What is the recommended dosing frequency for Toradol (Ketorolac) intramuscular (IM) injections?

From the Guidelines

Toradol (Ketorolac) IM injections should be administered no more frequently than every 15 to 30 minutes, with a maximum daily dose of 120 mg and a maximum duration of therapy not exceeding five days, as indicated in the study published in the American Family Physician in 2002 1. The recommended dosing frequency for Toradol (Ketorolac) intramuscular (IM) injections is based on the medication's efficacy and safety profile.

• The typical IM dosing is 60 mg every 15 to 30 minutes, with a maximum daily dose of 120 mg.
• Treatment should not exceed five days, as prolonged use can increase the risk of serious adverse effects.
• It's essential to use the lowest effective dose for the shortest duration possible to minimize the risk of complications such as gastrointestinal bleeding, cardiovascular events, and renal dysfunction.
• Patients should be monitored for signs of these complications, and Toradol should not be used concurrently with other NSAIDs or in patients with certain conditions such as advanced renal disease, history of peptic ulcer disease, or high risk for bleeding, as noted in the study 1. The medication's efficacy and safety profile, as well as its potential risks and benefits, should be carefully considered when determining the appropriate dosing frequency for Toradol (Ketorolac) IM injections.
• The study published in the American Family Physician in 2002 1 provides guidance on the recommended dosing frequency and maximum daily dose for Toradol (Ketorolac) IM injections.
• Healthcare providers should consult the latest clinical guidelines and manufacturer's recommendations for the most up-to-date information on the safe and effective use of Toradol (Ketorolac) IM injections.

From the FDA Drug Label

The recommended dose is 30 mg ketorolac tromethamine injection every 6 hours. The maximum daily dose for these populations should not exceed 120 mg 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 maximum daily dose for these populations should not exceed 60 mg.

The recommended dosing frequency for Toradol (Ketorolac) intramuscular (IM) injections is:

• Every 6 hours for patients <65 years of age, with a maximum daily dose of 120 mg.
• Every 6 hours for patients ≥65 years of age, renally impaired patients, and patients less than 50 kg (110 lbs), with a maximum daily dose of 60 mg 2.

From the Research

Recommended Dosing Frequency for Toradol (Ketorolac) IM Injections

The recommended dosing frequency for Toradol (Ketorolac) intramuscular (IM) injections is as follows:

• A 30- or 60-mg intramuscular (IM) loading dose, followed by 15- or 30-mg doses IM every 6 hours, with a maximum first-day dose of 150 mg and 120 mg on subsequent days up to a recommended maximum of 5 days 3.
• The lower dose range is recommended for elderly patients, patients weighing less than 50 kg, and patients with impaired kidney function 3.

Considerations for Dosing

Considerations for dosing include:

• The risk of adverse events, such as gastrointestinal bleeding and renal impairment, increases with high doses, prolonged therapy (>5 days), or in vulnerable patients (e.g., the elderly) 4.
• Ketorolac should be prescribed at the lowest dosage necessary to control pain, and the duration of therapy should be limited to as few days as possible 4.
• The use of ketorolac has been associated with an increased risk of upper gastrointestinal tract bleeding, particularly with higher daily doses 5.

Alternative Dosing Regimens

Alternative dosing regimens have been studied, including:

• A noninferiority randomized controlled trial comparing intravenous ketorolac at three doses (10,20, and 30 mg) for treating renal colic in the emergency department, which found similar analgesic efficacy among the three doses 6.
• A retrospective chart review of ED patients 65 years and older who received at least one dose of parenteral ketorolac, which found that parenteral ketorolac doses of 15 mg IV or 30 mg IM did not demonstrate a greater need for rescue analgesia compared to doses of 30 mg IV or 60 mg IM 7.