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Pain Medications – Toradol vs Tramadol

Toradol (generic ketorolac) and tramadol (brand name Ultram) are both prescription pain medications. Their names sound similar, and they are both used to treat pain, but there are some important differences between these two medications.

Also see our blog where ketorolac may no longer be covered with insurance.

Toradol is a nonsteroidal anti-inflammatory drug, also known as an NSAID. It is an analgesic (pain reliever), but also works as an antipyretic (fever reducer) and as an anti-inflammatory drug. Although not completely understood, it is believed to work by blocking the production of prostaglandins, which are substances your body releases in response to injury and illness. Prostaglandins cause pain, swelling, inflammation, and fever. Reducing the amount of prostaglandins released at the site of injury relieves pain. Toradol is available as an IV or IM injection, as well as oral tablets. Toradol is only approved for the short-term use of moderately severe acute pain; it should not be used for minor pain or chronic pain conditions.

Tramadol is an opioid analgesic. Although it is not as strong as other opioid pain relievers, it is still classified as a Class IV controlled substance by the DEA. This means it carries some potential for abuse and risk for dependence, but this risk is lower than other opioids (like oxycodone or morphine). Tramadol works by binding to opiate receptors in your brain and blocking pain signals to the rest of your body. It also blocks the reuptake of chemical messengers norepinephrine and serotonin, which may also help change your body’s response to pain. Tramadol is available as an immediate release or extended-release oral tablet. Tramadol can be used for both acute and chronic pain, but use should be limited to patients who did not experience relief or tolerate non-opioid pain relievers.

Side effects of Toradol:

Common side effects of Toradol include:

  • Abdominal pain
  • Headache
  • Increased blood pressure
  • Constipation or diarrhea
  • Dizziness
  • Drowsiness    

More serious side effects include an increased risk of cardiovascular events such as heart attack or stroke as well as an increased risk for stomach ulcers and GI bleeding. These side effects can be fatal. The risk of these side effects increases with higher doses and longer duration of use.

Ketorolac should only be used for short term pain relief; duration of therapy should never exceed 5 days because of the increased risk for severe side effects.

Side effects of Tramadol:

Common side effects of Tramadol include:

  • Constipation
  • Heartburn
  • Nausea
  • Dry mouth
  • Dizziness
  • Drowsiness
  • Headache

More serious side effects include respiratory depression, which can be fatal. Tramadol can also be addictive; the risks of opioid addiction may lead to overdose or death.

Which is more effective?
Tramadol and Toradol are both very effective pain-relieving medications. There are conflicting studies with some showing that tramadol works better, while others indicate Toradol is more effective.

Tramadol usually begins working within 1 hour of administration, with peak effects noticed in 2-3 hours. Oral Toradol begins working about 30 minutes after administration, and peak effects are usually noticed within 2-3 hours.

Only your healthcare provider can determine which medication is best for you.

How much do they cost?

Generic formulations of both medications are covered by most Medicare and commercial insurance plans; brand names are often not covered or may have a high copay. If you are having trouble paying for medications, Easy Drug Card may be able to provide medication discounts at one of the 65,000+ participating nationwide and local neighborhood pharmacies.

Save up to 80% on the cost of your prescriptions at your local pharmacy with EasyDrugCard.com. Download your free drug card and begin saving today.

TL;DR:

Toradol is an NSAID while tramadol is an opioid; both are effective pain-relieving medications but carry risks for significant side effects. Your trusted medical provider will decide which medicine is best for you. If you take Toradol or tramadol, it is important to take it exactly as prescribed and for the shortest period of time possible.

References:

1. Marion, DW. Toradol. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2021.

2. Marion, DW. Tramadol. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2021

3. Vadivelu, N., Chang, D., Helander, E. M., Bordelon, G. J., Kai, A., Kaye, A. D., … & Julka, I. (2017). Ketorolac, oxymorphone, tapentadol, and tramadol: a comprehensive review. Anesthesiology clinics, 35(2), e1-e20.

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ABOUT THE AUTHOR

Dr. Joanna L. Hodder

Dr. Joanna L. Hodder is a transitions of care pharmacist for a large hospital system in Denver, Colorado. She received her BA in English Literature from Iowa State University and PharmD from University of Minnesota College of Pharmacy. Dr. Hodder completed a post-graduate year 1 (PGY-1) residency at Northeast Iowa Family Practice Center, where she delivered quality patient care in both hospital and primary care settings. She is passionate about empowering patients to take charge of their health through evidence-based education and improving access to medications. When she isn’t working closely with patients, Dr. Hodder enjoys gardening, hiking with her dog, and yoga.

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