Toradol IV/IM (Oral, Injection)

Ketorolac is used to relieve moderately severe pain, usually pain that happens after surgery or another painful procedure. It is part of a group of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs). Ketorolac is not a narcotic and does not cause addiction. It will not lead to physical or mental dependence, unlike narcotics. However, ketorolac is sometimes used with a narcotic to provide better pain relief than either medicine alone.

Ketorolac can have side effects that can be very dangerous. The chance of having a serious side effect increases with higher doses of ketorolac and with longer treatment. Therefore, ketorolac should not be used for more than 5 days. Before using this medicine, you should talk with your doctor about the benefits and risks of taking it.

Ketorolac is available only with your doctor's prescription.

Taking certain other medicines with ketorolac may increase the risk of side effects. This risk depends on how much of each medicine you take daily and how long you take them together. Therefore, do not take acetaminophen (e.g., Tylenol) with ketorolac for more than a few days unless your medical doctor or dentist tells you otherwise. Also, do not take any of the following medicines with ketorolac unless directed by your medical doctor or dentist, who will monitor your progress:

• Aspirin or other salicylates
• Diclofenac (e.g., Voltaren®)
• Diflunisal (e.g., Dolobid®)
• Etodolac (e.g., Lodine®)
• Fenoprofen (e.g., Nalfon®)
• Floctafenine (e.g., Idarac®)
• Flurbiprofen (e.g., Ansaid®)
• Ibuprofen (e.g., Motrin®)
• Indomethacin (e.g., Indocin®)
• Ketoprofen (e.g., Orudis®)
• Meclofenamate (e.g., Meclomen®)
• Mefenamic acid (e.g., Ponstel®)
• Nabumetone (e.g., Relafen®)
• Naproxen (e.g., Naprosyn®)
• Oxaprozin (e.g., Daypro®)
• Phenylbutazone (e.g., Butazolidin®)
• Piroxicam (e.g., Feldene®)
• Sulindac (e.g., Clinoril®)
• Tenoxicam (e.g., Mobiflex®)
• Tiaprofenic acid (e.g., Surgam®)
• Tolmetin (e.g., Tolectin®)
• Zomepirac (e.g., Zomax®)

Ketorolac may make some people feel dizzy or drowsy. If you experience either of these side effects, do not drive, operate machinery, or do anything else that could be dangerous if you are not alert.

Serious side effects can happen while using this medicine. Sometimes these serious side effects can occur without warning. However, possible warning signs may include swelling of the face, fingers, feet, and/or lower legs; severe stomach pain, black or tarry stools, and/or vomiting blood or material that looks like coffee grounds; unusual weight gain; and/or skin rash. Also, signs of serious heart problems might occur, such as chest pain, tightness in the chest, fast or irregular heartbeat, or unusual flushing or warmth of the skin. Stop taking this medicine and contact your doctor immediately if you notice any of these warning signs.

In deciding to use a medication, the risks of taking the medicine must be weighed against the beneficial it will do. This is a decision you and your physician will make. For this medication, the following should be considered:

Allergies

Inform your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. As well tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies on this medication have been done only in adult patients, and there is no specific information comparing use of ketorolac in children up to 16 years of age with use in other age groups.

Geriatric

Stomach or intestinal issues, swelling of the face, feet, or lower legs, or sudden decrease in the amount of urine may be especially likely to occur in elderly patients, who are typically more sensitive than younger adults to the effects of ketorolac. Also, elderly people are more likely than younger adults to get very sick if the medication causes stomach issues. Studies in older adults have shown that ketorolac stays in the body longer than it does in younger people. Your doctor will consider this when deciding on how much ketorolac should be given for each dose and how often it should be given.

Breast Feeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medicine should be prescribed or you should discontinue breastfeeding while using this medicine.

Interactions with Medications

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are using this medication, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following drugs is not recommended. Your doctor may decide not to treat you with this medicine or change some of the other medications you take.

• Aceclofenac
• Acemetacin
• Amtolmetin Guacil
• Aspirin
• Bromfenac
• Bufexamac
• Celecoxib
• Choline Salicylate
• Clonixin
• Dexibuprofen
• Dexketoprofen
• Diclofenac
• Diflunisal
• Dipyrone
• Droxicam
• Etodolac
• Etofenamate
• Etoricoxib
• Felbinac
• Fenoprofen
• Fepradinol
• Feprazone
• Floctafenine
• Flufenamic Acid
• Flurbiprofen
• Ibuprofen
• Indomethacin
• Ketoprofen
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Morniflumate
• Nabumetone
• Naproxen
• Nepafenac
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Oxaprozin
• Oxyphenbutazone
• Parecoxib
• Pentoxifylline
• Phenylbutazone
• Piketoprofen
• Piroxicam
• Probenecid
• Proglumetacin
• Propyphenazone
• Proquazone
• Rofecoxib
• Salicylic Acid
• Salsalate
• Sodium Salicylate
• Sulfasalazine
• Sulindac
• Tenoxicam
• Tiaprofenic Acid
• Tolfenamic Acid
• Tolmetin
• Valdecoxib

Using this drug with any of the following drugs is typically not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how frequently you use one or both of the medicines.

