Ketorolac Tromethamine (Toradol)
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Category:
Description:
Indications:
Contraindications:
-
Patients
with active or history of peptic ulcer disease, gastrointestinal
bleeding or perforation.
-
Patients
with advanced renal impairment or at risk of renal failure due to
volume depletion.
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Labor
and delivery.
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Prophylactic
analgesia or intraoperative analgesia.
-
Patients
with suspected or confirmed cerebrovascular bleeding, hemorrhagic
diathesis, incomplete hemostasis, and at high risk of bleeding.
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Patients
currently on aspirin or other NSAIDs.
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Epidural
or intrathecal injection.
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Concomitant
use with probenecid.
Precautions:
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Pregnancy
Category C
-
Ketorolac
therapy should not continue over a duration of 5 days.
After days, switch to another appropriate analgesic agent.
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Ketorolac
is an extremely potent NSAID and may experience cause potentially
serious GI effects, including GI bleeding and ulceration, as well as
kidney failure.
-
Avoid
use with anticoagulants (warfarin) due to
increased bleeding times and potential for GI bleeding and decreased
platelet aggregation.
-
When
administering as IV bolus, administer over a 15 second period.
-
When
administering as IM bolus, give slowly and deeply into muscle tissue.
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Analgesic
effects begin in about 30 minutes and peak at 1-2 hours, with a
duration of 2-6 hours.
Adverse
Reactions (Side Effects):
-
GI
effects: nausea (12%), dyspepsia (11%), GI pain (13%), diarrhea (7%)
-
CNS
effects: headache (17%), dizziness (7%), drowsiness (6%)
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Dosage:
Administered
as an oral tablet or injection (IM or IV)
May
be used as a “one time” dose or as “prn” treatment
Single-Dose
Treatment:
-
IM
(patients <65 years old): 60mg, one dose
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IM
(patients >65 years old, with renal impairment or less than 50kg):
30mg, one dose
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IV
(patients <65 years old): 60mg, one dose
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IV
(patients >65 years old, with renal impairment or less than 50kg):
30mg, one dose
Multi-Dose
Treatment:
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IM
or IV (patients <65 years old): 30mg q6h (not to exceed 120mg per
day)
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IM
or IV (patients >65 years old, with renal impairment or less than
50kg): 15mg q6h (not to exceed 60mg per day)
Transition
from IM/IV to oral:
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Patients
<65 years old: 2 tablets (20mg) first dose, followed by 1 tablet
(10mg) q4-6h (not to exceed 40mg per day)
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Patients
>65 years old, with renal impairment or less than 50kg: 1 tablet
(15mg) first dose, followed by 1 tablet (10mg) q4-6h (not to exceed
40mg per day)
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Source:
Operational Medicine 2001, Health
Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau
of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington,
D.C., 20372-5300
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