What is the recommended dosing for Toradol (ketorolac) for moderate to severe pain management?

From the Guidelines

Ketorolac (Toradol) for moderate to severe pain is typically dosed at 15-30mg IV or 30mg IM as a single initial dose, followed by 15-30mg IV/IM every 6 hours as needed, not to exceed 120mg total daily dose, with a maximum duration of 5 days total across all routes of administration due to increased risk of serious adverse effects with longer use 1.

Key Considerations

• The recommended dose for oral administration is 10mg every 4-6 hours, not exceeding 40mg daily.
• Elderly patients, those under 50kg, or patients with renal impairment should receive reduced doses (typically half the standard dose) 1.
• Ketorolac works by inhibiting cyclooxygenase enzymes, reducing prostaglandin synthesis and thereby decreasing pain and inflammation.
• It should be used cautiously in patients with renal impairment, history of GI bleeding, cardiovascular disease, or those on anticoagulants.
• Common side effects include GI irritation, renal impairment, and increased bleeding risk.
• Concurrent use with aspirin or other NSAIDs should be avoided.

Important Warnings

• Ketorolac should be limited to short-term use only, with a maximum duration of 5 days total across all routes of administration due to increased risk of serious adverse effects with longer use 1.
• Patients at high risk for renal, GI, cardiac toxicities, thrombocytopenia, or bleeding disorder should use NSAIDs with caution 1.

Administration

• IV administration: 15-30mg every 6 hours as needed, not to exceed 120mg total daily dose.
• IM administration: 30mg as a single initial dose, followed by 15-30mg every 6 hours as needed, not to exceed 120mg total daily dose.
• Oral administration: 10mg every 4-6 hours, not exceeding 40mg daily.

From the FDA Drug Label

KETOROLAC TROMETHAMINE INJECTION Ketorolac tromethamine injection may be used as a single or multiple dose on a regular or “prn” schedule for the management of moderately severe, acute pain that requires analgesia at the opioid level, usually in a postoperative setting. Single-Dose Treatment: The following regimen should be limited to single administration use only 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. Intravenous Dosing Patients <65 years of age: One dose of 30 mg. Patients ≥65 years of age, renally impaired and/or less than 50 kg (110 lbs) of body weight: One dose of 15 mg Multiple-Dose Treatment (Intravenous or Intramuscular) Patients <65 years of age: 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 for Toradol (ketorolac) for moderate to severe pain management is as follows:

• Single-Dose Treatment:
  • Intramuscular: 60 mg for patients <65 years of age, and 30 mg for patients ≥65 years of age, renally impaired and/or less than 50 kg (110 lbs) of body weight.
  • Intravenous: 30 mg for patients <65 years of age, and 15 mg for patients ≥65 years of age, renally impaired and/or less than 50 kg (110 lbs) of body weight.
• Multiple-Dose Treatment:
  • Patients <65 years of age: 30 mg every 6 hours, not to exceed 120 mg per day.
  • Patients ≥65 years of age, renally impaired patients, and patients less than 50 kg (110 lbs): 15 mg every 6 hours, not to exceed 60 mg per day 2.

From the Research

Toradol Dosing for Moderate to Severe Pain Management

The recommended dosing for Toradol (ketorolac) varies depending on the patient population and the route of administration.

• For adults with moderate to severe acute pain, a single dose of 10 mg, 15 mg, or 30 mg of intravenous ketorolac has been shown to be effective in reducing pain 3.
• In children, the recommended intravenous dosage of ketorolac is 0.5 mg/kg, followed by bolus injections of 1.0 mg/kg every 6 hours or an intravenous infusion of 0.17 mg/kg/h, with a maximum daily dosage of 90 mg and a maximum duration of treatment of 48 hours 4.
• For postoperative pain management in adults, a single dose of intravenous ketorolac (usually 30 mg) has been compared to placebo or other NSAIDs, with results suggesting that ketorolac provides substantial pain relief, but with a slightly higher rate of adverse events 5.
• In patients with pain following orthopaedic surgery, 10-mg doses of ketorolac in intramuscular injections followed by 10-mg doses of oral ketorolac have been shown to be as effective as Ketogan, a combination product containing a narcotic analgesic and a spasmolytic agent 6.
• The National Football League Physician Society Task Force recommends that ketorolac be used in the lowest effective therapeutic dose, not for more than 5 days, and under the direct supervision and order of a team physician, with specific guidelines for its use in professional football players 7.

Key Considerations

• The dosing and administration of Toradol should be individualized based on the patient's medical history, current condition, and response to treatment.
• Ketorolac should be used with caution in patients with certain medical conditions, such as gastrointestinal bleeding, renal compromise, or a history of allergic reactions to NSAIDs.
• The use of ketorolac should be monitored for potential adverse events, such as dizziness, nausea, and headache, and adjusted accordingly.