Can I administer Toradol (ketorolac) 30mg intravenous push (IVP)?

Ketorolac (Toradol) IV Push Administration Guidelines

Ketorolac 30mg IVP should not be administered as it exceeds the recommended single intravenous dose of 15-30mg, which should be given over 15-30 minutes rather than as a rapid push. 1

Appropriate IV Administration of Ketorolac

Ketorolac tromethamine (Toradol) is a potent non-steroidal anti-inflammatory drug (NSAID) with significant analgesic properties. When administering intravenously, follow these guidelines:

• Correct dosing:

  • Initial IV dose: 15-30mg 2
  • Administer over 15-30 minutes (not as a rapid IV push) 1
  • Maximum daily dose: 120mg 2
  • Treatment duration: Not to exceed 5 days 3

• Administration method:

  • Dilute and administer as a slow IV infusion over 15-30 minutes
  • Rapid IV push administration increases risk of adverse effects including pain at injection site and potential cardiovascular complications

Patient Selection and Contraindications

Ketorolac should only be used in appropriate patients:

• Contraindications:

  • Aspirin/NSAID-induced asthma
  • Pregnancy
  • Cerebrovascular hemorrhage
  • Bleeding disorders
  • Significant gastrointestinal bleeding history
  • Renal compromise
  • Concurrent use with other NSAIDs 2, 3

• Use with caution in:

  • Elderly patients (reduced clearance, increased half-life from 5 to 7 hours) 1
  • Patients with hepatic or renal impairment
  • Patients with cardiovascular disease (risk of thrombotic events) 1

Efficacy and Clinical Applications

Ketorolac is effective for:

• Moderate to severe acute pain management 2
• Postoperative pain (rated 3 out of 4 for efficacy in clinical studies) 2
• Reducing opioid requirements when used as part of multimodal analgesia 1

Adverse Effects and Monitoring

Monitor for these potential adverse effects:

• Common side effects:

  • Edema
  • Drowsiness
  • Dizziness
  • GI upset
  • Increased diaphoresis 2

• Serious concerns:

  • Renal effects: Monitor renal function, especially in at-risk patients
  • GI bleeding: Higher risk in elderly and those with prior GI issues
  • Cardiovascular events: Risk of thrombotic events, particularly with prolonged use
  • Anaphylactic reactions (rare but potentially fatal) 4

Alternative Approaches

If ketorolac is contraindicated or inappropriate:

• Alternative analgesics:
  • Other NSAIDs (ibuprofen, naproxen) with appropriate dosing 2
  • Acetaminophen (oral or IV)
  • Opioid analgesics for severe pain (morphine, hydromorphone) 2
  • Adjunctive medications (metoclopramide, prochlorperazine) 2

Key Takeaway

Ketorolac is a potent analgesic, but proper administration technique is crucial for safety. The 30mg dose should be administered as a slow IV infusion over 15-30 minutes, not as a rapid IV push. Always verify appropriate patient selection, contraindications, and monitor for adverse effects.