Recommended Dosage of IV Toradol for Severe Pain
For severe pain, the recommended initial IV dose of Toradol (ketorolac) is 30 mg for patients under 65 years of age and 15 mg for patients 65 years or older, renally impaired, or weighing less than 50 kg. 1
Dosing Guidelines Based on Patient Characteristics
Standard Adult Dosing (Under 65 years):
- Initial IV dose: 30 mg administered over at least 15 seconds
- Maintenance: 30 mg every 6 hours as needed
- Maximum daily dose: 120 mg
- Maximum duration: 5 days
Special Populations (≥65 years, renally impaired, or <50 kg):
- Initial IV dose: 15 mg administered over at least 15 seconds
- Maintenance: 15 mg every 6 hours as needed
- Maximum daily dose: 60 mg
- Maximum duration: 5 days
Pharmacokinetics and Efficacy
- Onset of action: ~30 minutes
- Peak effect: 1-2 hours
- Duration of analgesic effect: 4-6 hours 1
The FDA-approved labeling clearly specifies these dosing parameters, which are designed to provide effective analgesia while minimizing the risk of adverse effects. The 2017 randomized controlled trial by Motov et al. demonstrated that lower doses of IV ketorolac (10 mg) provided similar analgesic efficacy to higher doses (15 mg and 30 mg) for acute pain in the emergency department setting 2. However, the FDA labeling still recommends 30 mg as the standard initial dose for adults under 65 years.
Important Considerations and Precautions
Contraindications:
- Aspirin/NSAID-induced asthma
- Pregnancy
- Cerebrovascular hemorrhage
- Advanced renal impairment
- Active peptic ulcer disease
- Recent GI bleeding 3, 1
Common Adverse Effects:
- Edema
- Drowsiness
- Dizziness
- GI upset
- Increased diaphoresis 3
Administration Precautions:
- Correct hypovolemia before administration
- Administer IV bolus over no less than 15 seconds
- Do not mix in small volume with morphine, meperidine, promethazine, or hydroxyzine (will cause precipitation) 1
Clinical Application in Severe Pain Management
For patients with severe pain (rated 7-10 on a 10-point scale):
- Administer appropriate dose of IV ketorolac based on age/weight/renal function
- Consider combining with opioid therapy for enhanced analgesia in severe pain cases
- Reassess pain at 30 minutes (onset time) and 1-2 hours (peak effect)
- Switch to oral analgesics as soon as possible 3, 1
Ketorolac is particularly useful in the management of acute severe pain as it provides strong analgesia without the respiratory depression, sedation, or dependence potential associated with opioids. When used in combination with opioids, it can reduce opioid requirements by 25-50% 4.
Remember that ketorolac therapy should not exceed 5 days due to increased risk of serious adverse effects with prolonged use 1.