What is the appropriate dosing and administration instructions for Toradol (Ketorolac) 10mg for severe pain and Naproxen for moderate pain?

Appropriate Dosing of Toradol 10mg for Severe Pain and Naproxen for Moderate Pain

For severe pain, Toradol (ketorolac) 10mg should be given orally every 4-6 hours as needed, not exceeding 40mg daily, and limited to a maximum of 5 days of use. For moderate pain, naproxen sodium 275-550mg should be administered every 2-6 hours, with a maximum initial dose of 825mg and not exceeding 1.5g daily. 1, 2

Toradol (Ketorolac) Dosing for Severe Pain

Dosage and Administration

• Toradol oral therapy should only be used as continuation therapy following IV or IM dosing, not as initial therapy 1
• For adults 17-64 years: 20mg PO once, followed by 10mg every 4-6 hours as needed, not exceeding 40mg/day 1
• For adults ≥65 years, renally impaired patients, or those weighing <50kg: 10mg PO once, followed by 10mg every 4-6 hours as needed, not exceeding 40mg/day 1
• Use the lowest effective dose for the shortest duration consistent with treatment goals 1

Duration Limitations

• Total duration of treatment must not exceed 5 days (combined IV/IM and oral use) 1, 3
• Patients should be switched to alternative analgesics as soon as possible 1

Contraindications and Precautions

• Do not use in patients with history of:
  • Aspirin/NSAID-induced asthma 2
  • Pregnancy or cerebrovascular hemorrhage 2
  • Significant gastrointestinal bleeding 3
  • Renal compromise 3
  • History of complications related to NSAIDs 3
• Do not use concurrently with other NSAIDs 3

Common Adverse Effects

• Edema, drowsiness, dizziness, GI upset, increased diaphoresis 2
• Risk of GI bleeding increases markedly when used at high doses for more than 5 days, especially in elderly patients 4

Naproxen Dosing for Moderate Pain

Dosage and Administration

• Standard dosage: 275-550mg every 2-6 hours 2
• Maximum initial dose: 825mg 2
• Maximum daily dose: Do not exceed 1.5g per day 2, 5
• For prescription naproxen: 375-500mg twice daily (every 12 hours) is recommended 5
• For over-the-counter naproxen sodium (Aleve): 440mg (2 tablets of 220mg) twice daily 5

Duration of Treatment

• Initial treatment should be for 2-4 weeks at maximum tolerated and approved dosage 5
• Evaluate treatment response after 2-4 weeks 5
• If sufficient response is achieved, treatment can be continued with consideration for tapering after 12 weeks of sustained response 5

Contraindications and Precautions

• Do not use in patients with:
  • Aspirin/NSAID-induced asthma 2
  • History of peptic ulcer disease 5
  • Cardiovascular disease 5
  • Concomitant use of anticoagulants 5

Common Adverse Effects

• Dizziness, rash, pruritus, GI upset, constipation 2
• Dyspepsia and GI discomfort occur in 10-20% of patients 5

Clinical Pearls

• For both medications, use the lowest effective dose for the shortest duration to minimize adverse effects 1, 5
• Consider gastroprotection with a proton pump inhibitor or H2 blocker in high-risk patients taking either medication 5
• Monitor for signs of GI bleeding, especially in elderly patients or those on prolonged therapy 5, 4
• Ketorolac has been shown to provide similar analgesic efficacy to opioids like morphine in postoperative settings, making it a valuable non-opioid alternative for severe pain 6, 4
• Combined therapy with ketorolac and an opioid can result in a 25-50% reduction in opioid requirements, potentially reducing opioid-related adverse events 4