Ketorolac (Toradol)

• Generic name: Ketorolac Tromethamine
• Brand/Trade names: Toradol, Acular
• Dosages:
  Tablets 10 mg
  Injection 15 mg/mL, 30mg/mL
• Pharmacologic category: Nonsteroidal Anti-inflammatory Drug (NSAID)
• FDA approved: December 20, 1991
• Habit forming? No
• Pregnancy risk factor: C

Ketorolac is a quite potent non-steroidal anti-inflammatory drug (NSAID) which is licensed for short term use in the management of moderate to severe postoperative pain. It is one of the newest NSAIDs. In comparison to the other NSAIDs, ketorolac has poor anti-inflammatory activity.

• Onset of action: Intramuscular ~10 minutes, maximum effect within 2 hours.
• Duration of action: 6-8 hours
• Metabolism: Hepatic
• Elimination half-life: 2-6 hours; prolonged 30% to 50% in elderly; up to 19 hours in renal impairment
• Excretion: Urine (92%, 61% as unchanged drug)

• Injectable formulation. Available in injectable form which can be used in situations where oral NSAIDs are excluded (eg. acute post-operative pain).
• Less nausea and sedation than narcotic analgesics.

• Expensive. One of the most expensive NSAIDs.
• Weak anti-inflammatory action. In comparison to the other NSAIDs, ketorolac has poor anti-inflammatory activity.
• Severe gastrointestinal complications. Ketorolac is reported to have the highest rate of serious gastrointestinal side effects of all non-steroidal anti-inflammatory drugs (NSAIDs). Ketorolac can cause peptic ulcers, gastrointestinal bleeding and perforation of the stomach or intestines, which can be fatal. Results of a case control study2 comparing the GI toxicity of different NSAIDs suggest that ketorolac was approximately five times more likely to cause upper GI bleeding than other NSAIDs.
• Ketorolac may cause kidney failure.

• Severe migraine headache
• Pain after surgery in children

Ketorolac, like other NSAIDs, has analgesic, antipyretic and anti-inflammatory activity. The primary mechanism of action is the inhibition of prostaglandin synthesis by competitive blocking of the the enzyme cyclooxygenase (COX).

• 1. U.S. Food and Drug Administration. Ketorolac (Toradol) Prescribing Information.
• 2. Garcia Rodriguez LA, Cattaruzzi C, Troncon MG, Agostinis L. Risk of hospi- talization for upper gastroin- testinal tract bleeding asso- ciated with ketorolac, other anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs. Arch Intern Med. 1998;158(1):33-9.

Last modified: April, 2010