Can I administer 30 mg of a medication intramuscularly (IM) for 2 days in a row?

Can You Give Ketorolac (Toradol) 30 mg IM for 2 Days in a Row?

Yes, you can administer ketorolac 30 mg IM for 2 consecutive days, but this is approaching the maximum safe duration—ketorolac therapy must not exceed 5 days total, and you should transition to alternative analgesics as soon as clinically feasible. 1

Dosing Guidelines for Consecutive Day Administration

Multiple-Dose Regimen

• For patients under 65 years of age with normal renal function and body weight ≥50 kg: administer 30 mg IM every 6 hours, with a maximum daily dose of 120 mg 1
• For patients ≥65 years, renally impaired, or <50 kg body weight: reduce to 15 mg IM every 6 hours, with a maximum daily dose of 60 mg 1
• The analgesic effect begins in approximately 30 minutes, peaks at 1-2 hours, and lasts 4-6 hours 1

Critical Duration Limitation

• Total treatment duration must not exceed 5 days regardless of route of administration 2, 1
• The 2002 American Family Physician guidelines explicitly state that ketorolac treatment should not exceed 5 days 2
• After 2 days of therapy, you are at day 2 of a maximum 5-day window—plan transition to alternative analgesics immediately 1

Pre-Administration Requirements

Mandatory Assessment Before Each Dose

• Correct hypovolemia prior to administration, as ketorolac carries significant renal toxicity risk 1
• Verify the patient does not have aspirin/NSAID-induced asthma, active pregnancy, or cerebrovascular hemorrhage (absolute contraindications) 2
• Confirm adequate renal function, as ketorolac is contraindicated in renally impaired patients receiving the standard dose 2, 1

Administration Technique

• Administer slowly and deeply into the muscle 1
• Do not mix ketorolac in a syringe with morphine sulfate, meperidine, promethazine, or hydroxyzine, as this causes precipitation 1

Managing Breakthrough Pain

When Ketorolac Is Insufficient

• Do not increase the dose or frequency of ketorolac beyond the recommended regimen 1
• Instead, supplement with low-dose opioids on a PRN basis unless contraindicated 1
• This multimodal approach is safer than exceeding ketorolac dosing limits 1

Common Pitfalls to Avoid

Duration Errors

• The most critical error is continuing ketorolac beyond 5 days total, which substantially increases the risk of serious adverse effects including GI bleeding, renal failure, and cardiovascular events 2, 1
• Many clinicians mistakenly believe each "course" of ketorolac can be 5 days, but the 5-day limit is cumulative for the acute pain episode 1

Dosing in Special Populations

• Elderly patients (≥65 years) require dose reduction to 15 mg every 6 hours even if they appear robust, as age-related renal decline increases toxicity risk 1
• Patients under 50 kg require the same dose reduction regardless of age 1

Monitoring Requirements

• Watch for edema, drowsiness, dizziness, GI upset, and increased diaphoresis (common adverse reactions) 2
• Be vigilant for signs of GI bleeding, renal dysfunction, or cardiovascular complications, which can occur even with short-term use 2, 1

Transition Planning After Day 2

Alternative Analgesic Options

• Switch to oral NSAIDs (ibuprofen 400-800 mg every 6 hours or naproxen sodium 275-550 mg every 2-6 hours) if the patient can tolerate oral medications 2
• Consider acetaminophen-based regimens or combination products like isometheptene/acetaminophen/dichloralphenazone for moderate pain 2
• For severe pain requiring continued parenteral therapy, transition to opioid analgesics rather than extending ketorolac beyond 5 days 2, 1