Toradol Cream: What Exists, What Does Not, and How Topical Ketorolac Works
Toradol Cream: What Exists, What Does Not, and How Topical Ketorolac Works
Topical Ketorolac, Prescribed and Compounded
You have probably heard of Toradol. You probably have not heard of ketorolac, even though they are the same drug. Toradol was the brand name, sold as an injection and as tablets, and the brand is no longer marketed in the US. What people searching for Toradol cream usually want is topical ketorolac: the same drug, prepared as a cream or gel by a compounding pharmacy under a prescription.
This guide covers what ketorolac products actually exist, why the oral and injectable forms carry a 5-day limit, how a compounded topical differs from them, and how Toradol compares with Voltaren, Celebrex and naproxen. It also explains what the evidence does and does not say about ketorolac cream, so you can have an informed conversation with a provider.
Prescription required · Licensed-provider review · Compounded in a US pharmacy
Toradol Cream Key Takeaways
- Toradol is a brand name for ketorolac. It was sold as an injection and as tablets. No FDA-approved Toradol cream or gel has ever existed.
- The Toradol brand is no longer marketed in the US. Generic ketorolac injection and tablets remain available, and both require a prescription.
- Topical ketorolac exists only as a compounded prescription. A licensed pharmacy prepares the cream or gel to order after a provider prescribes it.
- Oral and injectable ketorolac carry a boxed warning and a combined 5-day limit because of gastrointestinal, kidney and bleeding risks.
- Topical NSAIDs as a class lower systemic exposure compared with the same drug taken by mouth. Lower is not zero, and the published data come mostly from diclofenac, not compounded ketorolac.
Is There a Toradol Cream?
No. Toradol was the brand name for ketorolac tromethamine injection, given in hospitals and clinics, and for the 10 mg tablet used to continue that course at home. The brand has since been discontinued, and the ketorolac you encounter today is generic. MedlinePlus lists Toradol with the note that the branded product is no longer on the market.
Ketorolac is FDA-approved as an injection, tablets, a nasal spray (Sprix) and eye drops (Acular, Acuvail). A cream or gel is not among them. When a ketorolac cream or gel exists, it is because a compounding pharmacy prepared it for one patient from a prescription. The FDA is clear that compounded drugs are not FDA-approved and that the agency does not verify their safety, effectiveness or quality before they are marketed, which is why a licensed prescriber stays involved at every step.
FDA-approved
Injection (IV or IM)
The original Toradol form. Given in a clinical setting for short-term moderately severe acute pain, usually after surgery.
FDA-approved
Tablets, 10 mg
Labeled only as continuation treatment after an injection, with a 40 mg daily maximum in adults.
FDA-approved
Nasal spray (Sprix)
A systemic form sprayed into the nose. Its label carries the same 5-day total limit, alone or combined with other ketorolac forms.
FDA-approved
Eye drops (Acular, Acuvail)
Ophthalmic ketorolac for eye inflammation and post-surgical eye pain. Unrelated to musculoskeletal pain.
Compounded, prescription only
Topical cream or gel
Prepared to order by a licensed pharmacy at a prescriber's direction. Not a branded or FDA-approved product. Formulas vary by pharmacy.
Does not exist
Toradol-brand cream or gel
No Toradol-brand topical was ever approved or marketed in the US. Search results for Toradol cream point to compounded ketorolac or to unrelated products.
Toradol vs Ketorolac: Same Drug, Two Names
Toradol and ketorolac are the same molecule. One is the retired brand, the other is the generic name you will see on any current prescription.
Ketorolac tromethamine is the generic name. Toradol was the brand. Because the brand name is what most patients and emergency departments used for years, the name stuck, and many people still say Toradol when a chart says ketorolac. Nothing about the drug changes between the two.
What does change is the route. Injection, tablets and nasal spray deliver ketorolac throughout the body. A compounded topical delivers it to the skin over one painful area. The next two sections explain why that distinction matters for how long each form can be used.
Why Toradol Is Limited to 5 Days
The most common question about Toradol is why providers are reluctant to prescribe it for more than a few days. The answer is written into the label.
Boxed warning
A combined course of tablets and injection is capped at 5 days
The ketorolac tablet label states that tablets are indicated for the short-term, up to 5 days in adults, management of moderately severe acute pain that requires analgesia at the opioid level, and only as continuation treatment following IV or IM dosing. It adds that the total combined duration of tablets and injection is not to exceed 5 days because of the potential of increasing the frequency and severity of adverse reactions. The Sprix nasal spray label carries the same 5-day total, alone or combined with other ketorolac forms.
