Toradol

The usual adult dose of Toradol (Ketorolac) when taken by mouth is 10 mg every 4 to 6 hours as required for pain. Taking more than 40 mg daily is not recommended. Take Toradol (Ketorolac) with meals or a snack to reduce stomach upset. After you have taken the medication, remain sitting or standing upright for 15 to 30 minutes to further reduce acid from the stomach irritating the throat.

The medication should be used for a maximum of 5 days for treatment of pain after surgery and for a maximum of 7 days when treating pain due to an injury. The lowest dose required to control the pain should be used. Toradol (Ketorolac) usually starts to work within an hour, but for some people, it may take up to a day to start working. If you don't notice improvement in your pain, contact your doctor. Toradol (Ketorolac) should be used for the shortest time period possible.

Toradol (Ketorolac) is also available for use in the hospital as an injectable medication. The usual recommended dose is 10 mg to 30 mg injected into a muscle for no more than 2 days.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to use Toradol (Ketorolac) exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Toradol (Ketorolac) at room temperature, protect it from light, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause headaches; it may cause diarrhea; it may cause indigestion; it may increase your blood pressure; it may cause nausea or, rarely, vomiting; it may cause drowsiness - use caution when driving. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Injection
Each mL of clear, slightly yellow, sterile solution contains 10 mg of Toradol (Ketorolac) tromethamine. Nonmedicinal ingredients: alcohol 10% w/v and sodium chloride in sterile water. The pH is adjusted with sodium hydroxide or hydrochloric acid.

Do not use Toradol (Ketorolac) if you:

• are allergic to Toradol (Ketorolac) or any ingredients of Toradol (Ketorolac)
• are allergic to Asa or other anti-inflammatory medications (e.g., Ibuprofen, Naproxen, Diclofenac) or have had allergic symptoms (e.g., runny nose, nasal polyps, Asthma, itchy skin rash) caused by these medications
• are currently taking other NSAIDs (e.g., ibuprofen, naproxen, diclofenac)
• are in the third trimester of pregnancy
• are in labour or delivery
• are breast-feeding
• are scheduled for surgery in the immediate future or have just had surgery
• are taking probenecid
• are taking oxpentifylline
• have a stomach or intestinal ulcer or a history of recurring ulcers
• have an inflammatory bowel disease (e.g., Ulcerative Colitis, Crohn's Disease)
• have bleeding disorders or bleeding in the brain
• have just had coronary artery bypass graft (CABG) surgery
• have severe, uncontrolled heart failure
• have high levels of potassium in the blood
• have severely reduced liver function or liver disease
• have reduced kidney function or are at risk of kidney failure

There may be an interaction between Toradol (Ketorolac) and any of the following:

• acetylsalicylic acid (ASA)
• alcohol
• Aliskiren
• alteplase
• aminoglycoside antibiotics (e.g., Amikacin, gentamicin, tobramycin)
• angiotensin converting enzyme inhibitors (ACEIs; Captopril, enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candasartan, Irbesartan, Losartan)
• Apixaban
• beta-blockers (e.g., atenolol, metoprolol)
• Bimatoprost
• bisphosphonates (e.g., Alendronate, etidronate)
• Clopidogrel
• Colesevelam
• Colestipol
• corticosteroids (e.g., Dexamethasone, Hydrocortisone, Prednisone)
• Cyclosporine
• dabigatran
• Dasatinib
• Deferasirox
• Desmopressin
• Digoxin
• Dipyridamole
• diuretics (water pills; e.g., Spironolactone, furosemide, hydrochlorothiazide)
• Edoxaban
• Eplerenone
• glucosamine
• Haloperidol
• Heparin
• herbal products that affect blood clotting (e.g., cat's claw, chamomile, fenugreek, evening primrose, feverfew, garlic, ginger, ginseng, turmeric)
• Hydralazine
• Latanoprost
• lithium
• low molecular weight heparins (e.g., Dalteparin, Enoxaparin, Tinzaparin)
• Mesalamine
• Methotrexate
• multivitamins
• other non-steroidal anti-inflammatory medications (NSAIDs; e.g., naproxen, diclofenac, ibuprofen)
• omega-3 fatty acids
• Pemetrexed
• Pentoxifylline
• potassium supplements
• Prasugrel
• probenecid
• quinolone antibiotics (e.g., ciprofloxacin, Norfloxacin, Ofloxacin)
• Rivaroxaban
• selective serotonin reuptake inhibitors (SSRIs; e.g., Paroxetine, Citalopram, Escitalopram)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• sodium phosphates
• Sulfasalazine
• Tacrolimus
• tenofovir
• Ticagrelor
• Ticlopidine
• tipranavir
• tricyclic antidepressants (e.g., Amitriptyline, Clomipramine, Desipramine, Trimipramine)
• vancomycin
• vitamin E
• Warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Toradol (Ketorolac). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Toradol (Ketorolac).

HEALTH CANADA ADVISORY

June 8, 2021

Health Canada has issued new information concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs). To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

A previous advisory on non-steroidal anti-inflammatory drugs (NSAIDs) was issued on October 30, 2020.

Allergic reactions: If you have had a reaction to acetylsalicylic acid (ASA) or other NSAIDs (e.g., ibuprofen, Ketoprofen, diclofenac) that included a runny nose, itchy skin rash, nasal polyps, or shortness of breath and wheezing, you should not take Toradol (Ketorolac). Get immediate medical attention if you experience symptoms of a severe allergic reaction (e.g., hives, difficulty breathing, wheezing, or swelling of the face, tongue, or throat).

