Recommended Dosing of Toradol and Rizatriptan for 13-Year-Old Female with Headache
For a 13-year-old female weighing 60.8kg with a 2-week headache, the recommended dose of Toradol (ketorolac) IV is 0.5mg/kg (maximum 30mg), and Rizatriptan (Maxalt) 10mg orally as a single dose.
Rizatriptan (Maxalt) Dosing
Recommended Dosing:
- For adolescents weighing ≥40kg (88lb): 10mg as a single dose 1
- For adolescents weighing <40kg: 5mg as a single dose 1
- Since this patient weighs 60.8kg, the 10mg dose is appropriate
Key Considerations:
- Maximum daily dose should not exceed 30mg in any 24-hour period 1
- A second dose may be administered 2 hours after the first dose if headache returns 1
- The safety of treating more than 4 headaches in a 30-day period has not been established 2
- Rizatriptan is strongly recommended by VA/DoD guidelines for short-term treatment of migraine 3
- Efficacy data shows that at 2 hours post-dose, up to 74% of patients experience pain relief with 10mg rizatriptan 4
Special Precautions:
- If the patient is taking propranolol, only a single 5mg dose of rizatriptan is recommended (maximum 5mg in 24 hours) 1
- For patients with significant nausea/vomiting, consider the orally disintegrating tablet formulation 2
Ketorolac (Toradol) IV Dosing
Recommended Dosing:
- For adolescents: 0.5mg/kg IV (maximum 30mg)
- Single dose administration is preferred for acute headache management
- Maximum duration of therapy should not exceed 5 days due to risk of adverse effects
Key Considerations:
- Ketorolac should be used at the lowest effective dose for the shortest duration
- Monitor for potential side effects including:
- Gastrointestinal bleeding or ulceration
- Renal impairment
- Increased risk of cardiovascular events
Treatment Algorithm
First-line therapy: Rizatriptan 10mg orally (due to patient's weight >40kg)
- If oral administration is difficult due to nausea/vomiting, consider orally disintegrating tablet formulation
- May repeat dose after 2 hours if needed (maximum 30mg/24 hours)
For severe pain or significant nausea/vomiting: Ketorolac IV 0.5mg/kg (30mg maximum)
- Single dose administration
- May be combined with an antiemetic if needed
For persistent headache: Consider combination therapy
Important Caveats
- The 2-week duration of headache warrants further investigation for secondary causes
- Medication overuse headache should be considered if analgesics have been used frequently
- Assess for high-risk factors including anxiety, depression, and medication overuse 3
- Consider prophylactic therapy if headaches are frequent (≥7 days/month) 3
Remember to evaluate the patient for red flags that might indicate secondary headache requiring further workup, especially given the 2-week duration of symptoms.