What is the recommended dosage of ketorolac (Toradol) injection for adult patients with normal renal function?

Ketorolac Injection Dosage

For adult patients with normal renal function under 65 years of age, the recommended ketorolac injection dose is 30 mg IV (given over at least 15 seconds) or 60 mg IM as a single dose, followed by 30 mg IV/IM every 6 hours for multiple-dose treatment, with a maximum daily dose of 120 mg and treatment duration not exceeding 5 days. 1

Single-Dose Regimen

For patients <65 years with normal renal function:

• Intramuscular: 60 mg as one dose 1
• Intravenous: 30 mg as one dose (administered over no less than 15 seconds) 1

For patients ≥65 years, renally impaired, or <50 kg body weight:

• Intramuscular: 30 mg as one dose 1
• Intravenous: 15 mg as one dose 1

The analgesic effect begins in approximately 30 minutes with maximum effect at 1-2 hours, and duration typically lasts 4-6 hours 1.

Multiple-Dose Regimen

For patients <65 years with normal renal function:

• Dose: 30 mg IV or IM every 6 hours 1
• Maximum daily dose: 120 mg 1
• Maximum duration: 5 days 1

For patients ≥65 years, renally impaired, or <50 kg body weight:

• Dose: 15 mg IV or IM every 6 hours 1
• Maximum daily dose: 60 mg 1
• Maximum duration: 5 days 1

Administration Guidelines

Intravenous administration must be given over no less than 15 seconds 1. Intramuscular administration should be given slowly and deeply into the muscle 1. Hypovolemia should be corrected prior to ketorolac administration 1.

Evidence for Dose Selection

Recent evidence demonstrates an analgesic ceiling effect at 10 mg IV, with no additional benefit from higher doses 2. A 2017 randomized controlled trial comparing 10 mg, 15 mg, and 30 mg IV ketorolac showed similar pain reduction across all three doses (mean numeric rating scale improvements of 2.6,2.5, and 3.0 respectively at 30 minutes), with no differences in rescue analgesia requirements 2. However, the FDA-approved dosing remains higher 1.

In elderly patients (≥65 years), a 2023 study found no significant difference in rescue analgesia needs between lower doses (15 mg IV/30 mg IM) versus higher doses (30 mg IV/60 mg IM), with 6.5% versus 13.5% requiring rescue analgesia respectively (p=0.094) 3.

Critical Safety Considerations

Treatment duration must not exceed 5 days to minimize serious adverse effects including gastrointestinal bleeding, renal toxicity, and cardiovascular complications 1. Patients should be switched to alternative analgesics as soon as possible 1.

Contraindications include:

• Aspirin/NSAID-induced asthma 4
• Pregnancy 4
• Cerebrovascular hemorrhage 4
• Active peptic ulcer disease 5
• Bleeding disorders 5
• Renal or hepatic impairment 5

High-risk populations requiring dose reduction or avoidance:

• Age ≥60 years with cardiovascular disease risk 4
• History of peptic ulcer disease 4
• Concurrent anticoagulant use 4
• Compromised fluid status 4

Rescue Analgesia

For breakthrough pain, do not increase the dose or frequency of ketorolac 1. Instead, consider supplementing with low-dose opioids unless contraindicated 1. Ketorolac demonstrates marked opioid-sparing effects when combined with opioid analgesics 6.

Common Pitfalls to Avoid

• Do not mix ketorolac in a syringe with morphine sulfate, meperidine, promethazine, or hydroxyzine, as this causes precipitation 1
• Do not exceed 5-day treatment duration regardless of pain control 1
• Do not use standard adult doses in elderly patients without dose adjustment 1
• Do not administer IV bolus faster than 15 seconds to avoid adverse reactions 1