Maximum Dose of Toradol (Ketorolac) in Deltoid Muscle
For intramuscular administration in the deltoid muscle, the maximum single dose of ketorolac is 60 mg for patients under 65 years of age, and 30 mg for patients 65 years or older, renally impaired, or weighing less than 50 kg. 1
Single-Dose Intramuscular Administration
The FDA-approved dosing for single IM injection is stratified by patient characteristics 1:
- Patients <65 years: One dose of 60 mg IM 1
- Patients ≥65 years, renally impaired, or <50 kg (110 lbs): One dose of 30 mg IM 1
The intramuscular injection should be given slowly and deeply into the muscle 1. While the FDA label does not specify injection site restrictions, the deltoid muscle is an appropriate site for IM administration in adults 2.
Multiple-Dose Regimens
If multiple doses are required, the dosing differs from single-dose administration 1:
- Patients <65 years: 30 mg IM every 6 hours (maximum 120 mg/day) 1
- Patients ≥65 years, renally impaired, or <50 kg: 15 mg IM every 6 hours (maximum 60 mg/day) 1
Total duration of ketorolac therapy must not exceed 5 days regardless of route 1, 3. This is a critical safety limitation due to dose- and duration-dependent adverse effects 4.
Important Clinical Considerations
Onset and Duration
The analgesic effect begins in approximately 30 minutes with maximum effect in 1-2 hours after IM dosing, with duration typically lasting 4-6 hours 1.
Contraindications
Ketorolac is absolutely contraindicated in 5:
- Aspirin/NSAID-induced asthma
- Pregnancy
- Cerebrovascular hemorrhage
- Active peptic ulcer disease or GI bleeding (use caution)
Common Pitfalls
Do not increase the dose or frequency for breakthrough pain 1. Instead, consider supplementing with low-dose opioids unless contraindicated 1. The evidence suggests an analgesic ceiling effect exists for doses greater than 10-15 mg, meaning higher doses may not provide additional pain relief but do increase risk of adverse effects 4.
Adverse Effects to Monitor
Patients may experience edema, drowsiness, dizziness, GI upset, and increased diaphoresis 5, 3. Ketorolac has reversible antiplatelet effects and can cause dose-related gastric ulcerations even when administered parenterally 6.
Special Populations
Elderly patients exhibit reduced clearance of ketorolac, and renal insufficiency causes drug accumulation 7. This pharmacokinetic difference justifies the lower maximum doses in these populations 1.