Toradol (Ketorolac): Warnings, Side Effects, Interactions and Abuse Potential

Ketorolac is a potent non-steroidal anti-inflammatory drug (NSAID) that is prescribed in the short term as an alternative to opioids for treating moderate to severe pain. While the drug can be useful, it carries a risk of side effects that are important to keep in mind if your doctor prescribes the medication.

Article at a Glance:

• Ketorolac (Toradol) is one of the most potent NSAIDs available.
• It is given by injection in the hospital but prescribed as tablets, nasal spray and eye drops at retail pharmacies.
• Toradol should be avoided by those with a history of cardiovascular problems, as it increases the risk of heart attack and stroke.
• A person should remain on ketorolac for no more than five days total to reduce the risk of major side effects.

What Is Toradol?

Toradol is one of the brand names for the NSAID ketorolac. In the United States, ketorolac is available primarily as a generic drug but is also sold under the brand name Sprix. While Toradol used to be a brand name for ketorolac in the United States, it is now only used in Canada. 

Toradol is available by prescription only to treat moderate to severe generalized pain. It is available in several different dosage forms, including:

• Nasal spray (available under the Sprix brand name)
• Oral tablet (available as a generic only)
• Injection (available as a generic and for hospital use only)

Ketorolac is also available as an eye drop to treat eye pain from eye surgeries like cataract removal or corneal surgery. It is available under special brand names like Acular and Acuvail for this purpose.

Warnings and Pre-Existing Conditions

Ketorolac should be avoided or used cautiously, depending on your medical history. Red flags that might lead your doctor to avoid ketorolac include:

• Upcoming or recent surgery, as ketorolac can increase your bleeding risk
• During childbirth, as ketorolac reduces uterine contractions and fetal circulation; however, ketorolac may be given while breastfeeding.
• Serious kidney problems, which ketorolac can worsen
• Stomach and intestinal conditions like peptic ulcer disease, bleeding, or perforations; ketorolac can irritate or worsen these conditions and may lead to more bleeding
• Cardiovascular problems, as NSAIDs like ketorolac are linked to heart attack and stroke
• Older age, as the risk of side effects is increased in those over the age of 75

Toradol (Ketorolac): Interactions and What To Avoid

Some drugs should be completely avoided if you take ketorolac, while others will require more careful monitoring while you are on the drug. Drugs that should be avoided while on ketorolac due to risks of excessive bleeding include:

• Aspirin
• Other NSAIDs, such as ibuprofen or naproxen
• Pentoxifylline, a medication sometimes used to improve blood flow
• Probenecid, a gout medication

Some drugs merely require additional monitoring while you are on ketorolac. You do not necessarily need to stop the medication while you take ketorolac, but you may need additional doctor’s visits or lab work. Medications that require closer monitoring include:

• Certain blood pressure medications, especially those that end in -pril or -artan (such as lisinopril and losartan), as your blood pressure and kidneys may be impacted
• Seizure medications like carbamazepine and phenytoin, as your seizures may not be as well controlled
• Cyclosporine, as your kidney function may worsen
• Digoxin, as the blood levels of this drug may rise
• Diuretics like furosemide or hydrochlorothiazide, as your kidneys may be impacted
• Lithium, as the blood levels of this drug can increase
• Methotrexate, as this drug’s side effects may intensify
• Pemetrexed, as side effects may intensify
• Psychotropic medications, including antidepressants, benzodiazepines and muscle relaxants, as side effects may worsen
• Warfarin, as bleeding risk may increase

You should never stop taking a medication without consulting your doctor or pharmacist. Even if you believe the medication may be interacting with ketorolac, you should first seek medical advice before stopping a drug.

Dosage and How to Take

Ketorolac is one of the most potent NSAIDs available and is often prescribed for severe pain as an alternative to opioids. For this reason, the medication is often started while a person is in the hospital and is given by injection or intravenously.

Following this initial dose in the hospital, a person is often prescribed either the oral tablet form or the nasal spray form. Ketorolac is not a long-term drug, and the total duration of ketorolac therapy should not exceed five days due to the risk of side effects.