Bladder symptoms: Toradol (Ketorolac) can cause bladder symptoms such as frequent or painful urination and blood in urine. If you develop these symptoms, stop taking Toradol (Ketorolac) and contact your doctor immediately.

Bleeding: Toradol (Ketorolac) may cause the platelets in the blood to not stick together very well. This can make it difficult to stop cuts from bleeding. If you have a condition where your blood does not clot easily, or if you are taking medications to prevent your blood from clotting, discuss with your doctor how Toradol (Ketorolac) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Toradol (Ketorolac), and whether any special monitoring is needed.

If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.

Blood pressure: Like other NSAIDs, Toradol (Ketorolac) can cause increased blood pressure, which may contribute to other heart conditions. If you have high blood pressure, discuss with your doctor how Toradol (Ketorolac) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Toradol (Ketorolac), and whether any special monitoring is needed.

Drowsiness and dizziness: Toradol (Ketorolac) can cause drowsiness or dizziness. Do not drive or operate machinery until you are sure that Toradol (Ketorolac) does not affect your ability to do these safely.

Fertility: As with other NSAIDs, Toradol (Ketorolac) may make it more difficult for a couple to conceive if the woman is taking Toradol (Ketorolac). Stopping the medication allows the body's chemistry to return to normal which often resolves this issue.

Heart conditions: Toradol (Ketorolac) can cause fluid retention, which will make symptoms of certain heart conditions worse. If you have heart failure, high blood pressure, or other medical conditions that increase your risk of fluid retention (e.g., kidney problems), discuss with your doctor how Toradol (Ketorolac) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Toradol (Ketorolac), and whether any special monitoring is needed.

Heart problems: Like other NSAID medications, Toradol (Ketorolac) may increase the risk of heart attacks, strokes, and Blood Clots. If you have any risk factors for heart problems, such as high blood pressure, High Cholesterol, Diabetes, peripheral arterial disease, heart failure, or Coronary Artery Disease, discuss with your doctor how Toradol (Ketorolac) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Toradol (Ketorolac), and whether any special monitoring is needed.

Infection: Toradol (Ketorolac) may mask signs of infection such as fever or muscle aches. If you notice other symptoms of infection (e.g., painful or frequent urination, sore throat, cough), contact your doctor.

Kidney function: Kidney Disease or reduced kidney function may cause Toradol (Ketorolac) to build up in the body, causing side effects. Toradol (Ketorolac) can also affect kidney function. You have a higher risk of developing kidney problems if you are a senior, take diuretics (water pills; e.g., Hydrochlorothiazide, Furosemide), or already have kidney disease, liver disease, or heart failure. Your doctor may monitor your kidney function with blood tests if you take Toradol (Ketorolac).

Liver function: Toradol (Ketorolac) may affect your liver function or cause liver problems. If you experience symptoms of liver problems (e.g., nausea, vomiting, feeling tired, yellowing of the skin or eyes), contact your doctor immediately. If you have liver problems, discuss with your doctor how Toradol (Ketorolac) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Toradol (Ketorolac), and whether any special monitoring is needed. People with severely reduced liver function or have active liver disease should not take Toradol (Ketorolac).

Long-term use: Long-term use of Toradol (Ketorolac) (beyond 5 to 7 days for the tablets, or 2 days for the injection) is not recommended, as the risk of side effects increases with the length of treatment.

Potassium levels: Toradol (Ketorolac) may cause high blood potassium levels. If you are a senior, have diabetes or kidney failure, or are taking beta-blockers (e.g., Metoprolol, Atenolol), angiotensin converting enzyme (ACE) inhibitors (e.g., Ramipril, Enalapril), or some diuretics (e.g., triamterene, Amiloride), you are more at risk of high blood potassium. Because extremely high blood potassium levels can contribute to other conditions, such as heart problems, your doctor will monitor your potassium level with blood tests while you are taking Toradol (Ketorolac).

Ulcers and bleeding in the stomach and intestines: Toradol (Ketorolac) may cause stomach ulcers and bleeding from the stomach. These complications can occur at any time and are sometimes severe.

If you have had a stomach or intestinal ulcer, diverticulosis, Crohn's disease, or ulcerative colitis, discuss with your doctor how Toradol (Ketorolac) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Toradol (Ketorolac), and whether any special monitoring is needed.

If you experience symptoms of an ulcer or other stomach problems (e.g., stomach or abdominal pain, black stools, bloody or coffee-ground-like vomit, weakness) contact your doctor immediately or get immediate medical attention.

Pregnancy: Toradol (Ketorolac) should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Toradol (Ketorolac), contact your doctor immediately. It must not be used during the last 3 months of pregnancy as it may cause heart and kidney problems for the developing baby and cause prolonged labour with excessive bleeding during delivery.

Breast-feeding: Toradol (Ketorolac) passes into breast milk. If you are a breast-feeding mother and are taking Toradol (Ketorolac), it may affect your baby. Breast-feeding is not recommended while you are taking Toradol (Ketorolac).

Children: The safety and effectiveness of using Toradol (Ketorolac) have not been established for children less than 18 years of age.

Seniors: Seniors have a higher risk of side effects with Toradol (Ketorolac). If you are a senior, your doctor will closely monitor you for side effects and may prescribe a lower dose than usually recommended.

This medication is typically used 4 times a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Generally, it is used only as needed. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication may irritate the stomach, and should be taken with food. It is best to avoid coffee, spicy food or alcohol.