Toradol vs. tramadol: Uses, effectiveness, costs, side effects, and more

In this article:

• Main differences
• Conditions treated
• Efficiacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficiacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

Toradol (ketorolac) and tramadol (generic Ultram) are two prescription medications that are approved by the FDA (United States Food and Drug Administration) for pain relief. 

Toradol is classified as a non-steroidal anti-inflammatory drug (NSAID). Toradol helps to relieve pain and decrease inflammation. The way Toradol works is not completely understood, but it is speculated to work by inhibiting the production of prostaglandins. Prostaglandins are part of cell-signaling pathways that lead to pain and inflammation. By inhibiting prostaglandin production, Toradol helps with pain and inflammation. 

Tramadol is classified as an opioid analgesic. It is a controlled substance, meaning that it has some potential for abuse and dependence. The way it works is not completely understood but is believed to be by binding to opioid receptors as well as inhibiting the euptake of norepinephrine and serotonin, resulting in pain relief.

Although toradol and tramadol are both used for pain, they have many differences. Continue reading below to learn more about toradol and tramadol.

What are the main differences between Toradol and tramadol?

Toradol (What is Toradol?) is classified as an NSAID or nonsteroidal anti-inflammatory prescription drug. Toradol is a brand name that is no longer available in the US. It is available in generic form, as ketorolac, and can be injected into a vein (IV, or intravenous, injection) or muscle (IM, or intramuscular, injection). It is also available in tablet form, as 10 mg tablets, as a nasal spray called Sprix, and as an ophthalmic solution (eye drop) called Acular. A patient must have the IV or IM form before using the tablet form, and the total length of treatment (IV/IM/tablet/nasal spray) should not exceed five days. This is to limit the risk of potentially serious side effects, such as gastrointestinal bleeding. 

Tramadol (What is Tramadol?) is the generic version of Ultram. It is an opioid analgesic (pain reliever) listed as a DEA Schedule IV controlled substance. It is available in tablet form, as well as extended-release tablet, capsule, and liquid solution form called Qdolo. It is also available as Ultracet, which contains tramadol and acetaminophen (acetaminophen is generic Tylenol, also known as APAP). 

	Toradol	Tramadol
Drug class	NSAID	Opioid analgesic
Brand/generic status	Generic (ketorolac)	Generic
What is the generic name? Or What is the brand name?	Generic: ketorolac (ketorolac tromethamine)	Brand: Ultram
What form(s) does the drug come in?	IV (intravenous), IM (intramuscular), tablet, nasal spray, ophthalmic solution	Tablet, extended-release capsule,  extended-release tablet, liquid solution
What is the standard dosage?	Tablet used as a continuation of IV or IM ketorolac.  For adults, 20 mg once if weight is more than 50 kg and age less than 65 years, then 10 mg every 4 to 6 hours as needed.  Maximum of 40 mg/day  Not to exceed 5 total days of treatment	The adult dose is slowly titrated up to 50 mg to 100 mg every 4 to 6 hours  Maximum 400 mg per day
How long is the typical treatment?	5 days or less	Short term, some patients continue for longer based on the prescriber’s discretion
Who typically uses the medication?	Adults only for oral formulation	Adults

Conditions treated by Toradol and Tramadol

According to the FDA warning on its label, ketorolac is only indicated in adults for the short-term management of moderately severe acute pain, usually in a post-operative (after surgery) setting, that requires opioid-level pain relief. Treatment with oral tablets should only follow IV or IM dosing. Total length of treatment with Toradol should not exceed five days. It is not indicated for minor pain or for chronic pain.

Tramadol is indicated in adults with pain intensity severe enough to require an opioid pain reliever when non-opioid alternatives are not adequate or not tolerated. NSAIDs and acetaminophen are the most common other analgesic options.

Is Toradol or tramadol more effective?

A study in India compared Toradol to tramadol for post-op pain after maxillofacial surgery in 50 adults. Both drugs were given IM (intramuscular). Both drugs caused a significant decrease in pain, but tramadol resulted in better pain control than Toradol at every hour and was better tolerated. 

