What is the frequency of administration for intravenous (IV) ketorolac (Toradol)?

From the Guidelines

Toradol (ketorolac) can be given intravenously every 15 to 30 minutes, with a maximal dosage of 120 mg per day, and treatment should not exceed five days 1.

Key Considerations

• The dosage of Toradol IV is 60 mg, and it can be repeated every 15 to 30 minutes as needed 1.
• The maximal daily dosage of Toradol IV should not exceed 120 mg 1.
• Treatment with Toradol IV should not exceed five days 1.

Important Safety Information

• Toradol is contraindicated in patients with aspirin/NSAID-induced asthma, pregnancy, and cerebrovascular hemorrhage 1.
• Common adverse reactions to Toradol include edema, drowsiness, dizziness, GI upset, and increased diaphoresis 1.

Clinical Guidance

• Before administering Toradol IV, assess for contraindications and ensure adequate hydration to minimize renal risks.
• For patients requiring longer pain management, transition to alternative analgesics should be planned due to the 5-day limit of Toradol therapy.
• It is essential to carefully monitor the use of Toradol IV, especially in patients with impaired renal function or those at risk of gastrointestinal bleeding 1.

From the FDA Drug Label

The clearance of the racemate in normal subjects, elderly individuals and in hepatically and renally impaired patients is outlined in Table 2 Accumulation Ketorolac tromethamine administered as an intravenous bolus, every 6 hours, for 5 days, to healthy subjects (n = 13), showed no significant difference in Cmax on Day 1 and Day 5. Intravenous-Administration: In normal subjects (n=37), the total clearance of 30 mg intravenous-administered Ketorolac Tromethamine was 0.030 (0.017-0.051) L/h/kg. The terminal half-life was 5.6 (4.0-7.9) hours.

The recommended dosing interval for intravenous administration of ketorolac is every 6 hours 2.

• The terminal half-life of ketorolac tromethamine is approximately 5.6 hours.
• Accumulation of ketorolac tromethamine has been studied in healthy subjects, with no significant difference in Cmax on Day 1 and Day 5 when administered every 6 hours for 5 days 2.

From the Research

Administration Frequency of Toradol IV

The frequency of administering Toradol (ketorolac) intravenously depends on various factors, including the patient's condition, pain severity, and medical history.

• According to the study 3, the risk of adverse events increases with high doses or prolonged therapy (>5 days).
• The study 4 also mentions that the risk of adverse events increases with high doses or prolonged therapy, especially in vulnerable patients such as the elderly.
• A randomized controlled trial 5 compared the analgesic efficacy of three single-dose regimens of intravenous ketorolac (10,15, and 30 mg) for treating acute pain in the emergency department, and found that all three doses provided similar pain reduction at 30 minutes.
• However, another study 6 found that current use of ketorolac was associated with a distinctly elevated risk of gastroduodenal lesions, highlighting the need for careful patient selection and dosage guidelines.

Dosage Guidelines

• The study 3 recommends prescribing ketorolac at the lowest dosage necessary to control pain and limiting the duration of therapy to as few days as possible.
• The study 4 also emphasizes the importance of following label warnings and dosage guidelines to minimize the risk of adverse events.
• The randomized controlled trial 5 suggests that intravenous ketorolac administered at the analgesic ceiling dose (10 mg) provides effective pain relief without increased adverse effects.

Patient Selection

• The study 3 highlights the importance of careful patient selection, excluding patients with a history of gastrointestinal bleeding, risk of renal failure, compromised haemostasis, or hypersensitivity to aspirin or other NSAIDs.
• The study 4 also emphasizes the need for careful patient selection, particularly in vulnerable patients such as the elderly.
• The study 6 found that current use of ketorolac was associated with a higher risk of gastroduodenal lesions, highlighting the need for careful patient selection and monitoring.