What is Toradol Injection?

Toradol injection, generically known as ketorolac tromethamine, is a powerful nonsteroidal anti-inflammatory drug (NSAID) administered via intramuscular (IM) or intravenous (IV) injection. It is primarily used for short-term management of moderate to severe pain in adults, particularly after surgeries. Unlike opioids, it is non-addictive, making it a preferred option in hospital and outpatient settings.

Mechanism of Action

Toradol works by inhibiting the cyclooxygenase (COX) enzymesCOX-1 and COX-2which are responsible for the synthesis of prostaglandins, the chemical messengers that cause inflammation, pain, and fever. By blocking these enzymes, Toradol provides fast-acting and significant pain relief.

Key Indications of Toradol Injection

Toradol is widely administered in clinical settings for:

• Postoperative pain management
  
  

• Renal colic (kidney stones)
  
  

• Musculoskeletal pain
  
  

• Migraines
  
  

• Dental surgery pain
  
  

• Cancer-related pain (short-term)
  
  

Its opioid-sparing effect allows physicians to reduce the need for narcotics, minimizing side effects such as respiratory depression or sedation.

Dosage Guidelines

Dosage and duration of Toradol must be carefully managed due to potential side effects and toxicity risks.

Adult Dosage:

• IM administration: 60 mg as a single dose or 30 mg every 6 hours. Maximum daily dose: 120 mg.
  
  

• IV administration: 30 mg as a single dose or every 6 hours. Maximum daily dose: 120 mg.
  
  

Geriatric and Renally Impaired Patients:

• IM/IV dose: 15 mg every 6 hours. Maximum daily dose: 60 mg.
  
  

Toradol should not be used for more than 5 days in any form, as prolonged use increases the risk of renal damage, gastrointestinal bleeding, and cardiovascular complications.

Contraindications and Warnings

Despite its benefits, Toradol is not suitable for everyone. It is strictly contraindicated in:

• Patients with active peptic ulcer or gastrointestinal bleeding
  
  

• Individuals with advanced renal impairment
  
  

• People with known hypersensitivity to NSAIDs
  
  

• During labor and delivery
  
  

• Children under 17 years of age
  
  

• Concomitant use with other NSAIDs or anticoagulants
  
  

Caution must be exercised in patients with cardiovascular disease, hypertension, asthma, or hepatic dysfunction.

Common Side Effects

Toradol, while effective, comes with a profile of potential side effects, especially if not used within the recommended time frame.

Gastrointestinal:

• Nausea
  
  

• Dyspepsia
  
  

• Abdominal pain
  
  

• Gastrointestinal bleeding (in serious cases)
  
  

Renal:

• Increased serum creatinine
  
  

• Renal failure (especially in dehydrated or elderly patients)
  
  

Cardiovascular:

• Hypertension
  
  

• Edema
  
  

• Increased risk of heart attack and stroke with prolonged use
  
  

Others:

• Headache
  
  

• Dizziness
  
  

• Injection site pain
  
  

• Elevated liver enzymes
  
  

Drug Interactions

Toradol can interact with a range of medications, which may increase the risk of side effects or reduce efficacy.

• Anticoagulants and antiplatelet agents (e.g., warfarin, aspirin): Increased bleeding risk
  
  

• ACE inhibitors or ARBs: Reduced renal function
  
  

• Diuretics: Decreased efficacy and potential renal impairment
  
  

• SSRIs/SNRIs: Increased gastrointestinal bleeding risk
  
  

• Methotrexate and lithium: Increased serum levels and toxicity
  
  

Close monitoring or dosage adjustments may be required if used concurrently with any of the above.

Administration Tips

• For intramuscular injection, choose a large muscle mass (e.g., gluteus) and administer deeply.
  
  

• For intravenous use, infuse over at least 15 seconds to reduce vein irritation.
  
  

• Rotate injection sites to minimize localized reactions.
  
  

Toradol Injection vs. Oral NSAIDs

Toradol injection is significantly more potent and faster-acting than oral NSAIDs like ibuprofen or naproxen. Its parenteral route bypasses the gastrointestinal system, offering superior efficacy in acute pain, especially where patients are NPO (nothing by mouth) or experiencing nausea.

Use in Emergency Settings

In emergency rooms, Toradol is frequently used for:

• Renal colic
  
  

• Severe musculoskeletal pain
  
  

• Post-injury inflammation
  
  

• Migraines resistant to oral treatments
  
  

Its opioid-sparing capability makes it essential in multi-modal pain management protocols, often combined with acetaminophen or local anesthetics.

Storage and Stability

• Store at controlled room temperature (20C to 25C / 68F to 77F)
  
  

• Do not freeze
  
  

• Keep away from light and moisture
  
  

• Use immediately once the vial is opened, and discard any unused portion
  
  

Special Populations

Pregnancy and Lactation:

• Category C (prior to 30 weeks gestation), Category D (after 30 weeks)
  
  

• Avoid during the third trimester due to risk of premature closure of the ductus arteriosus
  
  

Pediatric Use:

• Not approved for children under 17
  
  

• Severe adverse reactions have been reported with off-label pediatric use
  
  

When to Seek Immediate Medical Attention

Seek urgent care if you notice:

• Black, tarry stools or vomiting blood
  
  

• Swelling of the face, lips, or throat
  
  

• Shortness of breath
  
  

• Signs of kidney failure (little to no urine, swelling in legs)
  
  

• Unusual bruising or bleeding
  
  

Conclusion

Toradol injection remains a cornerstone in acute pain management, delivering powerful, non-opioid relief when administered with care and precision. While its benefits are significant, the strict limitations on duration, dosage, and patient selection must be followed to minimize risks. For healthcare professionals and informed patients, Toradol is a safe and effective tool when used judiciously.