The Roche Ketorolac Package insert for Toradol tablets and the ketorolac package inserts from generic manufacturers state that ketorolac is contraindicated in advanced renal impairment, but the degree of renal dysfunction is not specified (i.e. moderate or severe), and specific values for serum creatinine or creatinine clearance are not given. Hospira Medical Information states that the package insert only states “advanced renal failure” as a contraindication, and the degree of renal dysfunction (i.e. moderate or severe) is left to the discretion of the clinician. Drug references such as the Lexicomp Drug Information Handbook and others interpret this as meaning that ketorolac is only contraindicated in severe renal failure, and can be dosed in moderate renal failure at the reduced dose of IV or IM 15mg q6hrs.
Hi
The following links are interested plz check out
Thanks
http://www.sciencedirect.com/science/article/pii/S0272638612802150
http://link.springer.com/article/10.2165/00003495-199753010-00012
http://www.nature.com/ki/journal/v44/n3/abs/ki1993293a.html
Better to avoid even in CKD 1 because it can cause AKI like anything
Ketorolac is an NAID and its use is gernerally restircted to 2-3 days due to renal.toxicity. That is a shame b/c it is a very good analisic but toxic. I don't know how long you have to wait to to give it again after the first 2-3 days, but the manufacturer mught have that info. Monitor creatinine., push fluids by oral and IV routes, and monitor urine output, Don't take a chance precipitating ARF, especially in the elderly of those with some degree of renal impoairment with cr cl ,60.
It should be avoided and use for short duration, in addition to renal side effects, also consider GI side effects.
You may review the following paper for pain management in CKD
https://www.researchgate.net/publication/259271901_Management_of_acute_and_post-operative_pain_in_chronic_kidney_disease?ev=prf_pub
Article Management of acute and post-operative pain in chronic kidney disease
It should be avoid! As a NAID it can cause AKI. The pathophysiologic possibilities include prerenal failure, acute tubular necrosis and acute intersticial nephritis. Neprotoxicity as a cause of acute kidney injury in children. Patzer L. Pediatr Nephrol 2008;23:2159-73.
Avoid using at all cost, esp in those with any stage of CKD or proteinuria, those on inhibitors of the renin ang system, in obesity, or anyone who may be predisposed to AKI. De novo oligiric AKI can occur even in young patients who have no CKD.
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