Recommended Intramuscular (IM) Dose of Toradol (Ketorolac)
The recommended intramuscular (IM) dose of Toradol (ketorolac) is 60 mg as a single dose for patients under 65 years of age, and 30 mg for patients who are 65 years or older, renally impaired, or weighing less than 50 kg (110 lbs). 1
Dosing Guidelines for IM Ketorolac
Single-Dose Treatment
- For patients <65 years: 60 mg IM as a single dose 1
- For patients ≥65 years, renally impaired, or <50 kg (110 lbs): 30 mg IM as a single dose 1
Multiple-Dose Treatment
- For patients <65 years: 30 mg IM every 6 hours, with maximum daily dose not exceeding 120 mg 1
- For patients ≥65 years, renally impaired, or <50 kg (110 lbs): 15 mg IM every 6 hours, with maximum daily dose not exceeding 60 mg 1
Administration Considerations
- The IM injection should be given slowly and deeply into the muscle 1
- Onset of analgesic effect begins in approximately 30 minutes 1
- Maximum effect is achieved in 1-2 hours after dosing 1
- Duration of analgesic effect is usually 4-6 hours 1
Important Limitations and Precautions
- Ketorolac therapy should not exceed 5 days 1, 2
- Hypovolemia should be corrected prior to administration 1
- For breakthrough pain, do not increase the dose or frequency; consider supplementing with low doses of opioids if not contraindicated 1
- Ketorolac has a relatively low incidence of adverse effects compared to opioids but carries risks of gastrointestinal bleeding, platelet inhibition, and renal impairment 2
- Risk of adverse events increases with high doses, prolonged therapy (>5 days), or in vulnerable patients (e.g., elderly) 2
Pediatric Considerations
- In children, ketorolac has different pharmacokinetics, with increased volume of distribution and higher plasma clearance 3
- For pediatric postoperative pain management, the recommended IV dosage is 0.5 mg/kg initially, followed by 1.0 mg/kg every 6 hours or an infusion of 0.17 mg/kg/h 3
- IM injections are generally not recommended in children unless IV access is unavailable 3
- Ketorolac is not recommended for use in infants aged <1 year 3
Clinical Advantages
- Ketorolac provides opioid-level analgesia without respiratory depression, nausea, vomiting, urinary retention, or sedation commonly associated with opioids 3
- When combined with opioids, ketorolac exhibits marked opioid-sparing effects, improving pain relief while reducing opioid-related adverse effects 3
Remember that ketorolac should be prescribed at the lowest effective dose for the shortest duration possible to minimize potential adverse effects while providing adequate pain control.