Another study looked at the two drugs for postoperative pain and compared oral Toradol to IM tramadol. The study found Toradol to be more helpful for pain relief than tramadol. Another clinical trial looked at the use of both drugs concurrently along with acetaminophen versus ketorolac alone after mandibular third molar surgery, and the combination was marginally but not significantly better than ketorolac alone.

Even though one study concluded tramadol was better, and other studies concluded that Toradol was better, some of the studies were done in other countries where tramadol was given by injection into the muscle or combined with other analgesics. In the US, tramadol is prescribed as an oral tablet in the outpatient setting. Toradol, or ketorolac, is given IV or IM by a healthcare provider and possibly continued with oral tablets for up to a maximum of five days. Therefore, it is difficult to extrapolate these results in terms of what you would generally be prescribed here in the US. 

In general, each drug can be very effective in treating pain. Often, other factors must be considered. 

Your doctor, who is the best source of medical advice, should determine the most effective drug for you. He or she can consider your medical history and condition(s) and other drugs you take that could potentially interact with toradol or tramadol.

Coverage and cost comparison of Toradol vs. tramadol

Toradol is usually covered by insurance, and Medicare Part D coverage varies. The out-of-pocket cost of generic Toradol (#20, 10 mg tablets) is about $67. With a SingleCare coupon, the generic cost for this quantity and strength of tablets starts at $12.

Tramadol is usually covered by insurance and Medicare Part D. The out-of-pocket cost of tramadol (#30, 50 mg tablets) is about $33. You can get the same strength and amount of generic tramadol tablets with a SingleCare discount coupon for $7, depending on which pharmacy you use.

	Toradol	Tramadol
Typically covered by insurance?	Yes (generic)	Yes
Typically covered by Medicare Part D?	Varies	Yes
Standard dosage	#20, 10 mg tablets	#30, 50 mg tablets
Typical Medicare Part D copay	Free to $14	Free to $1
SingleCare cost	$12-$26	$7-$24

Common side effects of Toradol vs. tramadol

The most common side effects of Toradol are GI (gastrointestinal) in nature, including abdominal pain, indigestion, and nausea, which tend to occur in more than 1 in 10 people according to ketorolac’s label. Most concerning, GI bleeding and ulcers are possible. Aside from GI side effects, headaches can commonly occur with Toradol, and kidney damage is a major worry. The adverse effects include the following:

• Abdominal pain
• Indigestion
• Nausea and vomiting
• Headache
• Drowsiness or dizziness
• Constipation or diarrhea
• GI ulcers and bleeding
• Abnormal kidney function
• Elevated liver enzymes
• Swelling from fluid retention
• High blood pressure

Occurring in more than 15% of people taking it, the most common side effects listed in tramadol’s drug label are nausea, constipation, headache, dizziness, and drowsiness. Less common but more worrisome, seizures, addiction, abuse, and withdrawal are possible. Tramadol’s significant side effects include the following:

• Dizziness
• Nausea and vomiting
• Constipation or diarrhea
• Headache
• Drowsiness and weakness
• Itchiness
• Sweating
• Indigestion
• Dry mouth
• Seizures
• Addiction, abuse, and withdrawal

These are not full lists of potential side effects. Other adverse events may occur. Consult your healthcare provider for more information about side effects. 

Drug interactions of Toradol vs. tramadol

Toradol may interact with anticoagulants such as heparin or warfarin, and due to bleeding risks, patients should avoid the combination or be carefully monitored if on this combination of drugs. Toradol should not be taken with other NSAIDs, due to the potential for GI bleeding and increased side effects. Taking Toradol with diuretics can increase the risk for renal (kidney) failure. Toradol therapy may need to be avoided or monitored with certain blood pressure medications, namelyACE inhibitors or ARBs, because the combination could cause kidney problems, especially in patients who are dehydrated. Taking Toradol with SSRI antidepressants can increase the risk of GI bleeding and may need to be avoided. The drug interactions with this NSAID include the following:

