Toradol vs. Tramadol: Differences, similarities, and which one is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

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

Toradol is classified as a nonsteroidal anti-inflammatory drug (NSAID). Toradol helps to relieve pain and decrease inflammation. The way Toradol works is not completely understood but is speculated to work by inhibiting the production of prostaglandin. Prostaglandin causes pain and inflammation. By inhibiting prostaglandin production, Toradol helps with pain and inflammation.

Tramadol is classified as an opioid analgesic. It is a DEA Schedule IV 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 reuptake 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 find out more about Toradol and tramadol.

What are the main differences between Toradol and tramadol?

Toradol (What is Toradol?) is an NSAID, or nonsteroidal anti-inflammatory prescription drug. 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, and as a nasal spray called Sprix. The 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 potential serious side effects, such as gastrointestinal bleeding.

Tramadol (What is Tramadol?) is the generic of Ultram. It is an opioid analgesic (pain reliever). It is available in tablet form, as well as extended-release tablet and capsule form. It is also available as Ultracet, which contains tramadol and acetaminophen (acetaminophen is generic Tylenol, also known as APAP).

Main differences between Toradol and tramadol
	Toradol	Tramadol
Drug class	NSAID	Opioid analgesic
Brand/generic status	Generic (ketorolac)	Generic
What is the generic name? What is the brand name?	Generic: ketorolac (ketorolac tromethamine)	Brand: Ultram
What form(s) does the drug come in?	IV and IM injections, tablet, nasal spray	Tablet, extended-release capsule, extended-release tablet
What is the standard dosage?	Tablet used as a continuation of IV or IM ketorolac. 20 mg once, then 10 mg every 4 to 6 hours as needed. Maximum of 40 mg per day Not to exceed 5 total days of treatment	The dose is slowly titrated up to 50 mg to 100 mg every 4 to 6 hours Maximum of 400 mg per day
How long is the typical treatment?	5 days or less	Short-term, some patients continue for longer based on prescriber’s direction
Who typically uses the medication?	People age 17 years and older	People age 17 years and older

Conditions treated by Toradol and Tramadol

Toradol is indicated in adults for the short-term management of moderately severe acute pain, usually in a post-op (after surgery) setting, that requires opioid level pain relief. The total length of treatment with Toradol should not exceed five days.

Tramadol is indicated in adults who have moderate to moderately severe pain that requires an opioid pain reliever, when non-opioid alternatives are not adequate or not tolerated.

Condition	Toradol	Tramadol
Short-term (5 days or less) management of moderately severe acute pain requiring opioid level analgesia, usually in a postoperative setting	Yes	No
Moderate to moderately severe pain in adults (severe enough to require an opioid analgesic, when other treatments are not adequate or tolerated)	No	Yes

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. 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, in Mexico, 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.

Even though one study concluded tramadol was better, and one study concluded that Toradol was better, both studies were done in other countries where tramadol was given by injection into the muscle.

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

The most effective drug for you should be determined by your healthcare provider, who is the best source of medical advice. He or she can take into account your medical history and conditions 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 for generic Toradol (20, 10 mg tablets) is about $50. With a SingleCare coupon the generic medications starts at $18.

Tramadol is usually covered by insurance and Medicare Part D. The out-of-pocket cost of tramadol (60, 50 mg tablets) is approximately $43. You can get tramadol with a SingleCare discount coupon for $12 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	60, 50 mg tablets
Typical Medicare Part D copay	$15-239	$0-$47
SingleCare cost	$18-$38	$12-$20

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Common side effects of Toradol vs. tramadol

The most common side effects of Toradol are gastrointestinal (GI) in nature, including abdominal pain, indigestion, and nausea. Other GI adverse effects can occur, such as constipation, diarrhea, and vomiting. Headaches also can commonly occur with Toradol.

The most common side effects of tramadol are nausea, constipation, headache, dizziness, and drowsiness.

This is not a full list of potential side effects. Other adverse events may occur. Consult your healthcare provider for more information about side effects.

