What is the difference in dosing between Toradol (Ketorolac) 15mg intramuscularly (IM) and 30mg intramuscularly (IM)?

From the Guidelines

The difference between 15mg and 30mg IM Toradol (ketorolac) doses is significant, with the 30mg dose providing greater pain relief, but also potentially increasing the risk of side effects, as indicated by the dosage guidelines in the study 1. When considering the dosing of Toradol IM, it's essential to weigh the benefits of pain relief against the potential risks of adverse reactions.

• The standard single dose for moderate to severe acute pain in most adults is 30mg IM, while 15mg may be more suitable for older patients (>65 years), those with renal impairment (creatinine clearance <30mL/min), or patients weighing less than 50kg, as these populations may be more susceptible to the adverse effects of the medication 1.
• The duration of action for both doses remains similar, lasting around 4-6 hours, which is a crucial consideration for managing acute pain effectively.
• Toradol works by inhibiting prostaglandin synthesis through COX enzyme blockade, reducing inflammation and pain, which is a key mechanism in providing relief for patients suffering from acute pain conditions.
• It's critical to limit the use of Toradol to short-term (≤5 days) due to the increased risk of gastrointestinal bleeding and renal complications associated with longer use, highlighting the need for careful patient monitoring and dose adjustment as necessary 1.
• Common side effects include nausea, dyspepsia, and dizziness, with risks increasing at higher doses, especially in elderly patients or those with compromised kidney function, underscoring the importance of dose selection based on individual patient factors.

From the FDA Drug Label

Single-Dose Treatment: ... Intramuscular Dosing ... Patients <65 years of age: One dose of 60 mg ... Patients ≥65 years of age, renally impaired and/or less than 50 kg (110 lbs) of body weight: One dose of 30 mg. Multiple-Dose Treatment (Intravenous or Intramuscular) ... Patients <65 years of age: The recommended dose is 30 mg ketorolac tromethamine injection every 6 hours. ... For patients ≥65 years of age, renally impaired patients (see WARNINGS), and patients less than 50 kg (110 lbs): The recommended dose is 15 mg ketorolac tromethamine injection every 6 hours.

The dosing of Toradol (ketorolac) IM is 15mg or 30mg, with the choice of dose depending on the patient's age, weight, and renal function.

• For patients <65 years of age, the recommended dose is 30mg every 6 hours.
• For patients ≥65 years of age, renally impaired, or <50kg, the recommended dose is 15mg every 6 hours. There is a significant difference in the recommended dosing of Toradol IM between these two patient populations, with the 30mg dose being recommended for younger, healthier patients and the 15mg dose being recommended for older, renally impaired, or smaller patients 2.

From the Research

Dosing Comparison of Toradol IM 15mg vs 30mg

• The study 3 compared the analgesic efficacy of three doses of intravenous ketorolac (10,15, and 30 mg) in patients with acute pain, and found that there were no significant differences in pain reduction between the groups at 30 minutes.
• The mean numeric rating scale pain scores at baseline were similar across the groups, and improved to similar levels at 30 minutes, regardless of the dose used.
• The rates of rescue analgesia were also similar between the groups, suggesting that the higher dose of 30mg did not provide a significant advantage over the lower dose of 15mg.
• Another study 4 noted that the risk of adverse events associated with ketorolac increases with high doses, prolonged therapy, or in vulnerable patients, which may suggest that using the lower dose of 15mg could be beneficial in reducing the risk of adverse effects.
• However, it is essential to consider the individual patient's needs and medical history when determining the appropriate dose of ketorolac, as the optimal dose may vary depending on the specific clinical context 5.

Key Findings

• No significant difference in pain reduction between 10,15, and 30 mg doses of intravenous ketorolac at 30 minutes 3.
• Similar rates of rescue analgesia and adverse effects between the different dose groups 3.
• Higher doses of ketorolac may increase the risk of adverse events, particularly in vulnerable patients 4.

Clinical Implications

• The choice of dose for toradol IM should be based on individual patient needs and medical history.
• Using the lowest effective dose of ketorolac may help minimize the risk of adverse effects 4, 5.