What is the recommended dosage of Toradol (ketorolac) for managing moderate to severe pain?

Toradol (Ketorolac) Dosing Recommendations

For adults under 65 years, administer ketorolac 30 mg IV every 6 hours or 60 mg IM as a single dose, with a maximum daily dose of 120 mg and treatment duration strictly limited to 5 days. 1

Standard Adult Dosing (Age 17-64 years, >50 kg)

Intravenous Administration

• Multiple-dose regimen: 30 mg IV every 6 hours, maximum 120 mg/day 1
• Single-dose regimen: 30 mg IV as one-time dose 1
• IV bolus must be administered over at least 15 seconds 1
• Onset of analgesia begins in approximately 30 minutes, with maximum effect at 1-2 hours and duration of 4-6 hours 1

Intramuscular Administration

• Multiple-dose regimen: 30 mg IM every 6 hours, maximum 120 mg/day 1
• Single-dose regimen: 60 mg IM as one-time dose 1
• Must be administered slowly and deeply into muscle 1

Oral Administration

• Dosing: 20 mg orally, typically given 40-60 minutes before procedures for pain prevention 2
• Oral formulation should be used under typical circumstances when transitioning from parenteral therapy 3

High-Risk Population Dosing Adjustments

Elderly Patients (≥65 years), Renally Impaired, or <50 kg Body Weight

• IV multiple-dose: 15 mg every 6 hours, maximum 60 mg/day 1
• IV single-dose: 15 mg as one-time dose 1
• IM single-dose: 30 mg as one-time dose 1
• These reduced doses are critical to minimize risk of adverse events, which increase substantially in vulnerable populations 4

Critical Duration Limitation

Treatment must not exceed 5 days in any formulation (IV, IM, or oral), as prolonged therapy significantly increases risk of serious adverse events including gastrointestinal bleeding, renal impairment, and operative site bleeding 1, 4, 3

Dose-Response Evidence

Recent high-quality research demonstrates that lower doses provide equivalent analgesia: a 2017 randomized controlled trial found that 10 mg, 15 mg, and 30 mg IV doses produced statistically identical pain reduction at 30 minutes in ED patients with moderate to severe acute pain, with similar adverse effect profiles 5. This suggests the analgesic ceiling occurs at 10 mg IV, though FDA labeling and guidelines continue to recommend 15-30 mg dosing 1, 6.

Absolute Contraindications

• Active peptic ulcer disease or gastrointestinal bleeding 6, 2, 3
• Aspirin or NSAID-induced asthma 6, 2
• Pregnancy or breastfeeding 6, 4
• Cerebrovascular hemorrhage 6, 2
• History of significant renal compromise 3
• Known hypersensitivity to ketorolac, aspirin, or other NSAIDs 4, 3
• Concurrent use with other NSAIDs 3

Use With Caution

• Patients ≥60 years of age 6
• Compromised fluid status (correct hypovolemia before administration) 6, 1
• Interstitial nephritis or papillary necrosis 6
• Concomitant nephrotoxic drugs 6
• Moderate hepatic impairment 4

Required Monitoring

• Baseline: Blood pressure, BUN, creatinine, liver function tests, CBC, fecal occult blood 6, 2
• Long-term therapy (if approaching 5-day limit): Repeat monitoring every 3 months 6, 2
• Monitor for signs of GI bleeding, renal dysfunction, or cardiovascular events throughout therapy 6

Clinical Pearls

• Do not increase dose or frequency for breakthrough pain; instead, supplement with low-dose opioids if not contraindicated 1
• Ketorolac demonstrates significant opioid-sparing effects when used in multimodal analgesia, reducing opioid requirements by approximately 30-50% in postoperative settings 7
• Never mix ketorolac in a syringe with morphine sulfate, meperidine, promethazine, or hydroxyzine, as this causes precipitation 1
• The American Society of Critical Care Medicine supports single 30 mg IV doses for procedural pain (e.g., chest tube removal) with efficacy comparable to morphine 4 mg IV 6
• For post-cesarean delivery, the American College of Obstetricians and Gynecologists recommends 15-30 mg IV every 6 hours (maximum 5 days) as part of multimodal analgesia, administered at end of surgery unless contraindicated 6