You don’t Google pain meds when you feel fine. If you’re here, you or someone you love is hurting and a clinician mentioned Toradol. You want the straight story: what it is, when it’s the right call, how to use it without getting into trouble, and what to do if it’s not a fit.
I live in Dunedin with my kid, and I’ve seen Toradol used in the ED for kidney stone pain and after tough dental work-fast relief, short course, zero fluff. But it’s not a “take whenever” pill. It can save the day for the right patient and be risky for the wrong one. Here’s the no-nonsense version.
TL;DR:
- Toradol (ketorolac) is a powerful NSAID for short-term, moderate to severe pain-often after surgery, kidney stones, or severe dental pain. It’s not for chronic or minor aches.
- Use for a maximum of 5 days across all forms (tablets, IV, IM). Oral: 10 mg every 4-6 hours, max 40 mg/day. IV/IM: 10-30 mg every 6 hours; lower doses if 65+, lighter weight, or kidney issues.
- Don’t combine with other NSAIDs (ibuprofen, naproxen, diclofenac) or aspirin for pain. Paracetamol (acetaminophen) is usually okay.
- Skip it if pregnant (especially after 20 weeks), have ulcers/bleeding, severe kidney disease, uncontrolled heart disease, or a history of asthma reactions to NSAIDs.
- Get help now for chest pain, black stools, vomiting blood, fainting, or sharply reduced urine. In NZ, ketorolac is prescription-only and often given in hospital settings.
What Toradol Is, What It Treats, and How It Works
Toradol is the brand name for ketorolac trometamol, a non-steroidal anti-inflammatory drug (NSAID). It blocks COX enzymes that make prostaglandins-the chemicals that dial up pain, swelling, and fever. In plain terms: it turns down the pain signal and the inflammation that fuels it.
Why clinicians reach for it: it can hit pain fast, often as hard as a mild opioid, without the respiratory depression or dependence risks that come with opioids. That makes it useful for short, intense pain flares.
Common real-world uses I see in New Zealand:
- Post-operative pain when you need something stronger than ibuprofen but want to avoid opioids.
- Renal colic (kidney stones) in ED/urgent care settings.
- Severe dental pain, like after extraction or root canal, for a very short course.
- Migraines treated in ED with IM/IV ketorolac when triptans fail or aren’t suitable.
What it’s not for:
- Chronic pain (back pain that’s been going on for months, arthritis long term) - risks outweigh benefits.
- Minor aches you’d treat with paracetamol or a standard ibuprofen dose.
- Prophylaxis or around heart bypass surgery.
Onset and duration by route:
- IV: often starts working within 10-15 minutes; peak around 1-2 hours.
- IM: relief in 30-60 minutes; similar peak.
- Oral: relief in about 30-60 minutes; peak around 2 hours.
Availability in NZ: ketorolac is prescription-only and most commonly given in hospitals or clinics. Tablets exist but are usually prescribed to step down from an injection for a very short time. There’s no OTC version here.
Evidence snapshot: The FDA label carries strong warnings about bleeding, kidney, and heart risks; the Medsafe NZ data sheet echoes the 5-day maximum and key contraindications. Cochrane reviews and ED guidelines back ketorolac for certain acute pain scenarios (e.g., renal colic, migraine) because it lowers pain and opioid use when used correctly.
Dosing, Routes, and How to Use It Safely (NZ-focused)
Use the lowest effective dose, for the shortest possible time, and never past 5 days total across all forms. That 5-day cap isn’t negotiable; it’s about safety, not stinginess.
Typical adult dosing:
- Oral tablets: 10 mg every 4-6 hours as needed (max 40 mg/day). Some clinicians start with 10-20 mg once, then 10 mg going forward.
- IV or IM: 10-30 mg every 6 hours as needed. Total daily max depends on age, body weight, and kidney function:
- Adults under 65 with good kidneys and weight ≥50 kg: up to 120 mg/day.
- Adults 65+, under 50 kg, or with mild renal impairment: max 60 mg/day.
Transitions: You might get an injection first (say in ED) and then a short oral course to finish out up to the 5-day limit. The clock starts with the first dose, not the first tablet.
Food or no food? You can take tablets with food if your stomach is touchy. It won’t block absorption meaningfully, but it may reduce nausea.
Hydration matters: Stay well hydrated. NSAIDs can reduce kidney blood flow, and dehydration makes that worse. I always carry a bottle and set a phone nudge-simple, but it helps.
Missed “dose”? This is as-needed. If pain returns after the minimum interval (usually 4-6 hours for tablets, 6 hours for injections), take the next dose if you still need it and you’re within the daily limit. Don’t double up to “catch up.”
Driving and work: Toradol doesn’t sedate like opioids, but pain itself can impair attention. If you feel lightheaded or unwell, don’t drive or operate machinery.
Pediatric use: In NZ community settings, ketorolac isn’t used routinely in children. Hospitals may use IV/IM ketorolac in specific circumstances with specialist dosing. Don’t give it to kids unless a clinician has prescribed it for them.
Source sanity check: Dosing and limits align with Medsafe NZ ketorolac data sheets, NZ Formulary (2025), and the FDA label.
