What is the first-line dose of Toradol (Ketorolac) for acute pain management?

First-Line Dosing of Ketorolac (Toradol) for Acute Pain Management

The first-line dose of ketorolac for acute pain management is 30 mg IV/IM for patients under 65 years of age and 15 mg IV/IM for patients who are elderly (≥65 years), renally impaired, or weigh less than 50 kg. 1, 2

Dosing Guidelines Based on Administration Route

Intravenous/Intramuscular Administration

• Patients <65 years: 30 mg IV/IM every 6 hours (maximum daily dose: 120 mg) 1, 2
• Patients ≥65 years, renally impaired, or <50 kg: 15 mg IV/IM every 6 hours (maximum daily dose: 60 mg) 1, 2
• IV bolus must be administered over no less than 15 seconds 2
• IM injections should be given slowly and deeply into the muscle 2

Oral Administration (for continuation therapy only)

• Patients <65 years: Initial dose of 20 mg PO once, then 10 mg PO every 4-6 hours (maximum daily dose: 40 mg) 1
• Patients ≥65 years, renally impaired, or <50 kg: Initial dose of 10 mg PO once, then 10 mg PO every 4-6 hours (maximum daily dose: 40 mg) 1

Important Clinical Considerations

Timing and Duration

• Onset of analgesic effect: ~30 minutes 2
• Peak effect: 1-2 hours after administration 2, 3
• Duration of effect: 4-6 hours 2
• Maximum treatment duration: 5 days (combined IV/IM and oral therapy) 1, 2

Special Populations

• Pediatric patients: Not FDA approved for oral use in children under 17 years. For postoperative pain in children ≥1 year: 0.5 mg/kg IV initially, followed by 1.0 mg/kg IV every 6 hours or 0.17 mg/kg/hour IV infusion (maximum daily dose: 90 mg, maximum duration: 48 hours) 1
• Elderly patients: Higher risk of adverse effects; use reduced dosing 1
• Renal impairment: Increased risk of acute renal failure; use reduced dosing 1

Efficacy Considerations

• Ketorolac has a ceiling analgesic effect - doses above recommendations do not provide additional pain relief but increase adverse effect risk 1
• For breakthrough pain, do not increase dose or frequency; consider supplementing with low-dose opioids if not contraindicated 2

Contraindications

• History of peptic ulcer disease
• GI bleeding or perforation
• Advanced renal impairment
• Cerebrovascular bleeding
• Hemorrhagic diathesis/coagulation disorders
• Pregnancy
• Concurrent use with aspirin or other NSAIDs 1

Monitoring

• Baseline monitoring should include blood pressure, renal function tests, liver function tests, complete blood count, coagulation profile, and fecal occult blood test 1
• Monitor for signs of renal impairment, especially if patient is receiving potentially nephrotoxic medications 1

Common Adverse Effects

• GI upset, bleeding, perforation
• Edema
• Drowsiness and dizziness
• Acute renal failure (usually reversible upon discontinuation)
• Inhibition of platelet aggregation and increased bleeding time 1

Ketorolac is an effective non-opioid analgesic for acute pain management when used appropriately at the correct dosage for the shortest duration possible.