Frequency of Intramuscular Ketorolac (Toradol) Injections
Intramuscular ketorolac (Toradol) injections should not be administered more frequently than every 6 hours, with a maximum duration of 5 days total treatment. 1, 2
Dosing Guidelines
Standard Dosing
- Adults under 65 years:
- 30 mg IM every 6 hours
- Maximum daily dose: 120 mg 1
Special Populations
- Adults 65 years and older, renally impaired, or under 50 kg (110 lbs):
- 15 mg IM every 6 hours
- Maximum daily dose: 60 mg 1
Single-Dose Treatment
- Adults under 65 years: One dose of 60 mg IM
- Adults 65 years and older, renally impaired, or under 50 kg: One dose of 30 mg IM 1
Important Safety Considerations
Duration Limitations
- Treatment with ketorolac must not exceed 5 days total duration 1, 2, 3
- Patients should be switched to alternative analgesics as soon as possible 1
Administration Technique
- Intramuscular injections should be given slowly and deeply into the muscle 1
- The analgesic effect begins in approximately 30 minutes with maximum effect in 1-2 hours
- Duration of analgesic effect is usually 4-6 hours 1
Contraindications
Ketorolac is contraindicated in patients with:
- History of or current risk of gastrointestinal bleeding
- Risk of renal failure
- Compromised hemostasis
- Hypersensitivity to aspirin or other NSAIDs
- Pregnancy
- Cerebrovascular hemorrhage 2
Monitoring Requirements
Baseline assessment recommended for:
- Blood pressure
- BUN and creatinine
- Liver function tests
- CBC and fecal occult blood 2
Discontinue ketorolac immediately if:
- Renal function tests double
- Hypertension develops or worsens
- Liver function studies increase beyond normal limits 2
Clinical Pearls
- For breakthrough pain, do not increase the dose or frequency of ketorolac 1
- Consider supplementing with low doses of opioids "prn" unless otherwise contraindicated 1
- Hypovolemia should be corrected prior to administration of ketorolac 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
Remember that ketorolac is intended for short-term management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting 1. The strict adherence to dosing frequency and maximum duration limits is essential to minimize the risk of serious adverse effects.