Names and pronunciation
(kee-toe′role-ak) Toradol , Sprix
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Drug reference
(kee-toe′role-ak) Toradol , Sprix
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Func. class.: NSAIDs
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Chem. class.: Acetic acid
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Do not confuse: ketorolac/Ketalar, ketoprofen
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ACTION: Inhibits prostaglandin syn- thesis; analgesic antiinflammatory anti- pyretic effects
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USES: Mild to moderate pain (short term), including postsurgery
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CONTRAINDICATIONS: Preg- nancy 3rd trimester, hypersensitivity to this product, salicylates, asthma, hepatic disease, peptic ulcer disease, CV bleed- ing, C-section, intracranial bleeding
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Black Box Warning: Severe renal dis- ease, L&D, before major surgery, epidur- al/intrathecal administration, GI bleed- ing/perforation, hypovolemia, NSAID hypersensitivity, peptic ulcer disease, CABG, hematologic disease, intracranial bleeding Precautions: Pregnancy/breastfeeding, GI/cardiac disorders, hypersensitivity to other antiinflammatory agents, CCr <25 mL/min Black Box Warning: Bleeding, MI, stroke; limit duration of use; geriatric pa- tients, children, infants/neonates, serious hypersensitivity reactions or anaphylaxis Black Box Warning: Aspirin sensitiv- ity, asthma: patients may be more likely to develop hypersensitivity to NSAIDs; K monitor for hypersensitivity • Pain: type, location, intensity, ROM before and 1 hr after treatment, do not use long term or for minor pain Black Box Warning: Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, HB before treatment, periodically thereaf- ter; check for dehydration Black Box Warning: Bleeding: check for bruising, bleeding, occult blood in urine, stool guaiac, can prolong bleed- ing time Black Box Warning: Do not use epidur- ally, intrathecally; alcohol is present in the solution • Eye/ear problems: blurred vision, tin- nitus (may indicate toxicity) • Hepatic dysfunction: jaundice, yellow sclera and skin, clay-colored stools Black Box Warning: CV thrombotic events: MI, stroke; do not use in peri operative pain in CABG • Audiometric, ophthalmic exam be- fore, during, after treatment Black Box Warning: Beers: avoid in old- er adults; increased risk of GI bleeding, peptic ulcer disease; those >65 and 50 kg, adjust dose to CCr, risk is increased; max 60 mg/day Black Box Warning: To report blurred vi- sion, ringing/roaring in ears (may indicate toxicity) • To avoid driving, other hazardous ac- tivities if dizziness or drowsiness occurs Black Box Warning: To report change in urine pattern, weight increase, edema; pain increase in joints, fever, blood in urine (indicates nephrotoxicity); bruising, black tarry stools (indicates bleeding); pruritus, jaundice, nausea, right upper quadrant pain, abdominal pain (hepato- toxicity); to notify prescriber immediately • To report immediately signs of MI, stroke • To maintain hydration • To take with food (PO) • That pain may occur with IM • To avoid alcohol, salicylates, other NSAIDs • To report product use to all health care providers, not to use with other products unless approved by prescriber; use for ≤5 days • Nasal: to discard within 24 hr of opening; may cause irritation, may drink water after dose, to read instructions provided Black Box Warning: Pregnancy/breast- feeding: to notify prescriber if pregnancy is planned or suspected; not to breast- feed; contraindicated during labor and delivery
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SIDE EFFECTS CNS: Dizziness, drowsiness, tremors, seizures, headache CV: Hypertension, pallor, edema, CV thrombotic events, MI, stroke EENT: Tinnitus, hearing loss, blurred vision GI: Nausea, anorexia, vomiting, diarrhea, constipation, flatulence, cramps, dry mouth, peptic ulcer, GI bleeding, perfora- tion, taste change, hepatic failure GU: Nephrotoxicity: dysuria, hematuria, oliguria HEMA: Blood dyscrasias, prolonged bleeding INTEG: Purpura, rash, pruritus, sweat- ing, angioedema, Stevens-Johnson syn- drome, toxic epidermal necrolysis
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INTERACTIONS Increase: toxicity—methotrexate, lith- ium, cycloSPORINE, pentoxifylline, pro- benecid, cidofovir Increase: bleeding risk—anticoagulants, salicylates, tirofiban, thrombolytics, SSRIs, SNRIs Increase: renal impairment—ACE inhibitors, ARBs Increase: GI effects—corticosteroids, alcohol, aspirin, NSAIDs Decrease: effects—antihypertensives, diuretics Drug/Lab Test Increase: AST, ALT, LDH, bleeding time
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DOSAGE AND ROUTES Max 5 combined days of all routes, only use PO as continuation to IV/IM • Adult: IM/IV: Single dose: ≥50 kg 60 mg IM or 30 mg IV once; <50 kg 30 mg IM or 15 mg IV once • Adult: IM/IV: Multiple dose: ≥50 kg 30 mg IM/IV q6hr as needed; max 120 mg/day; Nasal 31.5 mg q6-8hr (1 spray each nostril); <50 kg 15 mg IM/IV q6hr as needed; max 60 mg/day; Nasal 15.75 mg q6-8hr (1 spray in 1 nostril). Continuation therapy (should not be given as an initial dose) • Adult: PO ≥50 kg 20 mg once, then 10 mg q4-6hr as needed; <50 kg: 10 mg, then 10 mg q4-6hr as needed, max 40 mg/day Renal dose • Adults: PO 10 mg, then 10 mg q4-6hr, max 40 mg
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Available forms: Inj 15, 30 mg/mL (prefilled syringes), 60 mg/2 mL; tab 10 mg; nasal spray 15.75 mg/spray
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Administer: • Store at room temperature IM route • IM inj deeply and slowly in large muscle mass, painful Nasal route • Prime pump before using for the first time, point away from person/pets, pump activator 5 times, no need to reprime • For single-use only, discard 24 hr after opening if not used • Do not share with others • Have patient blow nose, sit upright to spray IV route • Give undiluted over ≥15 sec, protect from light
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Assess:
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Evaluate: • Therapeutic response: decreased pain, stiffness, swelling in joints, ability to move more easily
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CLINICAL CONSIDERATIONS
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Patient and caregiver information:
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PHARMACOKINETICS Enters breast milk, metabolized by liver, excreted by kidneys PO: Onset 30-60 min, peak 2-3 hr, dura- tion 4-6 hr, half-life 2-9 hr IM: Onset 30 min, duration 4-6 hr, half- life 5-6 hr IV: Onset 30 min, peak 2-3 hr, duration 4-6 hr
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• Adult: IM/IV: Single dose: ≥50 kg 60 mg IM or 30 mg IV once; <50 kg 30 mg IM or 15 mg IV once
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• Adult: IM/IV: Multiple dose: ≥50 kg 30 mg IM/IV q6hr as needed; max 120 mg/day; Nasal 31.5 mg q6-8hr (1 spray each nostril); <50 kg 15 mg IM/IV q6hr as needed; max 60 mg/day; Nasal 15.75 mg q6-8hr (1 spray in 1 nostril). Continuation therapy (should not be given as an initial dose)
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• Adult: PO ≥50 kg 20 mg once, then 10 mg q4-6hr as needed; <50 kg: 10 mg, then 10 mg q4-6hr as needed, max 40 mg/day Renal dose
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• Adults: PO 10 mg, then 10 mg q4-6hr, max 40 mg
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