Toradol is a nonsteroidal anti-inflammatory drug with a unique indication of only a five day period (ultra-short term) for patients with moderate to severe pain providing analgesia (pain relief) at the opioid level, though it does not produce sedation nor provide anxiety relief. It achieves peak relief of pain within 2-3 hours of dosage. Toradol is available in multiple forms for administration by IV (intravenous) or IM (intramuscular) 15mg/cc or 30mg/cc routes, generally the initial dose, followed by the 10mg tablet oral route for a total of the five days if necessary. The recommended total oral daily dose is 40mg compared to the continued IV/IM of 120mg daily. Patients either 65 years of age or with a body weight less than 110 pounds should not exceed 60mg of the IV/IM daily dose. The drug is not recommended in patients younger than 16 years of age. Orally, the drug is given with a low fat meal or empty stomach without regards to antacids.

As a potent nonsteroidal it is not to be used for chronic pain due to its many risks. The medication is generally used post-operative with the initial dose given by the anesthesiologist just upon completion of surgery to the patient while still in the operating room.

The adverse reactions affect the gastrointestinal tract, the kidney, has significant risks of hemorrhage, respiratory system with bronchospasm, and is contraindicated in labor, delivery and in nursing mothers.

Gastrointestinal effects include nausea, vomiting, diarrhea, constipation, flatulence (abdominal gas, bloating), vomiting, peptic ulceration, perforation, bleeding and should be avoided in patients with a history of or pre-disposition to such ailments. Patients with advanced renal (kidney) impairment may experience depleted body fluid volumes and is contraindicated. As Toradol inhibits platelet function as a NSAID, patients with a history of bleeding disorders, suspected cerebrovascular incidents, poor clotting history or those at high risk of bleeding should not be given this medication. It may produce localized purple blushing patches of local bleeding into the skin (purpura), also due to its platelet effect; it should not be given pre-operatively or intra-operatively as it may increase bleeding during surgery. Patients with hepatic (liver) diseases should be monitored closely as the drug is primarily metabolized in the liver.

It may cause edema in the extremities, hypertension, a pruritic (itching) rash, headaches, dizziness, drowsiness, sweating, fever- like symptoms,

Patients with history of a general hypersensitivity to various medications should be administered Toradol with extreme caution, as reactions from bronchospasm to severe anaphylactic shock could occur and appropriate personnel and equipment should be readily available. It should not be administered via the epidural or intrathecal route (in the spine) because of its alcohol content. Since it is a NSAID, it should not be used in conjunction with other medications of this class (ibuprofen, naproxen, ketoprofen etc) Toradol produces a ‘opioid sparing effect” reducing the concomitant amount of morphine or other opioid with the same r improved analgesia.

REFERENCES

TORADOL (KETOROLOAC TROMETHAMINE), Roche Laboratories, Product Literature, December 1994.

PDR, PHYSICIANS’ DESK REFERENCE, EDITION 59, 2005.

My personal experience with Toradol as noted is post-operative osseous (bone) surgery or extensive soft tissue procedures which require significant dissection when post operative pain is anticipated. I have the anesthesiologist administer Toradol after the tourniquet (a pneumatic pressure cut about the ankle) is released and the patient is still in the operating room prior to recovery. When I believe pain, based both on my knowledge of the patient’s pain threshold and extent of surgical involvement, I will use the oral tablets for another 3-4 days, with a acetaminophen/ semi-synthetic codeine derivative oral mediation such at Lorcet (acetaminophen /hydrocodone). I have found this regiment very successful in producing necessary relief for my patients.

ADDITIONAL REFERENCES

Drugs.com

Mayo Clinic

MedlinePlus