• Heparin, Warfarin, Eliquis, Xarelto, and Pradaxa
• Aspirin, Plavix, and Brilinta
• Advil, Aleve, and meloxicam
• Lisinopril, enalapril, Diovan, Cozaar, and Avapro
• Lasix, Bumex, hydrochlorothiazide, and spironolactone
• Celexa, Zoloft, Prozac, Lexapro, Effexor, and Cymbalta
• Alcohol

Tramadol should not be taken with benzodiazepines, other CNS (central nervous system) depressant medications, or alcohol. Tramadol should absolutely not be taken with MAO inhibitors (MAOIs) and may need to be avoided or monitored with other drugs that increase serotonin (SSRI, SNRI, or tricyclic antidepressants; triptans, and muscle relaxants) because the combination could cause a life-threatening condition called serotonin syndrome. Tramadol should be separated from an MAOI by at least 14 days. 

Tramadol has been associated with seizures, so it may need to be avoided when using other medications that can have this effect. Tramadol also interacts with drugs that are CYP metabolic enzyme inducers or inhibitors. Collectively, its drug interactions include the following:

• Roxicodone, morphine, hydrocodone, and codeine
• Ativan, Xanax, and Klonopin
• Alcohol
• Celexa, Zoloft, Prozac, Lexapro, Effexor, Cymbalta, and Wellbutrin
• Cyclobenzaprine, baclofen, and Robaxin
• Imitrex, Maxalt, and Relpax
• Phenelzine, selegiline, and tranylcypromine
• Clarithromycin, erythromycin, Diflucan, and Paxlovid

These are not full lists of drug interactions. Other interactions with over-the-counter and prescription medication may occur. Consult your healthcare provider for a full list of prescription and OTC drug interactions with Toradol and tramadol.

Warnings of Toradol and Tramadol

Toradol (ketorolac) warnings:

• Toradol (ketorolac) tablets should only be used as a continuation of treatment following IV or IM dosing if needed. The total duration of ketorolac should not exceed five days.
• Toradol (ketorolac) tablets should not be used in children, and should not be used for minor or chronic pain. 
• The maximum daily dose of Toradol (ketorolac) is 40 mg. Increasing the dose above 40 mg per day will not improve pain relief, but will increase the potential risks of serious side effects. 
• Toradol (ketorolac) can cause serious GI problems, including peptic ulcers, bleeding, or perforation of the stomach or intestines, which could be fatal. Any of these events can occur without warning. Toradol (ketorolac) is contraindicated (should not be used) in patients with active peptic ulcer disease, patients with recent GI bleeds, and patients with a history of ulcer disease or GI bleeds. Elderly patients are at greater risk for GI events. 
• NSAIDs can cause an increased risk of serious cardiovascular events, such as heart attack or stroke, which can be fatal. The risk can occur early in treatment, and the risk increases with the duration of treatment. 
• Toradol (ketorolac) should not be used:
  • in the setting of coronary artery bypass graft (CABG) surgery
  • in patients who have recently had a heart attack
  • in patients with serious kidney problems and in patients at risk for kidney failure due to dehydration
  • before any major surgery
  • in labor and delivery
  • in patients who take other NSAIDs
  • in patients with severe heart failure/edema
  • in patients with certain bleeding conditions or at risk of bleeding. 
• Toradol (ketorolac) can cause new or worsened hypertension (high blood pressure).
• Certain patients require dosage adjustment, including those 65 years of age or older, those weighing under 110 lbs, and those with elevated serum creatinine. 
• Toradol (ketorolac) may cause an anaphylactic reaction, which could be fatal. Patients with Samter’s triad of asthma, nasal polyps, and aspirin sensitivity should not take ketorolac.
• Skin reactions can occur, including exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. Patients should stop taking ketorolac at any sign of a skin reaction and seek emergency medical attention. 
• Toradol (ketorolac) should not be used in late pregnancy, because it could cause premature closure of the ductus arteriosus, which can lead to heart problems or even death of the fetus.

