What is the recommended dosage of Toradol (Ketorolac) for patients?

Recommended Dosage of Toradol (Ketorolac)

The recommended dosage of Toradol (ketorolac) for adults is 10-30mg IV/IM for initial dosing, followed by oral dosing of 10mg every 4-6 hours as needed, not exceeding 40mg per day orally or 120mg per day total, with treatment duration limited to a maximum of 5 days. 1, 2

Dosage Guidelines by Route of Administration

Intravenous/Intramuscular Dosing

• Standard adult dosing (age 17-64):

  • Initial dose: 30mg IV or 60mg IM
  • Subsequent doses: 15-30mg IV/IM every 6 hours
  • Maximum daily dose: 120mg 1

• High-risk populations (age ≥65, renal impairment, or weight <50kg):

  • Initial dose: 15mg IV or 30mg IM
  • Subsequent doses: 15mg IV/IM every 6 hours
  • Maximum daily dose: 60mg 1, 2

Oral Dosing (Only as continuation therapy after IV/IM dosing)

• Standard adult dosing (age 17-64):

  • Initial oral dose: 20mg once
  • Subsequent doses: 10mg every 4-6 hours as needed
  • Maximum daily oral dose: 40mg 2

• High-risk populations (age ≥65, renal impairment, or weight <50kg):

  • Initial oral dose: 10mg once
  • Subsequent doses: 10mg every 4-6 hours as needed
  • Maximum daily oral dose: 40mg 2

Important Clinical Considerations

Duration of Treatment

• Combined duration of IV/IM and oral ketorolac should not exceed 5 days 1, 2, 3
• Prolonged use significantly increases risk of serious adverse events, particularly in elderly patients 4

Analgesic Ceiling Effect

• Research shows no additional analgesic benefit from doses exceeding 10mg IV 5
• Using the lowest effective dose (10mg IV) provides effective pain relief with potentially fewer adverse effects 5

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
• Aspirin/NSAID-induced asthma 1

Monitoring Requirements

• Baseline assessment recommended for:
  • Blood pressure
  • BUN and creatinine
  • Liver function tests
  • CBC and fecal occult blood 1
• Discontinue immediately if:
  • Renal function tests double
  • Hypertension develops or worsens
  • Liver function studies increase beyond normal limits 1

Special Populations and Considerations

Perioperative Use

• For short-term perioperative therapy: 0.5-1mg/kg IV (up to 30mg) for a single intraoperative dose, or 0.15-0.2mg/kg (max 10mg) every 6 hours 1
• Effective for postoperative pain management with potential opioid-sparing effects of 25-50% 4, 6

Cancer Pain Management

• Can be administered via continuous subcutaneous infusion for cancer-related pain
• Particularly effective for bone metastasis-related pain 7
• May be mixed with opioids in syringe drivers for improved pain control 7

Emergency Department Use

• 10mg IV provides similar analgesic efficacy to higher doses (15mg and 30mg) for acute pain in the emergency department 5
• Effective for renal colic, migraine headache, musculoskeletal pain, and sickle cell crisis 4

Practical Application

• Always use the lowest effective dose for the shortest duration
• Oral formulation should not be given as an initial dose; only use as continuation therapy after IV/IM administration
• Do not shorten the dosing interval of 4-6 hours
• Avoid concurrent use with other NSAIDs to prevent increased risk of adverse effects 1, 2