toradol...reply to Pret et al...

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here my beef against Keto:


-relative risk (RR) value for GI side effects: Ibuprofen 2.1...Keto:24.7

Rodriguez G et al, Risk of Hospitalization for Upper Gastrointestinal 
Tract Bleeding Associated With Ketorolac, Other Non-Steroidal 
Anti-inflammatory Drugs, Calcium Antagonists, and other 
Antihypertensive drugs. Arch Intern Med, 1998; 158: 33-39.


-It is not considered an antiinflammatory medication it is mainly an 
analagesic...perhaps an antipyretic...
Houry D, Ernst A, Weiss S, et al,  Ketorolac Versus Acetaminophen for 
Treatment of Acute Fever in the Emergency Department, South Med J. 
1999;92:1171-1173

Held BI, et al, The effect of ketorolac on postoperative febrile 
episodes in patients after abdominal myomectomy, Am J Obstet Gynecol 
2002; 187(6): 1450-1455

-there is no adequate literature-based evidence to support the routine 
or even frequent use of ketorolac for acute pain in the ambulatory 
setting (post-op maybe different story) Come on Pret, you can recognize 
the papers written to date on renal colic for example tend to use a 
straw-man (inadequate) dose of a narcotic agent as the control . It is 
too high in both clinical and monetary costs, while no evidence 
demonstrates it offers any benefit over oral ibuprofen.

now I don't want to sound dogmatically negative about this drug, but 
prior to use think of alternatives

...boy what a headache you guys gave me, let me go and pop a diclofenac

Joe

-- 
Dr. Joe Nemeth
Assistant Professor
Emergency Medicine
Montreal General Hospital
Montreal Children's Hospital
McGill University Health Center

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