Dosage options include:

• Oral tablet: 20 mg once, then 10 mg every four to six hours as needed, up to a max dose of 40 mg per 24 hours. If the person is under 110 pounds, the initial dose should be reduced to 10 mg.
• Nasal spray: One spray in each nostril every six to eight hours as needed, up to a max of four doses daily. If the person is under 110 pounds, they should only use one spray in one nostril.

Although not necessary, ketorolac can be taken with food to reduce the risk of stomach-related side effects.

Toradol (Ketorolac): Side Effects

Ketorolac’s side effects vary depending on whether a person is taking the oral tablet or nasal spray form of the drug.

Common side effects for the nasal spray include:

• Nasal discomfort or stuffy nose
• Runny nose or eyes
• Throat irritation
• Reduced urine output
• Rash
• Slow heartbeat
• Increased blood pressure

Common side effects for the oral tablet include:

• Headache
• Drowsiness
• Dizziness
• Stomach upset or pain
• Nausea
• Diarrhea
• Swelling 

Ketorolac can have additional side effects in less than 1% of people taking the drug. These include:

• Infection
• Fever
• Heart failure
• Hair loss
• Light sensitivity
• Rash
• Dry mouth
• Increased appetite or thirst
• Fertility problems
• Swelling of the lips, tongue or face
• Chest pain
• Heart attack
• Stroke
• Pancreatitis
• Inflammatory bowel disease
• Trouble breathing
• Mood changes
• Blood in the urine or stool

Any side effect should be reported to your doctor as soon as you notice it. This is because ketorolac is a potent NSAID that should only be continued for a maximum of five days. Waiting to report the side effect may cause it to worsen. 

If you experience a side effect like chest pain, left-sided weakness, trouble breathing or stroke symptoms, you should call 911 immediately.

Overdose Messaging

A ketorolac overdose does not resemble what you might think a typical overdose looks like. Instead, taking too much ketorolac can lead to a variety of serious health problems, such as:

• Liver damage
• Kidney damage
• Serious skin rashes
• High blood lithium levels (if you also take the mood drug lithium)

If you or a loved one has taken too much ketorolac, you should immediately seek medical attention. Although the damage from ketorolac might not be immediately obvious, it can be very dangerous to your health.

Toradol (Ketorolac): Potential for Abuse

Ketorolac is not considered a drug of abuse. It is not a controlled substance, and no abuse has been reported in scientific literature. It is because of ketorolac’s potency and lack of abuse potential that the drug is sometimes used in place of an opioid for moderate to severe pain.

Sometimes, people struggling with chronic pain or mental health symptoms may turn to opioids, alcohol or other substances in an attempt to find relief. This can quickly cause an addiction to develop, and once this occurs, it can be difficult to recover on your own. Fortunately, professional rehab treatment can help you overcome substance abuse and learn more effective ways to cope with physical or mental health conditions.

If you or someone you love is struggling with a drug or alcohol addiction, The Recovery Village can help. Contact us today to learn more about addiction treatment programs that can work well for your situation. 

FAQs

What do you need to know before taking Toradol?

Before taking ketorolac, it is important to know that the drug is an extremely potent, prescription-strength NSAID. It should not be continued for more than five days due to the risk of side effects, which range from bleeding risk to heart attack and stroke.

How long does Toradol stay in your system?

Ketorolac has a half-life of up to six hours in most people. Since it takes five half-lives to remove a drug from your body, this means that it takes around 30 hours to remove a dose of ketorolac from your system. However, ketorolac has a half-life in the elderly of around seven hours, meaning it takes about 35 hours to remove a dose from your body. In those with kidney problems, the half-life is about 13.6 hours, meaning that it takes about 68 hours to remove a dose from your system.

How long after Toradol can you take ibuprofen?

You should not take a dose of ibuprofen if ketorolac is still active in your system. While most people clear ketorolac from their bodies in about 30 hours due to its half-life of around six hours, this can vary widely. You should talk to your doctor, who will be able to take your medical history into account and make a more specific recommendation.

How is Toradol most commonly prescribed?

Ketorolac is most commonly prescribed in its oral tablet form, which accounts for more than 57% of all its prescriptions. In 2020, more than one million Americans received a ketorolac prescription.

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more