Risks, Side Effects, and Who Should Avoid It
Toradol carries the same class risks as other NSAIDs-but it hits harder, so the guardrails are tighter. Here’s the plain-English version of the major warnings.
Big-ticket risks (seek help urgently if you hit these):
- Stomach/intestinal bleeding or ulcers: black stools, vomit that looks like coffee grounds, severe stomach pain.
- Kidney injury: peeing much less, swelling in legs or around eyes, sudden fatigue.
- Heart and circulation: chest pain, shortness of breath, weakness on one side, slurred speech.
- Allergic reactions: wheeze, face or throat swelling, hives-especially if you’ve had aspirin-sensitive asthma.
Common side effects:
- Stomach upset, heartburn, mild nausea.
- Dizziness, headache.
- Fluid retention or mild rise in blood pressure.
Who should give it a miss (or use only with specialist advice):
- Active or recent stomach/duodenal ulcers, GI bleeding, or inflammatory bowel disease flare.
- Severe kidney disease or dehydration; past kidney injury from NSAIDs.
- Uncontrolled heart failure, recent heart attack, significant cardiovascular disease, or right after coronary artery bypass surgery.
- Bleeding disorders, low platelets, or high bleeding risk surgeries.
- History of asthma, nasal polyps, or hives triggered by aspirin/NSAIDs.
- Pregnancy: avoid from 20 weeks onward due to fetal kidney and amniotic fluid risks; absolutely avoid in the third trimester (ductus arteriosus closure). Earlier in pregnancy is also risky without clear clinical justification.
- Breastfeeding: after a single dose, milk levels are low, but labels vary; many hospitals avoid ongoing ketorolac during breastfeeding, especially for newborns. If you’re lactating, ask your clinician for a safer plan (often paracetamol ± ibuprofen or diclofenac instead).
- Liver disease with coagulopathy.
Why the five-day maximum exists: risk climbs with time-the longer and higher the dose, the more chance of a bleeding ulcer, heart event, or kidney injury. Studies and post-marketing data convinced regulators (FDA, Medsafe) to set that hard stop.
Practical stomach protection: If you’re older than 65, on steroids, on SSRIs/SNRIs, or have a past ulcer, your doctor may co-prescribe a PPI (like omeprazole) while you’re on ketorolac. That’s not a free pass for long use-just a way to reduce stomach harm during the brief window.
Evidence backbone: Warnings mirror the FDA boxed warnings and Medsafe data sheets. Meta-analyses in journals like BMJ and The Lancet show elevated GI and cardiovascular risks across NSAIDs, with dose and duration being the big drivers.
Interactions, Combinations, and Smart Pain Plans
Some mixes are safe; some are landmines. Here’s the quick map.
Never combine with:
- Other NSAIDs: ibuprofen, naproxen, diclofenac, aspirin for pain-stacked GI bleeding risk without extra pain relief.
- Probenecid: it spikes ketorolac levels and is contraindicated.
Usually avoid or use only with specialist oversight:
- Anticoagulants/antiplatelets: warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel-bleeding risk jumps.
- SSRIs/SNRIs: sertraline, fluoxetine, venlafaxine-additive GI bleeding risk; consider PPI cover if the benefit is worth it.
- Systemic steroids: prednisone, dexamethasone-more GI risk.
- ACE inhibitors/ARBs and diuretics: enalapril, losartan, hydrochlorothiazide-the “triple whammy” with an NSAID can crash kidney function, especially if dehydrated.
- Lithium: ketorolac can raise lithium levels-monitor or avoid.
- Methotrexate: higher toxicity risk-avoid on high doses; caution even on low weekly doses.
- Cyclosporine or tacrolimus: increased kidney toxicity risk.
Usually safe to combine:
- Paracetamol (acetaminophen): different mechanism, no added bleeding risk; this is the go-to combo if you need more pain control without going to opioids.
- Topical NSAIDs (like diclofenac gel) are still systemic to a degree; during ketorolac use, I treat them as NSAIDs and avoid stacking.
Alcohol: skip it. Alcohol plus ketorolac raises GI bleeding risk and dizziness. Give your stomach a break while you’re on it.
Choosing Toradol vs other options-simple heuristics:
- Short, intense pain with inflammation (post-op day 1-3, renal colic): ketorolac can be a great short stint if you’re low risk.
- Everyday sprains or low back pain: try paracetamol first, then a standard NSAID like ibuprofen with stomach precautions if needed.
- History of ulcers, GI bleed, or on blood thinners: avoid ketorolac; paracetamol ± non-NSAID options are safer. Ask about nerve blocks or local anesthetic strategies for dental/surgical pain.
- Known kidney disease or dehydrated (gastro bug, heatwave, endurance event): avoid ketorolac and other NSAIDs until you’re well hydrated and cleared by your clinician.
- Postpartum/breastfeeding: many NZ services prefer paracetamol ± ibuprofen or diclofenac; ketorolac may be used once in hospital but is usually not sent home during breastfeeding, especially with newborns.
