Recommended IM Dose of Toradol (Ketorolac) for Back Pain
For adults under 65 years with normal renal function and body weight ≥50 kg, administer 60 mg IM as a single dose for acute back pain. 1
Standard Dosing Protocol
Single-Dose Treatment (Most Common for Acute Back Pain)
- Adults <65 years: 60 mg IM as a single dose 1
- Adults ≥65 years, renally impaired, or <50 kg body weight: 30 mg IM as a single dose 1
- Administer slowly and deeply into the muscle 1
- Analgesic effect begins in approximately 30 minutes, with maximum effect at 1-2 hours 1
- Duration of analgesia is typically 4-6 hours 1
Multiple-Dose Treatment (If Continued Therapy Required)
- 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
- Critical limitation: Total duration must not exceed 5 days 1, 2
- Switch to alternative analgesics as soon as possible 1
Evidence Supporting This Dosing
The 60 mg IM dose is well-established in clinical practice despite evidence suggesting lower doses may provide similar analgesia. Research demonstrates that ketorolac exhibits an analgesic ceiling effect, with 10 mg potentially being the ceiling dose 3. However, the FDA-approved dosing remains 60 mg IM for single-dose treatment in younger adults 1.
Clinical Trial Data for Back Pain
- Ketorolac (10 mg oral) provided comparable analgesia to morphine (5-10 mg IM) for postoperative orthopedic pain 4
- Ketorolac (60 mg IM) showed comparable efficacy to meperidine (1 mg/kg IM) for severe musculoskeletal low back pain, with 63% of patients achieving ≥30% pain reduction 5
- Ketorolac (10 mg oral every 4-6 hours) was superior to acetaminophen-codeine for acute low back pain in the ED, with fewer adverse events 6
Critical Safety Considerations
Mandatory contraindications and precautions:
- Correct hypovolemia before administration 1
- Avoid in patients with aspirin/NSAID-induced asthma 2
- Avoid in pregnant patients 2
- Avoid in patients with cerebrovascular hemorrhage 2
- Do not use with curative doses of anticoagulants 2
- Reduce dose by 50% in elderly (≥65 years), renally impaired, or patients <50 kg 1
Common adverse effects include:
- Edema, drowsiness, dizziness 2
- Gastrointestinal upset 2
- Increased sweating 2
- Dose-related gastric ulcerations (even with parenteral administration) 7
- Reversible platelet aggregation inhibition 7
Clinical Pearls
The 60 mg IM dose remains standard practice despite the analgesic ceiling effect, as demonstrated by a 10-year retrospective study showing 97% of IV doses and 96% of IM doses were prescribed above the theoretical 10 mg ceiling 3. The FDA-approved dosing should guide initial treatment 1.
For breakthrough pain, do not increase dose or frequency of ketorolac 1. Instead, consider supplementing with low-dose opioids unless contraindicated 1.
Ketorolac offers advantages over opioids for musculoskeletal back pain, including comparable analgesic efficacy with significantly fewer adverse events, less sedation, and no risk of respiratory depression 6, 5.