Ketorolac (Toradol) Injection Frequency Guidelines
Ketorolac (Toradol) injections should not exceed 5 days of total treatment duration, with a maximum daily dose of 120 mg for patients under 65 years and 60 mg for patients 65 years or older. 1
Dosing Guidelines
Standard Dosing Schedule
- Ketorolac can be administered every 6 hours as multiple doses 1
- For patients under 65 years: 30 mg IM/IV every 6 hours (maximum daily dose: 120 mg) 1
- For patients 65 years or older, renally impaired, or under 50 kg: 15 mg IM/IV every 6 hours (maximum daily dose: 60 mg) 1
Single-Dose Treatment
- For patients under 65 years: One dose of 60 mg IM or 30 mg IV 1
- For patients 65 years or older, renally impaired, or under 50 kg: One dose of 30 mg IM or 15 mg IV 1
Important Limitations
- Total treatment duration must not exceed 5 days regardless of administration route 1, 2
- Patients should be switched to alternative analgesics as soon as possible 1
- For breakthrough pain, do not increase the dose or frequency - consider supplementing with low doses of opioids if not contraindicated 1
Administration Considerations
- Intramuscular administration should be given slowly and deeply into the muscle 1
- Intravenous bolus must be administered over no less than 15 seconds 1
- Onset of analgesic effect begins in approximately 30 minutes with maximum effect in 1-2 hours 1, 3
- Duration of analgesic effect is usually 4-6 hours 1, 4
Special Populations
- Elderly patients (≥65 years) require reduced dosing (15 mg every 6 hours, maximum 60 mg daily) 1, 5
- Patients with renal impairment require the same reduced dosing as elderly patients 1
- Patients weighing less than 50 kg should follow the same reduced dosing schedule 1
Precautions and Contraindications
- Hypovolemia should be corrected prior to administration 1
- Contraindicated in patients with aspirin/NSAID-induced asthma, pregnancy, or cerebrovascular hemorrhage 2
- Use with caution in patients at high risk for renal, GI, or cardiac toxicities 2
- Monitor for adverse effects including edema, drowsiness, dizziness, GI upset, and increased diaphoresis 2
Clinical Pearls
- Ketorolac has potent analgesic effects comparable to opioids for acute pain management 3, 4
- Lower doses (15 mg IV) may provide similar pain relief to higher doses (30 mg IV) in elderly patients, suggesting a possible ceiling effect 5
- Ketorolac can be used as part of multimodal analgesia to reduce opioid requirements 6, 7
- The analgesic efficacy of ketorolac is rated as 3 on a scale of 1-4 (with 4 being most effective) 2
Remember that exceeding the recommended duration of 5 days significantly increases the risk of adverse effects, particularly renal toxicity and gastrointestinal complications.