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TORADOL Dr. Stuart B. Cherney Team Physician StonyBrook Seawolves Long Island Lizards

TORADOL Dr. Stuart B. Cherney Team Physician StonyBrook Seawolves Long Island Lizards. THE GOOD. THE BAD. THE UGLY. TORADOL. THE GOOD. THE BAD. THE UGLY. What is it?. TORADOL = KETOROLAC Non-Steroidal Anti-Inflammatory. Approved in 1989. Indications:.

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TORADOL Dr. Stuart B. Cherney Team Physician StonyBrook Seawolves Long Island Lizards

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  1. TORADOLDr. Stuart B. CherneyTeam PhysicianStonyBrookSeawolvesLong Island Lizards

  2. THE GOOD THE BAD THE UGLY TORADOL

  3. THE GOOD

  4. THE BAD

  5. THE UGLY

  6. What is it?

  7. TORADOL = KETOROLACNon-Steroidal Anti-Inflammatory Approved in 1989

  8. Indications: Short – term management of moderately severe acute pain that requires analgesia at the opioid level.

  9. Inhibits prostaglandin synthesis – COX 1 & COX 2Excreted in urine

  10. How GOOD is it?

  11. 800x more potent than Aspirin • More potent than Naproxen, Indomethacin, Phenalbutazone! • IM Analgesic efficacy – superior to MORPHINE!

  12. Oral Toradol definitely NOT as effective as IM/IV

  13. Usage in USA • 40 million injections in 2010 • More than 500 million injections total

  14. THE BAD

  15. All adverse Effects After SINGLE IM dose 17% - 41%.After 5 days oral Ketorolac – Adverse effects TWICE placebo. (but less than acetominophen)

  16. Adverse Effects after Multiple IM doses of Ketorolac • Somnolence 7% • Injection Site Pain 2% • Sweating 1% • Nausea 1% • Less than 1% - Headache, Dizziness, Vomiting, Pruritus, Vasodilation, Dysgeusia

  17. After 1 year Oral Toradol 30mg/day • 12% GI pain • 11% dyspepsia • 7% nausea

  18. Inhibition of Platelet AggregationProlonged Bleeding Time (?) (except ADP triggered up to 48 hours)

  19. Hypersensitivity • Bronchospasm -- Anaphylactic Shock • AvoidIf NSAID allergies exist • Avoid If asthmatic Do Not Use IF: Currently taking ASA / NSAID’S

  20. BLACK BOX WARNINGSLimitations of Use - 5days - Moderate/Moderately Severe Pain - Not indicated Minor/Chronic PainGI Risk - Peptic Ulcers - GI bleeding / PerforationBleeding Risk - Contraindicated in CVA; Hemorrhagic diasthesis; high risk

  21. BLACK BOX WARNINGS Cardiovascular Risk - may cause increased risk (MI & stroke) Renal Risk - contraindicated if risk for renal failure secondary to volume depletion

  22. THE UGLY NFL LAWSUIT 12/5/11 Negligence, Fraud, Fraudulent Concealment, Negligent Misrepresentation, Conspiracy “Repeatedly administering the painkiller Toradol”… “Worsening high-risk injuries like concussions” Increased risk of bleeding Masking pain

  23. THE UGLY N.Y Times April 13, 2012 “Concern Raised Over Painkiller’s Use in Sports”

  24. WHAT to do?

  25. CURRENT STATUSIOCALL PROFESSIONAL SPORTS LEAGUESNCAAToradol - Allowable - Classified as NSAID

  26. TORADOL 2012 – Game Day • Pain severe enough to prevent normal performance • Injury which will not worsen • Off other NSAID’s 24-48hrs • No medical contraindications or allergies • Athlete presented with treatment alternatives and advised of risks (waiver) • Never to be used following concussion OR to mask potentially serious medical/orthopedic conditions

  27. REMEMBERMost issues regarding Toradol and concussion / bleeding are IDENTICAL to the use of ALL COX-1 NSAID’S

  28. STAY TUNED

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