What are the administration instructions for ketorolac (Toradol) injection?

Ketorolac Injection Administration Instructions

Ketorolac tromethamine injection should be administered intramuscularly by injecting slowly and deeply into the muscle, or intravenously over no less than 15 seconds, with a maximum treatment duration of 5 days. 1

Dosing Guidelines

Intramuscular (IM) Administration

• Patients <65 years of age:

  • Single-dose treatment: 60 mg
  • Multiple-dose treatment: 30 mg every 6 hours (maximum daily dose: 120 mg)

• Patients ≥65 years, renally impaired, or <50 kg (110 lbs):

  • Single-dose treatment: 30 mg
  • Multiple-dose treatment: 15 mg every 6 hours (maximum daily dose: 60 mg)

Intravenous (IV) Administration

• Patients <65 years of age:

  • Single-dose treatment: 30 mg
  • Multiple-dose treatment: 30 mg every 6 hours (maximum daily dose: 120 mg)

• Patients ≥65 years, renally impaired, or <50 kg (110 lbs):

  • Single-dose treatment: 15 mg
  • Multiple-dose treatment: 15 mg every 6 hours (maximum daily dose: 60 mg)

Clinical Effects Timeline

• Onset of action: ~30 minutes
• Peak analgesic effect: 1-2 hours after administration
• Duration of analgesic effect: 4-6 hours 1

Important Precautions

Contraindications

• Active peptic ulcer disease
• Recent gastrointestinal bleeding
• Advanced renal impairment or risk of renal failure
• History of hypersensitivity to aspirin or NSAIDs
• Cerebrovascular bleeding
• Hemorrhagic diathesis
• Incomplete hemostasis
• High risk of bleeding
• Pregnancy 2, 1

Renal Considerations

• Hypovolemia should be corrected prior to administration
• Monitor blood pressure, BUN, creatinine, and liver function tests at baseline and periodically
• Discontinue immediately if BUN or creatinine doubles or if hypertension develops/worsens 3, 1

Compatibility Information

Ketorolac should NOT be mixed in a small volume (e.g., in a syringe) with:

• Morphine sulfate
• Meperidine hydrochloride
• Promethazine hydrochloride
• Hydroxyzine hydrochloride

This will result in precipitation of ketorolac from solution 1.

Clinical Pearls

1. Inspect solution visually for particulate matter and discoloration before administration
2. For breakthrough pain, do not increase the dose or frequency of ketorolac
3. Consider supplementing with low doses of opioids "prn" unless contraindicated
4. Patients should be switched to alternative analgesics as soon as possible
5. Ketorolac therapy should not exceed 5 days 1

Pediatric Considerations

For children, the recommended intravenous dosage is:

• Initial dose: 0.5 mg/kg
• Followed by either:
  • Bolus injections of 1.0 mg/kg every 6 hours, or
  • IV infusion of 0.17 mg/kg/h
• Maximum daily dose: 90 mg
• Maximum duration: 48 hours
• Not recommended for infants <1 year of age 4

Remember that despite common practice of using higher doses, research suggests that ketorolac exhibits an analgesic ceiling effect, with 10 mg possibly being the ceiling dose 5. However, the FDA-approved dosing as outlined above should be followed for safe administration.