Alternatives worth asking about in NZ:
- Paracetamol: baseline analgesic, gentle on the stomach and kidneys at standard doses.
- Ibuprofen or naproxen: for moderate inflammatory pain if you’re low risk and need more than paracetamol.
- Diclofenac: potent, but keep an eye on cardiovascular risk-use the lowest effective dose for the shortest time.
- Local options: dental nerve blocks, local anesthetic gels, steroid injections for joint flares.
- Short opioid course (e.g., codeine, tramadol, oxycodone) only if non-opioids fail and risks are managed-expect tight limits and a clear stop date.
Decision rule I use as a parent and patient: if an NSAID is the right tool and the pain is severe and time-limited, ketorolac is a strong but short hammer. If the pain might linger or you’ve got bleeding/kidney risks, step down to a gentler plan.
References behind the curtain: Medsafe ketorolac data sheet (NZ), FDA prescribing information, NZ Formulary (2025), Cochrane and ED guidelines for renal colic and migraine, LactMed for breastfeeding considerations, and large NSAID safety meta-analyses in BMJ and The Lancet.
Quick Tools: Checklists, Cheat Sheets, and FAQs
Use these to sanity-check your plan in 60 seconds.
Safe-use checklist before your first dose:
- Do I actually need a heavy-duty NSAID, or would paracetamol/ibuprofen do? (Ask your clinician.)
- Any past ulcers, GI bleeds, or aspirin/NSAID reactions? If yes, do not start.
- Pregnant or possibly pregnant? Avoid. Breastfeeding a newborn? Ask for alternatives.
- On blood thinners, SSRIs/SNRIs, steroids, ACE inhibitor/ARB + diuretic, lithium, or methotrexate? Check with your prescriber first.
- Dehydrated from vomiting/diarrhoea or long exercise? Rehydrate and reconsider.
- Have I set a hard stop date within 5 days? Put it in your calendar.
Dose cheat sheet (adults):
- Tablets: 10 mg every 4-6 hours as needed; max 40 mg/day; stop by day 5 (including any injections you already had).
- Injections (in hospital/clinic): 10-30 mg every 6 hours; max 120 mg/day if under 65 and ≥50 kg; otherwise max 60 mg/day.
Red flags that need urgent care:
- Black or bloody stools, vomiting blood, severe stomach pain.
- Sudden drop in urine output, swelling, or shortness of breath.
- Chest pain, severe headache, one-sided weakness, trouble speaking.
- Wheeze, facial swelling, or hives after a dose.
Mini-FAQ
- Is it safe to take Toradol with paracetamol? Yes-different mechanisms and no added bleeding risk. That’s the standard safe combo.
- Can I drink alcohol on it? Best not. Alcohol increases GI bleeding and dizziness during NSAID use.
- How fast will it work? IV 10-15 minutes; IM 30-60 minutes; oral 30-60 minutes, with peak around 1-2 hours.
- Can I take it for a week if the pain persists? No. The 5-day limit is strict. If you still hurt, you need a reassessment and a different plan.
- Migraine help? Many EDs use IM/IV ketorolac as part of a migraine cocktail. For home use, tablets are less predictable; discuss a migraine-specific plan (triptans, anti-nausea meds).
- Dental pain? Good for short-term severe pain after extraction when prescribed-pair with paracetamol. Don’t mix with ibuprofen or aspirin.
- Is it okay while breastfeeding? A single dose often results in low milk levels, but ongoing use is usually avoided, especially with newborns. Ask for a tailored plan.
- Not working? Check timing (give it 30-60 minutes), hydration, and consider adding paracetamol if allowed. If pain stays high, call your clinician.
- Kidney stones: better than opioids? Often, yes-ketorolac reduces ureteral spasm and inflammation. Many ED protocols prefer it first-line if you’re low risk.
Next steps / Troubleshooting
- If you’re low risk and were prescribed ketorolac: set a 5-day stop, avoid other NSAIDs, add paracetamol if needed, and hydrate. If pain isn’t improving after 24-48 hours, check back in.
- If you have GI, kidney, or heart risk factors: ask about a paracetamol-first plan, stomach protection, topical options, or local anesthesia techniques. You may still get a single ketorolac dose in hospital, but repeated dosing likely isn’t for you.
- If you’re pregnant or trying: avoid ketorolac and other NSAIDs from 20 weeks on; use paracetamol and obstetric-approved options.
- If you’re breastfeeding: ask for a plan centered on paracetamol ± ibuprofen/diclofenac, with clear dose and duration. If you received a single ketorolac dose in hospital, ask whether to time feeds or pump/discard for a brief window based on your baby’s age and health.
- If you’re on blood thinners or SSRIs/SNRIs: talk to your prescriber before any NSAID. You might need a different pain strategy.
- If pain keeps spiking: you may need imaging, dental review, or a nerve block-not just more pills. Persistent pain is a signal, not a challenge to out-tough.
Final note from the trenches in Dunedin: used right, ketorolac can be a brilliant short bridge over a painful few days. Used casually, it bites. Keep it short, keep it separate from other NSAIDs, and keep your clinician in the loop if anything feels off.
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