Toradol in Place of Opioid Pain Medications isn't a good idea. While
at the KRMC ER several months ago I overhead several patients who came to the ER for some type of pain being given Toradol
rather than an opioid pain medication.
I
know how dangerous Toradol is. I was given Toradol back in the 90’s when like
today doctors would give you anything rather than an opioid pain medication.
Two days later my stomach was really messed up, I was throwing up blood and ended
up back in the ER with IV’s to stop the bleeding.
If you know someone who was given Toradol rather than pain medications and had a serious side effect like ulcers, gastrointestinal bleeding or perforation of the stomach or intestines.
PLEASE FILE A COMPLAINT with Arizona Medical Board
Both
Toradol and Morphine have Black Box Warnings
Black Box Warning
A
black box warning is the strictest warning put in the labeling of prescription
drugs or drug products by the Food and Drug Administration (FDA) when there is
reasonable evidence of an association of a serious hazard with the drug. Having
the black box around the warning means that an adverse reaction to the drug may
lead to death or serious injury
Black Box Warning Toradol.
Appropriate Use
for short term (up to 5
days in adults) tx of moderately severe acute pain requiring opioid-level
analgesia and only as continuation of parenteral tx, if necessary; total
combined duration should not exceed 5 days; not indicated for minor or chronic
pain; oral tx not indicated in peds; max recommended total daily dose 40 mg PO
and 120 mg IV/IM; doses above label recommendations incr. serious adverse event
risk w/o improved efficacy
GI Risk
incr. serious GI adverse
event risk, incl. bleeding, ulcer, and stomach or intestine perforation, which
can be fatal; may occur at any time during use and w/o warning sx; elderly pts
at greater risk for serious GI events; contraindicated in active PUD, recent GI
bleeding or perforation, and PUD or GI bleeding hx
Cardiovascular Risk
NSAIDs incr. risk of
serious and potentially fatal cardiovascular thrombotic events, incl. MI, and
stroke; risk may occur early in tx and may incr. w/ duration of use;
contraindicated for CABG peri-operative pain
Renal Risk
contraindicated if adv.
renal impairment or if renal failure risk due to volume depletion
Bleeding Risk
contraindicated if
suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis,
incomplete hemostasis, or high bleeding risk because inhibits platelet fxn;
contraindicated as prophylactic analgesic before major surgery
Labor/Delivery Risk
contraindicated in
labor/delivery because may adversely affect fetal circulation and inhibit
uterine contractions
Concomitant NSAID Use
contraindicated in combo
w/ ASA or NSAIDs due to cumulative risk of serious NSAID-related side effects
Intrathecal/Epidural Use
contraindicated due to
alcohol content
Hypersensitivity Rxn
hypersensitivity rxns
range from bronchospasmqq to anaphylactic shock, have appropriate tx available;
contraindicated if previous ketorolac, ASA, or other NSAID hypersensitivity rxn
Special Populations
max total daily dose 60
mg IV/IM in pts 65 yo and older, if wt <50 kg, or moderately elevated Cr;
max single dose 30 mg IM and 15 mg IV in peds pts
Black
Box Warning Morphine.
Appropriate
Use
ER form should only be prescribed by healthcare professionals
knowledgeable in use of potent opioids for chronic pain management; reserve extended-release
and long-acting formulations for pts w/o tx alternatives; ER form not indicated
for prn analgesic use; proper dosing and titration essential to decr. resp.
depression risk
Medication
Error Risk
ensure accuracy when prescribing, dispensing, and administering
morphine oral solution; dosing errors due to confusion between mg and mL or
different concentrations can result in accidental overdose and death; morphine
concentrated oral solution (100 mg per 5 mL) indicated only in opioid-tolerant
pts
Addiction,
Abuse, and Misuse
opioid agonist Schedule II controlled substance w/ risk of
addiction, abuse, and misuse, which can lead to overdose and death; reserve
opioid analgesics for pts w/ inadequate tx alternatives; assess opioid abuse or
addiction risk prior to prescribing; regularly monitor all pts for misuse,
abuse, and addiction
Opioid
Analgesic REMS
FDA required risk evaluation and mitigation strategy (REMS)
program to ensure benefits outweigh risks; REMS-compliant education program
must be avail to healthcare providers; providers are strongly encouraged to
complete REMS-compliant program, counsel pts and/or caregivers w/ each Rx on
safe use, serious risks, storage, and disposal, emphasize importance of reading
med guide, and consider other tools to improve pt, household, and community
safety
Respiratory
Depression
serious, life-threatening, or fatal cases may occur even w/
recommended use; monitor for resp. depression esp. during tx start or after
dose incr; instruct pts to swallow ER tabs whole; crushing, dissolving, or
chewing ER tabs can cause rapid release and absorption of potentially fatal
morphine dose; instruct pts to swallow ER caps whole or sprinkle contents on
applesauce and swallow immed. w/o chewing; crushing, dissolving, or chewing pellets
w/in ER cap can cause rapid release and absorption of potentially fatal
morphine dose
Accidental
Ingestion
accidental ingestion of even one dose, esp. by children, can
result in fatal morphine overdose
Neonatal
Opioid Withdrawal Syndrome
prolonged maternal use of opioid tx during pregnancy can lead to
potentially life-threatening neonatal opioid withdrawal syndrome; infants may
require tx according to neonatology protocols; advise pregnant pts of risks and
ensure appropriate tx avail. if prolonged opioid use required
Avoid
Alcohol
instruct pts using ER caps not to consume alcoholic beverages or
use alcohol-containing prescription or non-prescription medications; alcohol
consumption during tx may result in incr. plasma levels and potentially fatal
morphine overdose
Risks
from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS
depressants, incl. alcohol, may result in profound sedation, resp. depression,
coma, and death; reserve concomitant use for pts w/ inadequate alternative tx
options; limit to minimum required dosage and duration; monitor pts for s/sx of
resp. depression and sedation
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