From the Guidelines
Intramuscular Toradol (ketorolac) should be administered at a dose of 60 mg every 15 to 30 minutes, with a maximum daily dose of 120 mg and a maximum duration of therapy of 5 days. This recommendation is based on the evidence provided by the American Family Physician study 1. The dosing frequency of every 15 to 30 minutes is crucial for managing acute pain effectively.
Key Considerations
- The maximum daily dose should not exceed 120 mg, and the treatment should not be extended beyond 5 days to minimize the risk of adverse effects such as gastrointestinal bleeding, renal dysfunction, and cardiovascular events.
- For patients with specific conditions such as aspirin/NSAID-induced asthma, pregnancy, or cerebrovascular hemorrhage, Toradol is contraindicated.
- Common adverse reactions include edema, drowsiness, dizziness, GI upset, and increased diaphoresis, which should be monitored closely.
Patient-Specific Adjustments
- While the provided evidence does not specify dose adjustments for elderly patients, those with renal impairment, or patients weighing less than 50 kg, clinical judgment suggests that such patients may require reduced doses, similar to the example provided, to mitigate potential risks.
- It is essential to assess the patient's renal function, history of peptic ulcer disease, bleeding disorders, and concurrent use of other NSAIDs or anticoagulants before administering Toradol to ensure safe use.
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 intramuscular (IM) administration of Toradol (Ketorolac) is every 6 hours.
- For patients <65 years of age: 30 mg every 6 hours, with a maximum daily dose of 120 mg.
- For patients ≥65 years of age, renally impaired patients, and patients less than 50 kg (110 lbs): 15 mg every 6 hours, with a maximum daily dose of 60 mg 2.
From the Research
Recommended Dosing Frequency for Intramuscular (IM) Administration of Toradol (Ketorolac)
The recommended dosing frequency for intramuscular (IM) administration of Toradol (Ketorolac) 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.
Important Considerations
- Ketorolac should be prescribed at the lowest dosage necessary to control pain; the duration of therapy should also be limited to as few days as possible 4.
- Careful patient selection is essential if use of ketorolac is considered, and contraindications to ketorolac use include a history of, or current risk of, gastrointestinal bleeding, risk of renal failure, compromised haemostasis, hypersensitivity to aspirin (acetylsalicylic acid) or other NSAIDs, labour, delivery and nursing 4.
Special Populations
- In children, the recommended intravenous dosage of ketorolac is 0.5 mg/kg, followed either 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 90mg, and the maximum duration of treatment is 48 hours 5.
- Intramuscular injections are not recommended in children, unless the intravenous route is unavailable 5.