What is the recommended dosage of Toradol (Ketorolac) for managing moderate to severe pain?

Ketorolac (Toradol) Dosing for Moderate to Severe Pain Management

For managing moderate to severe pain, ketorolac (Toradol) should be administered at the lowest effective dose for the shortest duration possible, with oral dosing of 10mg every 4-6 hours (not exceeding 40mg/day) and treatment limited to no more than 5 days total.

Dosage Recommendations

Oral Administration (Tablets)

• Initial dose: Only as continuation therapy following IV/IM dosing
  • Ages 17-64: 20mg PO once, then 10mg every 4-6 hours PRN
  • Ages ≥65, renally impaired, or weight <50kg: 10mg PO once, then 10mg every 4-6 hours PRN
• Maximum daily dose: 40mg/day
• Maximum duration: Combined IV/IM and oral therapy should not exceed 5 days 1

Intravenous Administration

• Research indicates that 10mg IV provides similar analgesic efficacy to higher doses (15mg or 30mg), suggesting that the analgesic ceiling dose is 10mg 2

Patient Selection and Contraindications

Ketorolac is contraindicated in patients with:

• 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 3

Special Populations

• Elderly patients (≥65 years): Higher risk of adverse effects; use reduced dosing (10mg PO)
• Renal impairment: Increased risk of acute renal failure; use reduced dosing
• Low body weight (<50kg): Require dose reduction
• Cardiovascular disease: Increased risk of thrombotic events
• Patients on anticoagulants: Increased bleeding risk 3

Monitoring Recommendations

Baseline and periodic monitoring should include:

• Blood pressure
• Renal function tests (BUN, creatinine)
• Liver function tests
• Complete blood count
• Coagulation profile
• Fecal occult blood test 3

Adverse Effects

• Gastrointestinal: GI upset, bleeding, and perforation (risk increases with higher doses and longer duration)
• Renal: Acute renal failure (usually reversible upon discontinuation)
• Hematologic: Inhibition of platelet aggregation, increased bleeding time
• Neurological: Drowsiness and dizziness
• Cardiovascular: Edema, hypertension 3, 4

Clinical Pearls

• Ketorolac should only be administered under direct supervision and order of a physician
• Should not be used prophylactically to reduce anticipated pain
• Particularly beneficial in pain resulting from bone metastases 3, 5
• When used in combination with opioids, ketorolac can reduce opioid requirements by 25-50%, potentially decreasing opioid-related adverse events 5

Important Cautions

• Monitor closely for toxicities in patients receiving chemotherapy due to potential additive nephrotoxicity
• Discontinue if BUN or creatinine doubles or if hypertension develops/worsens
• The risk of serious adverse events increases markedly when high dosages are used for more than 5 days, especially in the elderly 5, 4

Always use the lowest effective therapeutic dose for the shortest duration possible to minimize the risk of adverse effects while providing effective pain management.