Toradol interactions

[dsta]

I don't work in EM, but thought that EM PAs would probably be best at answering this. Is IM Toradol contraindicated for patients who take baby aspirin? The interaction checks I have done show that these are contraindicated, but I've seen providers give it to patients on aspirin. And what about warfarin and other anticoagulants? Do you ever give toradol to patients on these drugs? I've seen this done as well. I've never had to actually administer it, but there may come a time when I need to. 

[LT_Oneal_PAC]

Risk rating with aspirin is X, meaning don’t. Risk rating with Coumadin is D, consider something else.

Is it CLINICALLY significant for a one time or two time dose of 15mg, which maxes out the pain relief? I doubt it. I personally try to avoid it.

[Boatswain2PA]

I give toradol all the time in the ED, without regard to whether they take asa.  I don't think 15 or 30 mg IM once is going to do anyone any harm (unless they have CKD).

I rarely write rx's for it though, and on that rare occasion it's only for a few days.

[ohiovolffemtp]

I also do EM.  My key watchouts for toradol are:

• max of 30 IV, 60 IM
• half the dose or even quarter it in older (>65)
• ensure pt is not pregnant
• if giving for renal colic, make sure creatinine is OK 1st
• never give for HA if there's any risk of a bleed until CT is neg

I wouldn't consider a daily 81 or 325 ASA a barrier to giving it.  I'd likely check an INR before giving it to a patient on coumadin.  But, I'm only ordering a single dose.  I can count on the fingers of 1 hand, while wearing mittens, the number of times I've prescribed toradol.