Toradol (Ketorolac Tromethamine)
Also sold as: Toradol, Ketanov, Ketorol, Ketlur, Kenac
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet 10mg +2
Indications
- Moderate to severe acute pain (post-operative, renal colic, trauma)
- Short-term pain management as opioid-sparing strategy
- Post-operative inflammation (eye drops)
Adult Dosing
Acute pain (IM/IV)
Loading 30-60 mg IM OR 15-30 mg IV; then 15-30 mg IM/IV every 6 hours
MAXIMUM 5 days combined (oral + parenteral). Elderly: 15 mg IM/IV max.
Acute pain (oral — continuation)
10 mg PO every 4-6 hours
Oral only as continuation of IM/IV. Max 40 mg/day oral. Total therapy (IV+oral) ≤5 days.
Renal colic
30 mg IV or 60 mg IM single dose; comparable to opioids for ureteric colic
Pediatric Dosing
NOT for neonates or premature infants. Paediatric use IV/IM only under specialist supervision.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Mild CKD | Use cautiously; reduce dose |
| Moderate-Severe CKD (CrCl < 30) | AVOID — worsens renal function, fluid retention |
Hepatic Adjustment
Use cautiously; reduce dose in hepatic impairment
Pregnancy & Lactation
Pregnancy: Category C
AVOID in 3rd trimester — premature closure of ductus arteriosus, oligohydramnios, impaired renal function. Avoid from 20 weeks onward.
Lactation: Caution
Small amounts in breast milk. Short-term single-dose use generally acceptable.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Other NSAIDs / Aspirin | Increased GI bleeding and renal toxicity — AVOID combinations | Major |
| Anticoagulants (warfarin, heparin) | Increased bleeding risk — monitor closely or avoid | Major |
| ACE inhibitors / ARBs | Acute kidney injury risk | Major |
| Lithium | Reduces lithium clearance — toxicity risk | Major |
| Methotrexate | Reduces MTX clearance — toxicity | Major |
| SSRIs | Additive GI bleeding risk | Moderate |
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Side Effects
Common
- GI discomfort, nausea
- Drowsiness
- Injection site pain (IM)
- Headache
- Dizziness
Serious / Discontinue If
- GI ulceration and bleeding (Black Box — especially >5 days)
- Acute kidney injury (Black Box)
- Cardiovascular events (MI, stroke)
- Surgical site bleeding (platelet inhibition)
- Hypersensitivity/anaphylaxis
Contraindications
- Active peptic ulcer / GI bleed
- CrCl < 30 mL/min or hypovolaemia
- Pre-operative (increased surgical bleeding)
- Pregnancy (especially ≥20 weeks)
- Aspirin-sensitive asthma
- Cerebrovascular bleed
- Concurrent NSAID/aspirin
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Ketanov 10mg | Sun Pharma | 10 tab ₹42 |
| Ketorol 10mg | Dr Reddy's | 10 tab ₹38 |
| Ketlur 30mg/mL | Lupin | Amp ₹35 |
| Toradol 30mg/mL | Roche | Amp ₹85 |
Monitoring Required
- Renal function (BUN, creatinine) — daily if IV use
- GI symptoms
- Blood pressure
- Signs of bleeding
Patient Counseling Points
- Maximum 5 days TOTAL (injections + tablets combined) — strictly follow
- Take oral tablets with food
- Do NOT use with other pain killers (ibuprofen, diclofenac) simultaneously
- Avoid alcohol during therapy
- Report: black tarry stools, stomach pain, decreased urine output
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Clinically reviewed by: Dr. Suresh Pillai, MS (Orthopaedics), Pain Specialist
Last reviewed: 2026-04-01
References
- BNF — Ketorolac
- FDA Ketorolac Black Box Warning
- EAU Urolithiasis Guidelines
- IASP Acute Pain Guidelines