Toradol (Ketorolac) Dosing for Pain Management
For adults aged 17-64 years, administer ketorolac 15-30 mg IV/IM every 6 hours with a maximum daily dose of 120 mg, limiting total treatment duration (IV/IM plus oral combined) to no more than 5 days. 1, 2
Adult Dosing by Route and Age
Parenteral (IV/IM) Administration
- Ages 17-64 years: 15-30 mg IV/IM every 6 hours, maximum 120 mg/day 1
- Ages ≥65 years, renal impairment, or weight <50 kg: Use lower doses with caution 1
- Single-dose for procedural pain (ICU): 30 mg IV has comparable efficacy to morphine 4 mg IV 1
Oral Administration (Continuation Therapy Only)
Ketorolac tablets are FDA-approved only as continuation therapy following IV/IM dosing, not as initial treatment. 2
- Ages 17-64 years: 20 mg PO once, then 10 mg every 4-6 hours as needed, maximum 40 mg/day 2
- Ages ≥65 years, renal impairment, or weight <50 kg: 10 mg PO once, then 10 mg every 4-6 hours as needed, maximum 40 mg/day 2
- Do not shorten the 4-6 hour dosing interval 2
Critical Duration Limitation
The combined duration of IV/IM and oral ketorolac must not exceed 5 days in adults. 1, 2, 3 This strict time limit is essential to minimize serious adverse events, as risk increases substantially with prolonged therapy. 4
Dose-Response Evidence
Recent high-quality evidence demonstrates that 10 mg IV ketorolac provides equivalent analgesia to 15 mg and 30 mg doses in ED patients with moderate to severe acute pain, with similar adverse effect profiles across all three doses. 5 This suggests that the analgesic ceiling dose is 10 mg IV, and higher doses offer no additional pain relief while potentially increasing risk. 5
Absolute Contraindications
Do not use ketorolac in patients with: 1, 2
- Active peptic ulcer disease or GI bleeding
- Aspirin/NSAID-induced asthma
- Pregnancy, labor, delivery, or breastfeeding
- History of cerebrovascular hemorrhage
- Severe renal impairment
- History of allergic reactions to NSAIDs or aspirin
- Perioperative pain in coronary artery bypass graft surgery
High-Risk Populations Requiring Caution
Use reduced doses and enhanced monitoring in: 1
- Patients ≥60 years of age
- Compromised fluid status or dehydration
- Concurrent nephrotoxic drug use
- Interstitial nephritis or papillary necrosis history
- Congestive heart failure or cirrhosis
- Platelet abnormalities or coagulopathy
Clinical Applications Where Ketorolac Excels
- Post-cesarean delivery pain: 15-30 mg IV every 6 hours for maximum 5 days, followed by oral NSAIDs 1
- ICU procedural pain: Single 30 mg IV dose for chest tube removal 1
- Bone or visceral cancer pain: Particularly effective, can reduce opioid requirements by 76% 6
- Acute musculoskeletal low back pain: Superior adverse effect profile compared to acetaminophen-codeine 7
Monitoring Requirements
Baseline assessment before initiating therapy: 1
- Blood pressure
- BUN and creatinine
- Liver function tests
- Complete blood count
- Fecal occult blood
For therapy >3 months (not recommended for acute pain): Repeat monitoring every 3 months 1
Common Adverse Effects
Most frequent side effects include: 1
- Edema
- Drowsiness and dizziness
- Gastrointestinal upset
- Increased diaphoresis
Serious adverse events (GI bleeding, perforation, renal failure) have declined since dosage guidelines were revised to lower doses and shorter durations. 4 Risk remains elevated in elderly patients, with high doses, or with prolonged use beyond 5 days. 4
Critical Prescribing Pitfalls to Avoid
- Never use prophylactically to prevent anticipated pain before it occurs 3
- Never exceed 5 days total duration (IV/IM plus oral combined) 1, 2, 3
- Never co-administer with other NSAIDs or aspirin 3
- Never use doses above 30 mg IV/IM as they provide no additional analgesia 5
- Never give oral ketorolac as initial therapy—it must follow parenteral dosing 2
- Never use in patients with active GI bleeding risk or significant renal compromise 3, 4