Recommended Dosing Frequency for IM Toradol (Ketorolac)
IM ketorolac should be administered no more frequently than every 6 hours, with a maximum daily dose of 120 mg for patients under 65 years and 60 mg for patients 65 years or older, and treatment duration must not exceed 5 days. 1
Dosing Guidelines
Standard Dosing Regimen
Patients <65 years of age:
- 30 mg IM every 6 hours
- Maximum daily dose: 120 mg 1
Patients ≥65 years, renally impaired, or <50 kg (110 lbs):
- 15 mg IM every 6 hours
- Maximum daily dose: 60 mg 1
Single-Dose Treatment
Patients <65 years of age:
- One dose of 60 mg IM 1
Patients ≥65 years, renally impaired, or <50 kg (110 lbs):
- One dose of 30 mg IM 1
Important Considerations
Duration Limitations
- Treatment with ketorolac must not exceed 5 days total 1
- This strict limitation is critical to minimize risk of serious adverse effects
Pharmacokinetics
- Onset of analgesic effect: ~30 minutes
- Maximum effect: 1-2 hours after administration
- Duration of analgesic effect: 4-6 hours 1
Contraindications
- Aspirin/NSAID-induced asthma
- Pregnancy
- Cerebrovascular hemorrhage
- Hypovolemia (must be corrected prior to administration) 2, 1
Common Adverse Effects
- Edema
- Drowsiness
- Dizziness
- GI upset
- Increased diaphoresis 2
Clinical Pearls and Pitfalls
Important Warnings
- Never exceed 5 days of treatment - this is a strict limitation to prevent serious adverse effects
- Do not administer concurrently with other NSAIDs
- Avoid in patients with renal impairment, active peptic ulcer disease, or bleeding disorders
- Correct hypovolemia before administration 1
Administration Technique
- IM injections should be given slowly and deeply into the muscle 1
- For breakthrough pain, do not increase the frequency of ketorolac; consider supplementing with low doses of opioids if not contraindicated 1
Compatibility Issues
- Do not mix ketorolac in a small volume (e.g., in a syringe) with morphine sulfate, meperidine hydrochloride, promethazine hydrochloride, or hydroxyzine hydrochloride as this will cause precipitation 1
By adhering to these dosing guidelines and precautions, ketorolac can provide effective pain management while minimizing the risk of adverse effects.