What is the recommended dosing regimen for Toradol (Ketorolac) injection in a patient at least 17 years old with acute pain, no history of active peptic ulcer disease, recent gastrointestinal bleeding, or severe kidney disease?

Toradol (Ketorolac) Injection Dosing for Acute Pain

For adults ≥17 years with acute pain and no contraindications, administer ketorolac 10-15 mg IV as a single dose, with the option to repeat every 6 hours if needed, but never exceed 5 days of total therapy (IV/IM plus oral combined). 1, 2

Initial Dosing Strategy

Start with 10 mg IV as the preferred dose because research demonstrates this represents the analgesic ceiling for ketorolac—higher doses provide no additional pain relief but increase toxicity risk. 2

• A randomized controlled trial of 240 ED patients showed identical pain reduction at 30 minutes across 10 mg, 15 mg, and 30 mg IV doses (mean pain score reduction of approximately 2.6-3.0 points on a 10-point scale). 2
• The 10 mg dose provided effective pain relief without increased adverse effects compared to higher doses. 2
• Pain relief begins within 5-10 minutes of IV administration, with peak effect at 30-60 minutes. 3

Dosing Frequency and Duration

Administer every 6 hours as needed, but strictly limit total duration to 5 days maximum (combining all routes of administration). 1, 4

• The combined duration of IV/IM plus oral ketorolac cannot exceed 5 days due to cumulative risks of gastrointestinal bleeding, renal impairment, and operative site bleeding that increase substantially with prolonged therapy. 1
• Maximum daily dose should not exceed 90 mg in adults. 5

Age-Specific Considerations

For patients ≥65 years, use 15 mg IV or 30 mg IM as the standard dose rather than higher doses, as elderly patients show equivalent analgesia with lower doses. 6

• A retrospective study of 312 elderly ED patients found no difference in rescue analgesia needs between 15 mg IV/30 mg IM versus 30 mg IV/60 mg IM doses (6.5% vs 13.5%, p=0.094). 6
• Average pain score reduction was identical (2.8 vs 2.9 points) between lower and higher dose groups in elderly patients. 6

Absolute Contraindications

Do not administer ketorolac if any of the following are present: 7, 1, 4

• Active peptic ulcer disease 7
• History of gastrointestinal bleeding 4
• Chronic kidney disease or renal insufficiency 7, 4
• Pregnancy or breastfeeding 1
• Aspirin/NSAID-induced asthma or allergic reactions 1, 4
• Concurrent use of other NSAIDs 4

Route Selection

Prioritize IV administration over IM in clinical practice. 5

• IV route is preferred during the immediate postoperative or acute pain period until oral medication can be tolerated. 5
• IM injections are not recommended unless IV access is unavailable, particularly in children. 5

Transition to Oral Therapy

If pain management beyond initial IV doses is needed, transition to oral ketorolac 10 mg every 4-6 hours, but remember the 5-day total duration limit applies to combined IV/IM and oral therapy. 1

Common Pitfalls to Avoid

• Never use ketorolac prophylactically to prevent anticipated pain—it should only be given for diagnosed injuries or conditions. 4
• Do not exceed 5 days total duration across all routes of administration, as this dramatically increases serious adverse event risk. 1
• Avoid the outdated practice of using 30 mg IV doses routinely—the 10 mg dose is equally effective with better safety profile. 2
• Do not combine with other NSAIDs or aspirin (except low-dose cardioprotective aspirin if absolutely necessary with gastroprotection). 4