Why the cap exists
Gastrointestinal bleeding, kidney injury and bleeding risk
MedlinePlus summarizes the risks plainly: NSAIDs such as ketorolac may cause ulcers, bleeding or holes in the stomach or intestine, and ketorolac may cause kidney failure. The label also states that increasing the tablet dose beyond 40 mg a day will not provide better efficacy but will increase the risk of serious adverse events. These are the reasons prescribers treat Toradol as a short-course drug for acute pain, not a maintenance medication.
What this means for a topical
The label limit belongs to the systemic products
A compounded topical ketorolac has no FDA label, X. That is not the same as saying a topical is risk-free or unlimited. The prescriber sets how long and how often a compounded topical is used. Topical NSAIDs as a class produce lower systemic exposure than the same drug taken by mouth, studied most directly with diclofenac (Kienzler 2010). Equivalent published data for compounded topical ketorolac do not exist, so the honest position is lower exposure, not zero, under a provider's direction.
Topical Toradol: How Compounded Ketorolac Cream or Gel Works
The active ingredient is unchanged. What changes is where it goes. Here is how a compounded topical ketorolac is meant to work, and where cream and gel differ.
1
Inflammation produces pain signals
Injured or irritated tissue makes prostaglandins, chemical messengers that drive swelling, sensitize nerves and turn up pain at the affected site.
2
Ketorolac blocks COX enzymes
Ketorolac inhibits the COX-1 and COX-2 enzymes that make prostaglandins. With fewer prostaglandins, the inflammatory signaling that keeps an area painful settles down. This is the same mechanism whether the drug is injected, swallowed or applied.
3
Topical application lowers systemic exposure (class data)
Topical NSAIDs as a class produce lower systemic exposure than the same drug taken by mouth, studied most directly with diclofenac (Kienzler 2010). Equivalent published data for compounded topical ketorolac do not exist. How much is absorbed depends on the formulation, the dose and the area treated.
4
Cream or gel is a vehicle choice
A compounding pharmacy can prepare ketorolac in a cream base or a gel base. Toradol gel and Toradol cream describe the same drug in different vehicles. Gels tend to feel lighter and dry faster; creams are more emollient. Your prescriber and pharmacy choose the base.
The evidence for topical NSAIDs as a category comes mostly from diclofenac and ketoprofen trials. A 2016 Cochrane review found that several topical NSAIDs provided useful pain relief in chronic musculoskeletal conditions such as knee osteoarthritis (Derry 2016). Those are category findings, not a trial of any one compounded ketorolac formula.
For the full picture on uses, safety and what the topical NSAID evidence shows, read the ketorolac cream guide. If you are weighing a cream against a tablet, the guide to topical versus oral NSAIDs walks through the trade-offs, and the compounded medication guide explains how pharmacy compounding is regulated.
Toradol vs Voltaren, Celebrex and Naproxen
These four NSAIDs come up together in searches because people are trying to work out which one fits their situation. They differ more in route and labeling than in drug class.
Swipe to compare
| Product | Drug | Route | Prescription | Labeled use | Duration note |
|---|---|---|---|---|---|
| Toradol (generic ketorolac) | Ketorolac | Injection; tablets | Yes | Short-term moderately severe acute pain, usually postoperative; tablets only to continue an injection course | Combined course not to exceed 5 days |
| Compounded topical ketorolac (e.g., Ketro RX Pain Gel) | Ketorolac | Cream or gel on skin | Yes | Localized musculoskeletal pain at a prescriber's discretion; no FDA label | Set by the prescriber |
| Voltaren Arthritis Pain | Diclofenac 1% gel | Gel on skin | No (OTC) | Arthritis pain only in hand, wrist, elbow, foot, ankle and knee; no more than 2 body areas at once | Up to 21 days unless directed by a doctor; 4 times a day |
| Celebrex (celecoxib) | Celecoxib | Capsule by mouth | Yes | Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, menstrual pain and short-term pain from injury or surgery | Per prescriber |
| Naproxen (Aleve, Naprosyn) | Naproxen | Tablets, capsules (OTC) or liquid (Rx) by mouth | Both: OTC and Rx strengths | OTC for minor aches and fever; Rx strengths for arthritis, shoulder pain from bursitis or tendinitis, and menstrual pain | Per label or prescriber |
Toradol vs Voltaren
Different routes and different labels. Toradol is systemic ketorolac for short acute courses. Voltaren is OTC topical diclofenac labeled for arthritis pain in six body areas. Ketorolac's systemic reputation does not transfer to the skin: no trial compares a compounded ketorolac cream with diclofenac gel. Our Voltaren vs Ketro comparison goes deeper.
