Why Would You Not Give Toradol? Understanding the Risks and Contraindications

October 8, 2025 •

3 min read

Ketorolac tromethamine, commonly known as Toradol, is a powerful nonsteroidal anti-inflammatory drug (NSAID) used for short-term management of moderately severe acute pain. However, it carries significant risks and has numerous contraindications, which is why a healthcare provider might decide you would not give Toradol to a patient. Its potency and potential for severe adverse events necessitate careful patient selection and monitoring.

Quick Summary

Toradol is a potent NSAID restricted to short-term use due to serious risks. This article examines the critical reasons for withholding Toradol, focusing on its contraindications related to gastrointestinal, renal, and cardiovascular health, including a strict 5-day usage limit and black box warnings. It also discusses significant drug interactions and specific surgical considerations.

Key Points

Black Box Warnings: The FDA has issued multiple black box warnings for Toradol due to severe cardiovascular, gastrointestinal, and renal risks.
High GI Bleeding Risk: Toradol carries a high risk of causing gastrointestinal bleeding, ulcers, and perforation, especially in the elderly and those with a history of GI issues.
Renal Damage: The medication is contraindicated in patients with advanced kidney impairment and can cause acute kidney injury, particularly in those with pre-existing renal dysfunction or dehydration.
Increased Cardiovascular Events: Toradol increases the risk of serious cardiovascular thrombotic events like heart attack and stroke, and is contraindicated for pain management post-CABG surgery.
Severe Bleeding Risk: It inhibits platelet function and should not be given to patients with a high risk of bleeding, including those with cerebrovascular bleeding or bleeding diathesis.
Strict 5-Day Limit: To minimize risks, the combined duration of oral and injected Toradol should not exceed 5 days.
Pregnancy and Allergic Reactions: It is contraindicated in the third trimester of pregnancy and in patients with a history of allergic reactions to aspirin or other NSAIDs.

Serious Risks and Contraindications

Gastrointestinal (GI) Risks

Toradol can cause severe GI complications, including peptic ulcers, bleeding, and perforation, which can be fatal and may occur without warning. This is due to its inhibition of COX enzymes, reducing protective prostaglandins in the GI tract. Patients with a history of GI issues, the elderly, or those using certain medications like corticosteroids are at higher risk. The risk of GI bleeding is dose-dependent.

Renal (Kidney) Impairment

Toradol can impair kidney function by affecting renal blood flow, particularly in those with pre-existing kidney problems, dehydration, or heart failure. It is contraindicated in patients with advanced renal impairment and can lead to acute kidney injury.

Cardiovascular (CV) Risks

An increased risk of serious cardiovascular events, such as heart attack and stroke, is associated with Toradol use. This risk can increase with the duration of use. It is specifically contraindicated for pain treatment after coronary artery bypass graft (CABG) surgery due to a heightened risk of adverse cardiovascular events.

Bleeding Disorders

Toradol inhibits platelet function, prolonging bleeding time. It is contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, or incomplete hemostasis. Due to bleeding risks, it is not recommended as a prophylactic analgesic before major surgery.

Comparison of Toradol with other NSAIDs


Feature	Toradol (Ketorolac)	Ibuprofen	Naproxen
Potency	Very potent analgesic; often compared to opioids for acute pain.	Less potent than Toradol; useful for mild to moderate pain.	Less potent than Toradol; effective for mild to moderate pain.
Duration of Use	Maximum of 5 days (Oral or IV) due to high risk of adverse events.	Can be used for longer periods, typically weeks to months for chronic conditions.	Can be used for longer periods, though caution is still advised.
GI Risk	High risk of GI bleeding, ulceration, and perforation, especially with longer use.	Moderate risk; lower than Toradol but still significant.	Moderate risk; potentially lower cardiovascular risk than other NSAIDs.
Renal Risk	High risk of renal impairment, especially in at-risk patients.	Moderate risk; caution with long-term use or in patients with kidney issues.	Moderate risk; caution with long-term use or in patients with kidney issues.
Cardiovascular Risk	Increased risk of thrombotic events; contraindicated post-CABG.	Increased risk of thrombotic events, especially with high doses or long-term use.	Increased risk of thrombotic events, especially with high doses or long-term use.

Other Important Considerations

Pregnancy and Breastfeeding

Toradol is generally avoided during pregnancy, especially in the third trimester, due to risks to the fetus. It is also contraindicated during labor, delivery, and in nursing mothers.

Allergic Reactions

Patients with a history of allergic reactions to aspirin or other NSAIDs should not receive Toradol due to the risk of severe anaphylactic-like reactions.

Drug Interactions

Combining Toradol with certain medications can increase risks. Interactions include other NSAIDs or aspirin, anticoagulants, SSRIs, SNRIs, diuretics, ACE Inhibitors, lithium, and methotrexate, which can increase the risk of bleeding, renal impairment, or toxicity.

Conclusion

Toradol is a potent pain reliever but its use is strictly limited by significant risks to the GI, renal, and cardiovascular systems. FDA black box warnings and a 5-day maximum duration highlight these dangers. Careful assessment of patient history, especially regarding bleeding risk, kidney function, and cardiac health, is essential. The decision why would you not give Toradol is primarily based on these serious and potentially life-threatening side effects, prioritizing patient safety.

For more information on NSAID risks, consult the official FDA drug label for ketorolac.

Frequently Asked Questions

The maximum combined duration for both oral and injected Toradol is 5 days in adults. This strict limit is in place due to the increased risk of serious adverse effects, including GI bleeding and renal damage, with longer use.

No, Toradol is strictly contraindicated in patients with a history of peptic ulcer disease or gastrointestinal bleeding. The risk of re-bleeding or perforation is significantly higher in this patient population.

Toradol can compromise kidney function by inhibiting prostaglandins that regulate renal blood flow. In patients with pre-existing kidney disease or risk factors, this can lead to worsened function or acute kidney injury. Therefore, it is contraindicated in advanced renal impairment.

No, Toradol is contraindicated for pain management in the setting of coronary artery bypass graft (CABG) surgery. This is due to an increased risk of serious cardiovascular thrombotic events, including heart attack and stroke.

Taking Toradol with anticoagulants (blood thinners like warfarin) significantly increases the risk of serious and potentially fatal bleeding complications. The combination should be administered with extreme caution, if at all.

Toradol should be avoided during pregnancy, particularly in the first and third trimesters. It poses risks to the developing fetus, including an increased risk of miscarriage and premature closure of the fetal ductus arteriosus.

Patients with a known hypersensitivity to ketorolac, aspirin, or other NSAIDs are at risk for severe, potentially fatal, allergic-type reactions. Therefore, Toradol is contraindicated in these individuals.