Frequency of Toradol (Ketorolac) and Kenalog (Triamcinolone) Administration
Toradol (Ketorolac) Frequency
Ketorolac should be administered every 6 hours with a maximum treatment duration of 5 days, and must never exceed this timeframe regardless of clinical indication. 1
Dosing Schedule by Route and Patient Population
Intramuscular Dosing:
- Adults <65 years: 30 mg IM every 6 hours (maximum 120 mg/day) 1
- Adults ≥65 years, renally impaired, or <50 kg: 15 mg IM every 6 hours (maximum 60 mg/day) 1
Intravenous Dosing:
- Adults <65 years: 30 mg IV every 6 hours (maximum 120 mg/day) 1
- Adults ≥65 years, renally impaired, or <50 kg: 15 mg IV every 6 hours (maximum 60 mg/day) 1
- IV bolus must be given over at least 15 seconds 1
Critical Duration Limitation
The 5-day maximum duration is absolute and applies to all routes of administration (IV, IM, oral) combined. 2, 1, 3 This restriction exists due to cumulative risks of gastrointestinal bleeding, renal impairment, and operative site bleeding that increase substantially with prolonged therapy. 4
Important Clinical Caveats
- Do not use ketorolac prophylactically to prevent anticipated pain; it should only be administered for diagnosed injuries or conditions 3
- Onset of action: 30 minutes with maximum effect at 1-2 hours; duration of analgesia is 4-6 hours 1
- For breakthrough pain, do not increase dose or frequency—consider supplementing with low-dose opioids instead 1
- Ketorolac should not be used concurrently with other NSAIDs 3
Kenalog (Triamcinolone Acetonide) Frequency
For intralesional injection of inflammatory acne nodules, triamcinolone acetonide can be administered to individual lesions as needed, with most nodules flattening within 48-72 hours. 2
Dosing by Indication
Nodular Acne:
- Triamcinolone acetonide 10 mg/mL (may be diluted to 5 or 3.3 mg/mL) injected directly into inflammatory nodules 2
- Response typically occurs within 48-72 hours 2
Acne Keloidalis:
- Triamcinolone acetonide 10 mg/mL into inflammatory follicular lesions 2
- Triamcinolone acetonide 40 mg/mL into hypertrophic scars and keloids 2
Frequency Considerations
There is no specific maximum frequency stated in guidelines for intralesional corticosteroid injections, but repeated injections can suppress the hypothalamic-pituitary-adrenal axis. 2 The clinical approach should be:
- Inject individual lesions as they appear rather than on a fixed schedule 2
- Allow 48-72 hours to assess response before considering re-injection of the same lesion 2
- Limit the number of simultaneous injection sites to minimize systemic absorption 2
Critical Safety Warnings
Local overdose can cause permanent tissue atrophy, pigmentary changes, and telangiectasias. 2 These complications are dose-dependent and more likely with:
- Excessive volume per injection site
- Repeated injections in the same location
- Use of higher concentrations (40 mg/mL vs 10 mg/mL)
Severe postinjection flares can occur, mimicking septic arthritis with intense pain and joint effusion within 2 hours of injection. 5 This represents an acute crystal-induced inflammatory response to triamcinolone crystals. 5