What is the recommended dose of Toradol (ketorolac) for fever management?

Ketorolac Is Not Recommended for Fever Management

Ketorolac (Toradol) is not indicated or recommended for fever management. Ketorolac is a potent NSAID primarily indicated for short-term management of moderate to severe pain, not for antipyretic purposes.

Appropriate Indications for Ketorolac

Ketorolac is FDA-approved for:

• Short-term management of moderate to severe pain
• Maximum duration of 5 days total therapy
• Only as continuation therapy following IV/IM administration

According to the FDA drug label, ketorolac should be used at the lowest effective dose for the shortest duration consistent with individual patient treatment goals 1.

Dosing Information (Not for Fever)

While ketorolac is not recommended for fever management, its standard dosing for pain is:

• Adults age 17-64 years: 20 mg PO once, followed by 10 mg every 4-6 hours as needed, not exceeding 40 mg/day 1
• Adults ≥65 years, renally impaired, or weight <50 kg: 10 mg PO once, followed by 10 mg every 4-6 hours as needed, not exceeding 40 mg/day 1

Recommended Antipyretics for Fever Management

For fever management, the following medications are recommended instead:

1. Acetaminophen (Paracetamol):

   • Adults: 650-1000 mg every 4-6 hours, not exceeding 4000 mg/day
   • Children: 15 mg/kg every 4-6 hours

2. Ibuprofen:

   • Adults: 200-400 mg every 4-6 hours
   • Children: 5-10 mg/kg every 6-8 hours

Evidence Against Using Ketorolac for Fever

Research comparing ketorolac to acetaminophen for fever management found no difference in efficacy between the two medications 2. However, given ketorolac's significant side effect profile and the availability of safer alternatives, it is not recommended as an antipyretic.

Important Safety Considerations

Ketorolac carries significant risks including:

• Gastrointestinal bleeding
• Renal impairment
• Cardiovascular events
• Compromised hemostasis

These risks make it inappropriate for routine fever management when safer alternatives like acetaminophen and ibuprofen are available 3.

Clinical Decision Making

When treating fever:

1. First-line: Use acetaminophen or ibuprofen
2. Assess for underlying cause of fever
3. Reserve ketorolac for its approved indication of pain management only

Conclusion

Ketorolac should not be used for fever management. Instead, use acetaminophen or ibuprofen, which have established safety and efficacy profiles for antipyretic purposes with fewer risks.