Tramadol warnings: 

• Tramadol has the potential for abuse, misuse, and addiction, which could result in overdose and death. Take your medication as prescribed. Do not take additional doses or use the medication for other conditions than for which it was prescribed. 
• Serious, life-threatening respiratory depression (slowed breathing) may occur. Patients should be monitored for respiratory depression, especially during initiation of treatment and with any change in dose. Elderly patients and patients with certain chronic conditions, such as lung disease, are at higher risk for respiratory depression.
• Accidental ingestion by anyone, especially children, may result in a fatal overdose of tramadol. Keep out of the reach of children, preferably under lock and key. Life-threatening respiratory depression and death have occurred in children who received tramadol. Some of the cases occurred after tonsil or adenoid removal. 
• Using tramadol with other opioid medications, benzodiazepines, or other CNS (central nervous system) depressants can result in serious respiratory depression, profound sedation, coma, or death. If the combination cannot be avoided, the lowest dose should be used for the shortest duration, and the patient should be closely monitored.
• Seizures have occurred in patients taking tramadol, even at normal doses. Patients who take certain drugs (such as SSRI, SNRI, tricyclic antidepressants, opioids, or  MAO inhibitors) or patients with a history of seizures are at higher risk.
• Patients who are suicidal or addiction-prone should not take tramadol.
• Monitor blood pressure—low blood pressure may occur.
• Patients with impaired consciousness or in a coma should not take tramadol.
• Patients with a GI obstruction should not take tramadol. 
• When discontinuing tramadol, the drug should be tapered and not abruptly stopped, to avoid withdrawal symptoms.
• Serious and rarely fatal anaphylactic reactions have occurred, often after the first dose. Other allergic reactions include pruritus (itching), hives, bronchospasm, angioedema, toxic epidermal necrolysis, and Stevens-Johnson syndrome. If you have any of these symptoms, stop taking tramadol and seek emergency medical attention. 
• Do not drive or operate machinery until you know how you react to tramadol.
• Prolonged use of opioids, such as tramadol, during pregnancy can result in neonatal opioid withdrawal syndrome.

Frequently asked questions about Toradol vs. Tramadol

What is Toradol?

Toradol is an NSAID that helps with pain and inflammation. It is often used after surgery. It is available as an IV or IM injection and as a tablet. The tablet form can only be taken as a continuation of the IV or IM formulation. The total duration of ketorolac treatment must be five days or less. 

What is tramadol?

Tramadol is a strong painkiller, or opioid analgesic. It is the generic name for Ultram. It may be prescribed when other non-opioid medications are not strong enough or not tolerated.

Are Toradol and tramadol the same?

No. Toradol and tramadol are different in the way they work and have many other differences, such as adverse events and drug interactions, as detailed above. 

Is Toradol or tramadol better?

In studies (see above), results varied. In reality, though, both drugs have a place in the treatment of pain and/or inflammation. The drug that is better for you can only be determined by your healthcare provider. Each of these drugs has potential drug interactions as well as medical conditions that are not compatible. Your healthcare provider is the best source to determine which drug is best for you.

Can I use Toradol or tramadol while pregnant?

Use can be hazardous, and your healthcare provider will need to assess risks and benefits. Using Toradol while pregnant can cause fetal heart problems or even death. And using tramadol in pregnancy can cause fetal harm. Prolonged use of tramadol in pregnancy can cause a life-threatening condition called neonatal opioid withdrawal syndrome. 

Can I use Toradol or tramadol with alcohol?

Using Toradol with alcohol is dangerous and can increase the risk of gastrointestinal bleeding. Using tramadol with alcohol can increase the risk of severe breathing problems, and can even lead to a coma or death. 

Does Toradol make you sleepy?

Toradol can cause drowsiness in some patients, which occurs in 1 to 10% of patients. The most common side effects of toradol are stomach pain, indigestion, nausea, and headache.

How quickly does Toradol work?

Toradol (ketorolac) tablets start working within about one hour, and the peak effect is at two to three hours.