• Abciximab
• Acenocoumarol
• Amiloride
• Amineptine
• Amitriptyline
• Amitriptylinoxide
• Amoxapine
• Anagrelide
• Apixaban
• Ardeparin
• Argatroban
• Bemetizide
• Bemiparin
• Bendroflumethiazide
• Benzthiazide
• Betamethasone
• Betrixaban
• Bivalirudin
• Budesonide
• Bumetanide
• Cangrelor
• Certoparin
• Chlorothiazide
• Chlorthalidone
• Cilostazol
• Citalopram
• Clomipramine
• Clopamide
• Clopidogrel
• Cortisone
• Cyclopenthiazide
• Cyclosporine
• Cyclothiazide
• Dabigatran Etexilate
• Dalteparin
• Danaparoid
• Deflazacort
• Desipramine
• Desirudin
• Desmopressin
• Desvenlafaxine
• Dexamethasone
• Diazoxide
• Dibenzepin
• Digoxin
• Dipyridamole
• Dothiepin
• Doxepin
• Duloxetine
• Edoxaban
• Emtricitabine
• Enoxaparin
• Eplerenone
• Epoprostenol
• Eptifibatide
• Escitalopram
• Ethacrynic Acid
• Etozolin
• Feverfew
• Fluocortolone
• Fluoxetine
• Fluvoxamine
• Fondaparinux
• Furosemide
• Ginkgo
• Gossypol
• Heparin
• Hydrochlorothiazide
• Hydrocortisone
• Hydroflumethiazide
• Iloprost
• Imipramine
• Indapamide
• Inotersen
• Lepirudin
• Levomilnacipran
• Lithium
• Lofepramine
• Meadowsweet
• Melitracen
• Melphalan
• Methotrexate
• Methyclothiazide
• Methylprednisolone
• Metolazone
• Milnacipran
• Nadroparin
• Nefazodone
• Nortriptyline
• Opipramol
• Paramethasone
• Parnaparin
• Paroxetine
• Pemetrexed
• Pentosan Polysulfate Sodium
• Phenindione
• Phenprocoumon
• Piretanide
• Polythiazide
• Potassium Citrate
• Prasugrel
• Prednisolone
• Prednisone
• Protein C
• Protriptyline
• Quinethazone
• Reviparin
• Rivaroxaban
• Selexipag
• Sertraline
• Sibutramine
• Spironolactone
• Sulfinpyrazone
• Sulodexide
• Tacrolimus
• Tenofovir Alafenamide
• Tenofovir Disoproxil Fumarate
• Tianeptine
• Ticagrelor
• Ticlopidine
• Tinzaparin
• Tirofiban
• Torsemide
• Trazodone
• Treprostinil
• Triamterene
• Trichlormethiazide
• Trimipramine
• Venlafaxine
• Vilazodone
• Vorapaxar
• Vortioxetine
• Warfarin
• Xipamide

Using this drug with any of the following medicines may cause an increased chance of certain side effects, but using both drugs may be the best treatment for you. If both medications are prescribed together, your doctor may change the dose or how often you use one or both of the medications.

• Acebutolol
• Atenolol
• Azilsartan
• Azilsartan Medoxomil
• Benazepril
• Betaxolol
• Bisoprolol
• Candesartan
• Captopril
• Carteolol
• Carvedilol
• Celiprolol
• Enalapril
• Enalaprilat
• Eprosartan
• Esmolol
• Fosinopril
• Irbesartan
• Labetalol
• Levobunolol
• Lisinopril
• Losartan
• Metipranolol
• Metoprolol
• Moexipril
• Nadolol
• Nebivolol
• Olmesartan
• Oxprenolol
• Penbutolol
• Perindopril
• Pindolol
• Propranolol
• Quinapril
• Ramipril
• Sotalol
• Spirapril
• Telmisartan
• Timolol
• Trandolapril
• Valsartan

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medications may additionally cause interactions to occur. Discuss with your healthcare professional the use of your medication with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol abuse or
• Diabetes mellitus (sugar diabetes) or
• Edema (swelling of face, fingers, feet or lower legs caused by too much fluid in the body) or
• Kidney disease or
• Liver disease (serious) or
• Systemic lupus erythematosus (SLE)—The chance of serious side effects may be increased

• Asthma or
• Heart disease or
• High blood pressure—Ketorolac may make your condition worse.

