Ketorolac Long-Term Therapy Risk
A retrospective Drug Utilization Evaluation conducted by HOPE Research Centre, was presented to our WSIB Board of Directors in May 2002. This evaluation identified ketorolac (Toradol®) as a medication falling outside the recommended therapeutic guidelines for long-term use.
Ketorolac is reported to have the highest rate of serious gastrointestinal side effects of all non-steroidal anti-inflammatory drugs (NSAIDs). Based on current available evidence, ketorolac should be limited to acute, short-term therapy, for a maximum of 7 days at a maximum dose of 40mg/day.
Many workers who are entitled to drug benefits from WSIB are receiving longer-term therapy with ketorolac.
To reduce risk associated with long-term therapy with ketorolac, this medication will be de-listed from all WSIB Formularies effective September 1, 2003. This will not affect availability of ketorolac for short-term therapy for a maximum of 7 days in any 90-day period.
Long-term NSAID therapy options
The WSIB Formulary currently lists a wide range of other NSAIDs, including both traditional and COX-II inhibitor NSAIDs, generic and brand name products to meet the diverse needs of workers requiring NSAID therapy.
Clinical information about ketorolac risks and therapy options
The summer edition of Drug News Update, a newsletter for WSIB health care professionals published by the Drug Information and Research Centre, provides more clinical and case report information regarding ketorolac: "Long-term ketorolac use: an evidence based summary of safety and efficacy" (38k, pdf). To read this publication, you will need Acrobat Reader.
More changes ahead
As we look to the future, we will make changes to the Drug Benefit Program to more closely reflect evidence-based guidelines.
For further information or discussion please contact:
Dr. Michel Schofield
Acting Director, Clinical Services Branch
Health Services Division, WSIB
(416) 344-3001
Fax: (416) 344-5678
E-mail:michel_schofield@wsib.on.ca
Please note: Dr. Schofield cannot respond to any e-mails from non-health care practitioners. |
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