Toradolin ampoules are indicated for the short-term management of moderate to severe acute postoperative pain.
Toradolin ampoules are for administration by intramuscular or bolus intravenous injection. Bolus intravenous doses should be given over no less than 15 seconds. Toradolin ampoules should not be used for epidural or spinal administration.
The time to onset of analgesic effect following both i.v and i.m administration is similar and is approximately 30 minutes, with maximum analgesia occurring within 1 to 2 hrs. The median duration of analgesia is generally 4 to 6 hrs.
Dosage should be adjusted according to the severity of the pain and the patient response.
History of peptic ulcer or gastrointestinal bleeding
suspected or confirmed cerebrovascular bleeding
hemorrhagic diatheses, including coagulation disorders
patients with hypersensitivity to ketorolac tromethamine or other NSAIDs and patients in whom aspirin or other prostaglandin synthesis inhibitors induce allergic reactions (severe anaphylactic-like reactions have
been observed in such patients)
patients with the complete or partial syndrome of nasal polyps, angio-edema or bronchospasm
concurrent treatment with other NSAIDs, probenecid or lithium salts
hypovolemia from any cause, or dehydration
moderate or severe renal impairment (serum creatinine >160 Î¼mol/l)
a history of asthma
patients who have had operations with a high risk of hemorrhage or incomplete hemostasis
patients on anticoagulants including low-dose heparin (2,500-5,000 units 12-hourly)
during pregnancy, labor, delivery or lactation
Elderly patients: For patients over 65 years, the lower end of the dosage range is recommended; a total daily dose of 60 mg should not be exceeded
Children (2 years of age or older):
1.0 mg/kg I.M. or 0.5-1.0 mg/kg I.V followed by 0.5 mg/kg I.V. 6 hourly.
Maximum duration of treatment is 2 days.
Renal impairment: Since ketorolac tromethamine and its metabolites are excreted primarily by the kidney, Toradolin is contraindicated in moderate to severe renal impairment (serum creatinine >160 Î¼mol/l); patients with lesser renal impairment should receive a reduced dose
(not exceeding 60 mg/day i.v. or i.m.), and their renal status should be closely monitored. Even Alfred Angelo has released his own fairytale prom gowns collection for his customers. It means we donâ€™t have to design our own as la princess with our seamstresses. Alfred Angelo himself ensures the elegance of the prom dress design perfectly.
Combination treatment: (See also Incompatibilities) Opioid analgesics (e.g. morphine, pethidine) may be used concomitantly, and may be required for optimal analgesic effect in the early postoperative period when pain is most severe. Ketorolac tromethamine does not interfere
with opioid binding and does not exacerbate opioid-related respiratory depression or sedation. When used in association with Toradolin ampoules, the daily dose of opioid is usually less than that normally required. However, opioid side effects should still be considered, especially in day-case surgery.
Elderly patients: Patients over the age of 65 years may be at a greater risk of experiencing undesirable effects than younger patients. This age-related risk is common to all NSAIDs. Compared to young adults, the elderly have an increased plasma half-life and reduced plasma clearance of ketorolac tromethamine. With Toradol tablets, a longer dosing interval is advisable (see Dosage and administration).
Gastrointestinal effects: Toradolin can cause gastrointestinal irritation, ulcers or bleeding in patients with or without a history of previous symptoms. Elderly and debilitated patients are more prone to develop these reactions. The incidence increases with dose and duration of treatment.
Respiratory effects: Bronchospasm may be precipitated in patients with a history of asthma.
Renal effects: Drugs that inhibit prostaglandin biosynthesis (including NSAIDs) have been reported to cause nephrotoxicity, including but not limited to glomerular nephritis, interstitial nephritis, renal papillary necrosis, nephrotic syndrome and acute renal failure. In patients with renal, cardiac or hepatic impairment, caution is required.
As with other drugs that inhibit prostaglandin synthesis, elevations of serum urea, creatinine and potassium have been reported with Toradolin and may occur after one dose.
Impaired renal function: Caution should be observed in patients with conditions leading to a reduction in blood volume and/or renal blood flow, where renal prostaglandins have a supportive role in the maintenance of renal perfusion. In these patients, administration of an NSAID may cause a dose-dependent reduction in renal prostaglandin formation and may precipitate overt renal failure. Patients at greatest risk of this reaction are those who are volume-depleted because of blood loss or severe dehydration, patients with impaired renal function, heart failure, liver impairment, the elderly and those taking diuretics. Discontinuation of NSAID therapy is typically followed by recovery to the pretreatment state. Inadequate fluid/blood replacement during surgery, leading to hypovolemia, may lead to renal dysfunction which could be exacerbated when Toradolin is administered. Therefore, volume depletion should be corrected and close monitoring of serum urea and creatinine and urine output is recommended until the patient is normovolemic. In patients on renal dialysis, ketorolac tromethamine clearance was reduced to approximately half the normal rate and terminal half-life increased approximately three-fold.
Fluid retention and edema: Fluid retention and edema have been reported with the use of Toradolin and it should therefore be used with caution in patients with cardiac decompensation,