• Bleeding in the brain (history of) or
• Hemophilia or other bleeding issues—Ketorolac may increase the chance of severe bleeding

• Bleeding from the stomach or intestines (history of) or
• Colitis, stomach ulcer, or other stomach or intestinal problems (or history of)—Ketorolac may make stomach or intestinal issues worse. Also, bleeding from the stomach or intestines is more likely to occur during ketorolac therapy in people with these conditions

Along with its needed effects, a medicine may cause some unwanted effects. Not all of these side effects may occur, but if they do, they may require medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

• Swelling of face, fingers, lower legs, ankles, and/or feet
• Unusual weight gain

Less common

• Bruising (not at the place of injection)
• High blood pressure
• Skin rash or itching
• Small, red spots on skin
• Sores, ulcers, or white spots on lips or in mouth

Rare

• Severe abdominal or stomach pain, cramping, or burning
• Bleeding from the rectum or bloody or black, tarry stools
• Bloody or cloudy urine
• Blue lips and fingernails
• Blurred vision or other vision changes
• Burning, red, tender, thick, scaly, or peeling skin
• Chest pain
• Convulsions
• Cough or hoarseness
• Dark urine
• Sudden decrease in the amount of urine
• Fainting
• Fast, irregular, noisy, or troubled breathing
• Fever with severe headache, drowsiness, confusion, and stiff neck or back
• Fever with or without chills or sore throat
• Hallucinations (seeing, hearing, or feeling things that are not there)
• Hearing loss
• Hives
• Increased urination or urinating often
• Light-colored stools
• Loss of appetite
• Low blood pressure
• Mood changes or unusual behavior
• Muscle cramps or pain
• Severe nausea, heartburn, or indigestion
• Nosebleeds
• Pain in lower back and/or side
• Pain, tenderness, or swelling in the upper stomach area
• Painful or difficult urination
• Pale skin
• Puffiness or swelling of the eyelids or eyes
• Ringing or buzzing in ears
• Runny nose
• Severe restlessness
• Shortness of breath
• Swollen or painful glands
• Swollen tongue
• Ongoing thirst
• Tightness in the chest with or without wheezing
• Unusual tiredness or weakness
• Vomiting blood or material that looks like coffee grounds
• Yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Your health care professional may also have ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome, or if you have any questions about them:

More common

• Mild or moderate abdominal or stomach pain
• Bruising at the place of injection
• Diarrhea
• Dizziness
• Drowsiness
• Headache
• Indigestion
• Nausea

Less common or rare

• Bloating or gas
• Burning or pain at the place of injection
• Constipation
• Feeling of fullness in the abdominal or stomach area
• Increased sweating
• Vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Toradol
• Toradol IV/IM

Available Dosage Forms:

• Solution
• Tablet

Therapeutic Class: Analgesic

Pharmacologic Class: NSAID

Chemical Class: Acetic Acid (class)

For patients taking ketorolac tablets:

• To lessen stomach upset, ketorolac tablets should be taken with food (a meal or a snack) or with an antacid.
• Take this medicine with a full glass of water. Also, do not lie down for about 15 to 30 minutes after taking it. This helps to prevent irritation that may lead to trouble in swallowing.

For patients using ketorolac injection:

• Medicines given by injection are sometimes used at home. If you will be using ketorolac at home, your health care professional will teach you how the injections are to be given. You will also have a chance to practice giving injections. Be certain that you understand exactly how the medicine is to be injected.

For safe and effective use of this medicine, do not use more of it, do not use it more often, and do not use it for more than 5 days. Using too much of this medicine increases the chance of unwanted effects, especially in elderly patients.

Ketorolac should be used only when it is ordered by your doctor for treating certain kinds of pain. Because of the risk of serious side effects, do not save any leftover ketorolac for use in the future, and do not share it with other people.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets): For pain: Adults (patients 16 years of age and older)—One 10-milligram (mg) tablet four times a day, four to six hours apart. Some people may be directed to take two tablets for the first dose only. Children up to 16 years of age—Use and dose must be determined by your doctor.
• For injection dosage form: For pain: Adults (patients 16 years of age and older)—15 or 30 mg, injected into a muscle or a vein four times a day, at least 6 hours apart. This amount of medicine may be contained in 1 mL or in one-half (0.5) mL of the injection, depending on the strength. Some people who do not need more than one injection may receive one dose of 60 mg, injected into a muscle. Children up to 16 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Do not refrigerate. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

• How and where is the Toradol injection given?
• Which painkiller should you use?
• How long does ketorolac (Toradol) stay in your system?