 6 hours prn
Appears to be as effective as the 15 and 30 mg doses
Analgesic
ceiling dose may be 10 mg, above which are more adverse effects without benefit
Motov (2017) Ann Emerg Med 70(2):177-84 +PMID:27993418 [PubMed]
Dosing
Oral dose (continuation of
Parenteral
dosing)
Consider other
NSAID
s which are typically as effective, with less
Gastrointestinal Bleeding
risk
Maximum: 40 mg per day
Regular dose
First dose: 20 mg PO (two 10 mg tablets)
Subsequent dosing: 10 mg PO q4-6 hours prn
Low dose
Dose: 10 mg PO q4-6 hours prn
Dosing
Intranasal
Preparation: Ketorolac
Tromethamine
One spray delivers 15.75 mg of Ketorolac
Tromethamine
Use every 6-8 hours (maximum 4 times daily)
Typical Dose: One spray each notsril
Reduced Dose: One spray in one nostril
Indicated in over age 65 years, weight <110 lbs or renal
Impairment
Local adverse effects
See adverse effects below and
NSAID
s for systemic effects
Nasal discomfort
Increased
Lacrimation
Throat irritation
References
Fitzgerald (2020) Crit Dec Emerg Med 34(10): 24
Adverse Effects
See
NSAID
s
Gastrointestinal Bleeding
(
Peptic Ulcer Disease
)
See
NSAID Gastrointestinal Adverse Effects
Among the highest
Gastrointestinal Bleeding
risks of any
NSAID
Exacerbation of
Renal Insufficiency
See
NSAID Renal Adverse Effects
Bleeding risk
Efficacy
Most
NSAID
s have equivalent efficacy to
Parenteral
Ketorolac (and to some
Opioid
s)
Equivalents to Toradol 60 mg IM
Morphine
12 mg IM
Most
NSAID
S (and similar onset of action to
IM Injection
)
Ibuprofen
800 mg orally
Naprosyn
500 mg orally
Advantages over
Morphine
in ER with blunt limb
Trauma
Toradol has longer duration
Toradol less adverse effects
Toradol IV more effective than
Morphine
IV
References
Rainer (2000) BMJ 321:1247-51 [PubMed]
References
(2012) Presc Lett 19(6): 33
Turturro (1995) Ann Emerg Med 26:117-20 [PubMed]
(2000) Med Lett Drugs Ther 42(1085): 73-78 [PubMed]
Vadivelu (2015) Pain Pract 5(2):175-93 +PMID: 24738596 [PubMed]
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