	Toradol		Tramadol
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Abdominal pain	Yes	>10%	Yes	1-5%
Indigestion	Yes	>10%	Yes	5-13%
Nausea	Yes	>10%	Yes	24-40%
Constipation	Yes	1-10%	Yes	24-46%
Diarrhea	Yes	1-10%	Yes	5-10%
Vomiting	Yes	1-10%	Yes	9-17%
Headache	Yes	>10%	Yes	18-32%
Itching	Yes	1-10%	Yes	8-11%
Dizziness	Yes	1-10%	Yes	26-33%
Drowsiness	Yes	1-10%	Yes1	16-25%

Source: DailyMed (Toradol/ketorolac), DailyMed (tramadol)

Drug interactions of Toradol vs. tramadol

Toradol may interact with anticoagulants such as heparin or warfarin, and patients should 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 should not be taken with certain blood pressure medications (ACE 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 bleed and should be avoided.

Tramadol should not be taken with benzodiazepines, other CNS depressant medications, or alcohol. Tramadol should not be taken with drugs that increase serotonin (SSRI, SNRI, or tricyclic antidepressants; triptans; muscle relaxants; and MAO inhibitors) because the combination could cause a life-threatening condition called serotonin syndrome. Tramadol should be separated by an MAOI by at least 14 days. Tramadol also interacts with drugs that are enzyme inducers or inhibitors.

This is not a full list of drug interactions. Other drug interactions may occur. Consult your healthcare provider for a full list of prescription and OTC drug interactions with Toradol and tramadol.

Drug	Drug Class	Toradol	Tramadol
Heparin Warfarin	Anticoagulants	Yes	Yes (warfarin)
Aspirin Ibuprofen Meloxicam Nabumetone Naproxen	NSAIDs	Yes	No
Furosemide Hydrochlorothiazide	Diuretics	Yes	Yes
Lithium	Antimanic agent	Yes	Yes
Methotrexate	Antimetabolite	Yes	Yes
Benazepril Candesartan Enalapril Irbesartan Lisinopril Losartan Ramipril Telmisartan Valsartan	ACE inhibitors ARB (angiotensin receptor blockers)	Yes	Yes
Carbamazepine Phenytoin	Antiepileptic drugs	Yes	Yes
Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline	SSRI antidepressants	Yes	Yes
Alprazolam Clonazepam Diazepam Temazepam	Benzodiazepines	Yes (clonazepam and diazepam)	Yes
Codeine Fentanyl Hydrocodone Methadone Morphine Oxycodone	Opioids	No	Yes
Alcohol	Alcohol	Yes	Yes
Duloxetine Desvenlafaxine Venlafaxine	SNRI antidepressants	Yes	Yes
Amitriptyline Desipramine Imipramine Nortriptyline	Tricyclic antidepressants	Yes	Yes
Rizatripta Sumatriptan	Triptans	Yes	Yes
Baclofen Cyclobenzaprine Metaxalone	Muscle relaxants	No	Yes
Phenelzine Selegiline Tranylcypromine	MAOI (MAO inhibitors)	No	Yes (separate use by at least 14 days)
Digoxin	Cardiac glycoside	No	Yes
Benztropine Dicyclomine Diphenhydramine Tolterodine	Anticholinergic drugs	No	Yes
Clarithromycin Erythromycin Fluconazole Ketoconazole Ritonavir	CYP3A4 inhibitors	No	Yes
Bupropion Fluoxetine Paroxetine Quinidine	CYP2D6 inhibitors	Yes (bupropion, fluoxetine, paroxetine)	Yes

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 chance 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 duration of treatment.
• Toradol (ketorolac) should not be used:
  • in the setting of 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 patients who are 65 years or older, patients who weigh under 110 lbs, and patients with elevated serum creatinine.
• Toradol (ketorolac) may cause an anaphylactic reaction, which could be fatal. Patients with Samter’s triad 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 opioids, 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, or 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, 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, 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?

No. 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?

No. 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?

In some patients, Toradol causes drowsiness. This 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.