What do we check first when considering Toradol (ketorolac) for pain management in females?

What to Check First Before Administering Ketorolac (Toradol) in Females

Before administering ketorolac to any female patient, you must first determine if she is pregnant or breastfeeding, as pregnancy is an absolute contraindication to ketorolac use. 1

Essential Pre-Administration Screening

Absolute Contraindications to Rule Out

• Pregnancy status: Ketorolac is contraindicated in pregnancy, labor, delivery, and nursing 1, 2
• Active or history of peptic ulcer disease or GI bleeding 3, 2
• Aspirin or NSAID-induced asthma 3
• Cerebrovascular hemorrhage 3
• Compromised hemostasis or bleeding risk 2

High-Risk Populations Requiring Dose Adjustment

After ruling out contraindications, assess for factors requiring the lower dose regimen (10 mg instead of standard dosing):

• Age ≥65 years 3, 1
• Weight <50 kg (110 lbs) 3, 1
• Renal impairment 3, 1
• Compromised fluid status 3

Baseline Laboratory and Clinical Assessment

Before initiating ketorolac, obtain:

• Baseline renal function (BUN, creatinine) 3
• Liver function tests 3
• Complete blood count 3
• Baseline blood pressure 3
• Fecal occult blood (if prolonged use anticipated) 3

Special Considerations in Obstetric Patients

Postpartum Use After Cesarean Delivery

In the postpartum setting, ketorolac can be safely administered after delivery is complete:

• Give ketorolac 30 mg IV at the end of cesarean surgery (barring contraindications), followed by 30 mg IV every 6 hours for 24 hours, then transition to oral ibuprofen 600 mg every 6 hours 4
• Breastfeeding is not a contraindication in the immediate postpartum period when used as directed 4

Pregnancy-Related Absolute Contraindication

The FDA label explicitly lists pregnancy, labor, and delivery as contraindications 1. This means ketorolac should never be given to a pregnant woman or during active labor.

Dosing Based on Risk Stratification

Standard Adult Dosing (Age 17-64, >50 kg, Normal Renal Function)

• IV/IM: 15-30 mg every 6 hours (maximum 120 mg/day) 3, 1
• Oral (continuation only): 20 mg once, then 10 mg every 4-6 hours (maximum 40 mg/day) 1

Reduced Dosing (Age ≥65, <50 kg, or Renal Impairment)

• IV/IM: 15 mg every 6 hours (maximum 60 mg/day) 3
• Oral (continuation only): 10 mg once, then 10 mg every 4-6 hours (maximum 40 mg/day) 1

Critical Duration Limitation

Maximum treatment duration is 5 days (combined IV/IM and oral) regardless of patient population 3, 1. The risk of serious adverse events, particularly GI bleeding and renal failure, increases markedly with prolonged use beyond 5 days, especially in elderly patients 5, 2.

Common Pitfalls to Avoid

• Never use ketorolac as first-line without ruling out pregnancy in women of childbearing age 1
• Do not exceed 5-day total duration as adverse event risk increases substantially 2
• Avoid in elderly patients without dose reduction (use 15 mg instead of 30 mg doses) 3, 1
• Do not use oral ketorolac as initial therapy—it must be preceded by IV/IM dosing 1
• Monitor for signs of GI bleeding and renal dysfunction throughout treatment 3, 2