Oral Toradol (Ketorolac) Dosing
Oral ketorolac should be dosed at 20 mg once, followed by 10 mg every 4-6 hours as needed (maximum 40 mg/day) for patients aged 17-64 years, and must only be used as continuation therapy after IV/IM ketorolac, with total treatment duration not exceeding 5 days. 1
Standard Adult Dosing (Ages 17-64)
- Initial dose: 20 mg orally once 1
- Maintenance: 10 mg every 4-6 hours as needed 1
- Maximum daily dose: 40 mg 1
- Do not shorten the dosing interval below 4-6 hours 1
Special Populations Requiring Dose Reduction
For patients ≥65 years, renally impaired, or weighing <50 kg (110 lbs):
- Initial dose: 10 mg orally once 1
- Maintenance: 10 mg every 4-6 hours as needed 1
- Maximum daily dose: 40 mg 1
Critical Duration Limitations
- Oral ketorolac is NOT approved as initial therapy - it must follow IV or IM ketorolac administration 1
- Combined duration of IV/IM plus oral ketorolac cannot exceed 5 days in adults 1, 2
- This 5-day maximum is due to cumulative risks of gastrointestinal bleeding, renal impairment, and operative site bleeding that increase substantially with prolonged therapy 2
Pediatric Considerations
- Oral ketorolac is not approved for patients under age 17 1
- For pediatric postoperative pain, if ketorolac is used, the recommended oral dosage is 0.25 mg/kg to a maximum of 1.0 mg/kg/day for a maximum duration of 7 days, though this is based on research data rather than FDA-approved oral formulation labeling 3
Clinical Context and Efficacy
- Oral ketorolac provides analgesia equivalent to aspirin, acetaminophen, ibuprofen, and acetaminophen with codeine for moderate pain 4
- However, oral ketorolac has limited utility for acute moderate-to-severe pain requiring rapid relief due to prolonged onset (30-60 minutes) and significant non-responder rates (>25% in most studies) 4
- Oral ketorolac is most appropriate as step-down therapy after initial parenteral dosing when transitioning patients who can tolerate oral medications 1
Common Pitfalls to Avoid
- Never use oral ketorolac as first-line therapy - FDA labeling explicitly restricts it to continuation therapy only 1
- Never exceed 5 days total duration (IV/IM + oral combined) to minimize serious adverse effects 2, 1
- Do not use in patients <17 years old for oral formulation 1
- Always reduce dose in elderly, renally impaired, or low-weight patients 1
- Avoid in patients with aspirin/NSAID-induced asthma, pregnancy, or cerebrovascular hemorrhage 5