From the Guidelines
The recommended dosage of toradol (ketorolac) is 60 mg IM every 15 to 30 minutes, with a maximal dosage of 120 mg per day, and treatment should not exceed five days. When considering the management of acute pain, it's crucial to weigh the benefits against the potential risks, particularly with potent NSAIDs like toradol. The dosage guidelines are designed to minimize adverse effects while providing effective pain relief. Key considerations include:
- The route of administration: Intramuscular (IM) dosing is specified at 60 mg every 15 to 30 minutes, up to a maximum of 120 mg per day 1.
- Duration of treatment: It is critical not to exceed five days of treatment to avoid serious side effects such as gastrointestinal bleeding, kidney problems, and cardiovascular events.
- Patient factors: Elderly patients, those with renal impairment, or individuals weighing less than 50 kg may require dose adjustments, though specific guidance for these populations is not provided in the referenced study 1.
- Concomitant medication use: Caution is advised against using toradol with other NSAIDs due to increased risk of adverse effects.
- Hydration status: Patients should be well-hydrated during toradol treatment to protect kidney function. Given the potential for significant side effects, the decision to use toradol should be made with caution, considering the patient's overall health status, potential drug interactions, and the availability of alternative pain management strategies.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... In adults, the combined duration of use of IV or IM dosing of ketorolac tromethamine and ketorolac tromethamine tablets is not to exceed 5 days. Patients age 17 to 64: 20 mg PO once followed by 10 mg q4 to 6 hours prn not > 40 mg/day Patients age ≥ 65, renally impaired, and/or weight < 50 kg (110 lbs): 10 mg PO once followed by 10 mg q4 to 6 hours prn not > 40 mg/day
The recommended dosing is as follows:
- For patients 17 to 64 years: 1 initial dose of 20 mg, followed by 10 mg every 4 to 6 hours as needed, not to exceed 40 mg/day.
- For patients ≥ 65 years, renally impaired, and/or weight < 50 kg: 1 initial dose of 10 mg, followed by 10 mg every 4 to 6 hours as needed, not to exceed 40 mg/day. The total duration of treatment should not exceed 5 days 2.
From the Research
Dosage of Toradol
- The recommended dosage of Toradol (ketorolac) is a 30- or 60-mg intramuscular (IM) loading dose followed by 15- or 30-mg doses IM every 6 hours, with a maximum first-day dose of 150 mg and 120 mg on subsequent days up to a recommended maximum of 5 days 3.
- The lower dose range is recommended for elderly patients, patients weighing less than 50 kg, and patients with impaired kidney function 3.
- There is no specific mention of the number of doses recommended, but the maximum daily dose and duration of treatment are specified 3, 4.
Administration and Efficacy
- Toradol can be administered intramuscularly, with peak plasma levels reached in 45 to 50 minutes 3.
- The analgesic efficacy of Toradol has been extensively evaluated in the postoperative setting, and it provides relief from mild to severe pain in the majority of patients 4.
- Combined therapy with Toradol and an opioid results in a 25 to 50% reduction in opioid requirements, and in some patients, this is accompanied by a concomitant decrease in opioid-induced adverse events 4.
Comparison with Other Analgesics
- Toradol has been compared to other analgesics, including acetaminophen and opioids, in various studies 5, 6, 7.
- The results of these studies suggest that Toradol is an effective treatment for moderate to moderately severe short-term pain, and its efficacy is similar to or higher than that of opioid comparators 6.