Why Can't Toradol (Ketorolac) Be Used For A Long Period Of Time?

In our latest question and answer, the pharmacist discusses why Toradol (ketorolac) shouldn't be used for long periods of time (typically more than 5 days).

Question

Would Ketorolac every be prescribed 60 tablets at a time with no instructions on limiting use? Everything I can find online says it should only be used short term but I was given 60 to use "as needed" for frequent migraines with no other instruction besides not taking it at the same times as another NSAID.

Asked by Shiremaid On Apr 11, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Apr 12, 2018

Long Term Use Of KetorolacKetorolac (brand name Toradol) should not be prescribed as stated in your question (60 pills with no limit on use), even in the most extreme or unique cases, and never in such large quantity. Long term use of ketorolac can be extremely dangerous.


I wouldn't normally advise you not take or stop taking a prescribed medication, but in this case it's very important that you contact your doctor to verify the prescription before starting or continuing to take it.


If your doctor confirms that ketorolac is what was prescribed, then I've provided more information below on the risks of this drug to help you make a decision for yourself.


However, I have a gut feeling that your doctor meant to, or actually did prescribe ketoprofen. Ketoprofen is also an NSAID, is typically dosed twice a day (so 60 tablets = 30 days supply with max use), and is similar to naproxen or ibuprofen in possible side effects.


It may be that your doctor meant to write one thing and wrote another, or someone at the office mixed up the names. It is also possible that the pharmacy entered the prescription incorrectly. I've had interns who mixed up ketoprofen and ketorolac, which is one of the closest look-alike/sound-alike drug pairs there is.


Toradol (Ketorolac)

Ketorolac is a powerful NSAID used only on a short-term basis for controlling moderate-to-severe pain that requires analgesia (pain relief) at the opioid level. It is similar in efficacy to morphine, but doesn't cause respiratory depression like morphine and other opioids tend to.


There is a trade-off though; while all NSAIDs affect and can damage the kidneys to some degree, ketorolac is associated with a higher frequency of serious kidney damage. This risk is especially high in patients who are elderly, dehydrated, diabetic, have preexisting kidney or liver impairment, or taking a number of commonly prescribed medications that also affect the kidneys.


For this reason, ketorolac is usually given intravenously or intramuscularly in a hospital setting, where a patient's kidney function can be monitored. Even then, most practices limit use to less than 5 days of therapy. Oral prescriptions are generally only used to briefly continue a patient who was started on IV ketorolac, again limited to 5 days total.


In fact, the prescribing information for Toradol has a bolded warning right at the beginning of the document that states the following:

"WARNING: Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is indicated for the short-term (up to 5 days in adults), management of moderately severe acute pain that requires analgesia at the opioid level and only as continuation treatment following IV or IM dosing of ketorolac tromethamine, if necessary. 

The total combined duration of use of TORADOL should not exceed 5 days."

Start by contacting your doctor to confirm the script, and if they did prescribe ketorolac, don't be afraid to ask what the rationale is or if they would prescribe another NSAID if you are concerned about taking this one. Good luck, and be well.

About the Pharmacist

Dr. Randall Higgins Pharm.D

Randall is a Doctor of Pharmacy and drug information specialist. His experience as a pharmacist has taken him from retail to specialty infusion and intrathecal pump management. His interests include pain management (particularly non-opioid), substance abuse, addiction and chemical dependency, and drug/non-drug approaches to these areas. He's also extremely interested in finding better ways to provide people with information on complex and often confusing healthcare topics in a way they can understand and relate to.

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