The Core of the Medication: Ketorolac Tromethamine
The active ingredient in a Toradol shot is ketorolac tromethamine, a potent nonsteroidal anti-inflammatory drug (NSAID). It is used for the short-term (no more than 5 days) management of moderately severe acute pain, often after surgery. Ketorolac provides pain relief without the sedative or addictive properties of opioids.
Ketorolac works by inhibiting the cyclo-oxygenase (COX) enzyme system, which includes both COX-1 and COX-2. This blockage reduces the production of prostaglandins, substances that cause pain and inflammation. The S-form of the compound is associated with its pain-relieving effects.
The Inactive Ingredients (Excipients)
Toradol injections also contain inactive ingredients (excipients) that create a sterile solution suitable for intramuscular (IM) or intravenous (IV) administration. These excipients include:
- Ethanol: Serves as a solvent. Due to its presence, the injection should not be used epidurally or intrathecally.
- Sodium Chloride: Helps adjust the solution's tonicity for compatibility with body fluids.
- Sodium Hydroxide and/or Hydrochloric Acid: Used to maintain the solution's pH between 6.9 and 7.9, essential for drug stability.
- Water for Injections: The sterile carrier for the other components.
Comparison with Other NSAIDs
Ketorolac is a more potent NSAID than commonly available options. The table below compares key features of ketorolac, ibuprofen, and naproxen.
| Feature | Ketorolac (Toradol) | Ibuprofen (Advil, Motrin) | Naproxen (Aleve) |
|---|---|---|---|
| Availability | Prescription only | Prescription and OTC | Prescription and OTC |
| Potency | High; used for moderate to severe pain | Moderate; used for mild to moderate pain | Moderate; used for mild to moderate pain |
| Formulations | Injection (IM/IV), oral, nasal spray | Oral, liquid, gel | Oral |
| Duration of Use | Maximum 5 days due to side effect risks | Short-term for OTC; longer-term with prescription | Short-term for OTC; longer-term with prescription |
| Initial Treatment | Often initiated via injection in a medical setting | Typically oral from the start | Typically oral from the start |
| Main Risks | Significant risk of GI bleeding, ulcers, and kidney injury, especially with prolonged use | Similar risks, but generally milder than ketorolac | Similar risks, but generally milder than ketorolac |
Warnings and Important Considerations
Ketorolac has significant warnings and contraindications.
Black Box Warnings
The FDA has issued boxed warnings for ketorolac regarding serious risks.
- Gastrointestinal Risk: Can cause serious and potentially fatal GI bleeding, ulcers, and perforation. Risk increases with dose and duration, hence the 5-day limit.
- Cardiovascular Risk: Like other NSAIDs, ketorolac may increase the risk of serious cardiovascular thrombotic events such as heart attack and stroke, even early in treatment.
Other Contraindications and Precautions
Ketorolac is not suitable for individuals with:
- Advanced kidney impairment.
- Active or history of peptic ulcers or GI bleeding.
- Bleeding or clotting disorders.
- Pregnancy, labor, delivery, or breastfeeding.
- Undergoing coronary artery bypass graft (CABG) surgery.
Combining ketorolac with other NSAIDs or blood thinners increases risks.
Conclusion: A Potent but Short-Term Tool
A Toradol shot is a potent option for managing moderately severe acute pain, such as post-operative pain. Ketorolac tromethamine, its active ingredient, is a powerful NSAID that reduces pain and inflammation by blocking prostaglandin production. Inactive ingredients ensure a stable and safe injectable solution. However, its potency necessitates strict adherence to a maximum 5-day treatment period due to significant risks of gastrointestinal bleeding and cardiovascular events. Therefore, it is used selectively for patients who can benefit from its strong, non-opioid pain relief.
For more detailed prescribing information, refer to the official prescribing information for Ketorolac Tromethamine Injection.
