Is a 94kg 14-year-old adolescent eligible for a 30mg dose of ketorolac (Toradol)?

From the Guidelines

I strongly advise against administering a 30mg dose of ketorolac to a 94kg 14-year-old patient due to the potential risks of nephrotoxicity and other adverse effects associated with NSAIDs in adolescents. For pediatric patients under 16 years of age, ketorolac dosing should be weight-based, typically 0.5 mg/kg up to a maximum of 15-30mg per dose, with a maximum daily dose of 60mg 1. While the 30mg dose might appear appropriate based on weight alone, age is a critical factor in ketorolac administration. Adolescents have developing kidneys and may be more susceptible to the nephrotoxic effects of NSAIDs like ketorolac.

Some key points to consider when administering ketorolac to pediatric patients include:

• Reduced doses with renal dysfunction
• Increased risk of bleeding with peptic ulcer disorder
• Increased risk in older age
• Some concern for impaired bone healing
• Rarely can be used without adjunct drugs 1

Additionally, ketorolac carries significant risks including gastrointestinal bleeding, renal impairment, and increased bleeding risk, which must be carefully considered in younger patients. If pain management is needed, consider starting with a lower dose of ketorolac (15mg) or using alternative analgesics like acetaminophen or lower-dose NSAIDs with pediatric approval. Always consult with a pediatrician or pediatric pharmacist before administering ketorolac to adolescents, as individual patient factors may affect appropriate dosing.

From the Research

Ketorolac Dosage for a 94kg 14-Year-Old

• The standard dosing of ketorolac is weight-based with a cap at 30 mg, as mentioned in the study 2.
• A study published in 2024 2 compared the analgesic effect of intravenous ketorolac at doses of 15 mg versus doses greater than 15 mg in pediatric patients and found no statistically significant difference in the number of patients with a decrease in pain score between the two groups.
• However, the study 2 does not provide specific guidance on the maximum dose for a 94kg 14-year-old.
• Another study 3 suggests that ketorolac should be prescribed at the lowest dosage necessary to control pain and the duration of therapy should be limited to as few days as possible.
• The risk of adverse events associated with ketorolac increases with high doses, prolonged therapy, or in vulnerable patients, as stated in the study 3.
• There is no specific information in the provided studies that directly addresses the safety of a 30mg dose of ketorolac for a 94kg 14-year-old.

Considerations for Ketorolac Use

• Ketorolac may cause gastrointestinal bleeding, platelet inhibition, and renal impairment, as reported in the study 3.
• The risk of gastrointestinal or operative site bleeding related to ketorolac therapy is slightly higher than with opioids, according to the study 3.
• Other studies 4, 5, 6 discuss the gastrointestinal safety of NSAIDs, including ketorolac, but do not provide specific guidance on dosing for a 94kg 14-year-old.
• The study 5 found that current users of ketorolac had a distinctly elevated risk of gastroduodenal lesions, with an odds ratio of 4.2.
• The study 6 discusses the gastrointestinal safety of ibuprofen, but not specifically ketorolac, and found that the incidence of GI adverse events is low at OTC doses.