Recommended Intramuscular (IM) Dose of Toradol (Ketorolac)
The recommended IM dose of Toradol (ketorolac) for moderate to severe pain is 60 mg as a single dose for patients under 65 years of age, and 30 mg for patients who are elderly (≥65 years), renally impaired, or weighing less than 50 kg. 1
Dosing Guidelines
Single-Dose Treatment
- Patients <65 years: 60 mg IM as a single dose
- Patients ≥65 years, renally impaired, or <50 kg: 30 mg IM as a single dose
Multiple-Dose Treatment
- Patients <65 years: 30 mg IM every 6 hours (maximum daily dose: 120 mg)
- Patients ≥65 years, renally impaired, or <50 kg: 15 mg IM every 6 hours (maximum daily dose: 60 mg)
Administration Considerations
- Administer slowly and deeply into the muscle 1
- Onset of analgesic effect begins in approximately 30 minutes
- Maximum effect occurs in 1-2 hours after administration
- Duration of analgesic effect is usually 4-6 hours
- Treatment duration should not exceed 5 days 1
Important Precautions
Contraindications
- History of peptic ulcer disease
- GI bleeding or perforation
- Advanced renal impairment or risk of renal failure
- Cerebrovascular bleeding
- Hemorrhagic diathesis/coagulation disorders
- Pregnancy
- Concurrent use with aspirin or other NSAIDs 2
Risk Factors Requiring Dose Adjustment
- Elderly patients (≥65 years)
- Renal impairment
- Weight <50 kg
- Cardiovascular disease
- Concomitant anticoagulant therapy 2
Monitoring
- Baseline monitoring should include:
- Blood pressure
- Renal function tests (BUN, creatinine)
- Liver function tests
- Complete blood count
- Coagulation profile
- Fecal occult blood test 2
Adverse Effects
- GI upset, bleeding, and perforation (risk increases with higher doses and longer duration)
- Acute renal failure (usually reversible upon discontinuation)
- Inhibition of platelet aggregation and increased bleeding time
- Edema, drowsiness, and dizziness 2
Clinical Pearls
- For breakthrough pain, do not increase the dose or frequency of ketorolac
- Consider supplementing with low doses of opioids "prn" unless contraindicated 1
- Ketorolac should not be mixed in a small volume (e.g., in a syringe) with morphine sulfate, meperidine hydrochloride, promethazine hydrochloride, or hydroxyzine hydrochloride, as this will result in precipitation 1
- Hypovolemia should be corrected prior to administration 1
Ketorolac provides effective analgesia for moderate to severe pain with the advantage of not causing respiratory depression, sedation, nausea/vomiting, or urinary retention that are commonly associated with opioid analgesics 3. When used appropriately at recommended doses with attention to contraindications and precautions, it can be an effective component of multimodal pain management.