Toradol vs Celebrex
Both are prescription NSAIDs taken systemically, but Celebrex is an oral capsule used mainly for arthritis conditions and also labeled for short-term acute pain, while Toradol is reserved for short courses of acute pain. A provider choosing between them is usually deciding between ongoing management and a few days of post-procedure relief.
Toradol vs Naproxen
Naproxen is the more flexible option: it is available over the counter as Aleve and in prescription strengths for conditions including arthritis and shoulder pain from bursitis or tendinitis. Toradol is not available without a prescription in any form and is limited to 5 days. People who search this pairing are often looking for something they can keep using; that is a conversation for a provider, and a topical may be part of it.
Is There an Over-the-Counter Alternative to Toradol?
There is no OTC ketorolac in any form and no OTC equivalent to Toradol. The over-the-counter NSAID options are different drugs.
Oral OTC NSAIDs include ibuprofen and naproxen. The only NSAID sold over the counter as a topical in the US is diclofenac 1% gel. Voltaren sells it, and so do store brands and other labels, including Aspercreme Arthritis Pain, which is the same molecule at the same strength. Products such as Icy Hot, Biofreeze and Tiger Balm are counterirritants, not NSAIDs; they create a cooling or warming sensation rather than acting on inflammation. Our prescription vs OTC pain cream guide sorts the categories.
If the reason you are searching for a Toradol alternative is that you want an NSAID applied to one area rather than taken systemically, a licensed provider can advise where an OTC topical, an oral NSAID or a compounded prescription topical such as ketorolac fits. The condition pages on bursitis and tennis elbow cover the most common localized uses in more detail.
How to Get Topical Ketorolac
Ketro RX Pain Gel is one way to access compounded topical ketorolac. The process starts with a health questionnaire, not a purchase.
Prescription Topical NSAID
RX Pain Gel
Ketro RX Pain Gel contains prescription ketorolac in a compounded topical gel, originally developed by the same compounding team that works with professional sports organizations, including the Boston Red Sox. It is intended for localized application when a provider decides it is appropriate.
- Complete an online health questionnaire
- A licensed provider reviews your history
- If prescribed, a US compounding pharmacy prepares it
- Your prescription ships to your door
- Applied where it hurts, as directed by your provider
Because it is compounded, the gel is prepared for you rather than taken off a shelf, and a provider decides whether ketorolac is a reasonable choice for your symptoms. You can start the online health questionnaire here. For the science behind topical delivery, see how topical relief works.
Frequently Asked Questions
References
- Ketorolac Tromethamine tablet, film coated. Prescribing information, including boxed warning, indication and 5-day combined duration. DailyMed, US National Library of Medicine. DailyMed label
- Ketorolac. Drug information, including brand status, 5-day limit and GI and kidney warnings. MedlinePlus, US National Library of Medicine. medlineplus.gov/druginfo/meds/a693001
- Sprix (ketorolac tromethamine) nasal spray. Prescribing information. US Food and Drug Administration. FDA label (PDF)
- Compounding and the FDA: Questions and Answers. US Food and Drug Administration. fda.gov
- Voltaren Arthritis Pain (diclofenac sodium topical gel 1%). OTC Drug Facts label. DailyMed, US National Library of Medicine. DailyMed label
- Celecoxib. MedlinePlus, US National Library of Medicine. medlineplus.gov/druginfo/meds/a699022
- Naproxen. MedlinePlus, US National Library of Medicine. medlineplus.gov/druginfo/meds/a681029
- Kienzler JL, Gold M, Nollevaux F. Systemic bioavailability of topical diclofenac sodium gel 1% versus oral diclofenac sodium in healthy volunteers. J Clin Pharmacol. 2010. PubMed 19841157
- Derry S, Conaghan P, Da Silva JAP, Wiffen PJ, Moore RA. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews. 2016. PubMed 27103611
This page is for general education and is not medical advice. Ketorolac is a prescription medication. Compounded drugs are not FDA-approved. A licensed provider decides whether any NSAID, topical or systemic, is appropriate for you, and how long to use it. Do not combine NSAIDs without checking with a clinician or pharmacist.
Ketro RX Pain Gel
Compounded prescription topical ketorolac