What is the maximum dose of oral (PO) Toradol (ketorolac) for an adult patient with no significant medical history?

Maximum Dose of Oral Ketorolac (Toradol)

The maximum daily dose of oral ketorolac is 40 mg per day for adults aged 17-64 years, and 40 mg per day for adults ≥65 years, patients with renal impairment, or those weighing <50 kg (110 lbs). 1

Dosing Algorithm by Patient Population

Adults Age 17-64 Years (Standard Dosing)

• Initial dose: 20 mg PO once (must follow IV/IM ketorolac administration) 1
• Maintenance: 10 mg every 4-6 hours as needed 1
• Maximum daily dose: 40 mg/day 1

High-Risk Populations (Reduced Dosing Required)

The following patients require dose reduction 1:

• Age ≥65 years 2, 1
• Renal impairment 1
• Weight <50 kg (110 lbs) 1

Dosing for high-risk patients:

• Initial dose: 10 mg PO once (must follow IV/IM ketorolac) 1
• Maintenance: 10 mg every 4-6 hours as needed 1
• Maximum daily dose: 40 mg/day 2, 1

Critical Duration Limitation

The combined duration of IV/IM ketorolac plus oral ketorolac must not exceed 5 days in total. 1, 3 This is a hard stop—ketorolac should never be used beyond 5 days regardless of route 4, 1.

Essential Prescribing Requirements

Oral Ketorolac Cannot Be Used as Initial Therapy

• Oral ketorolac is only indicated as continuation therapy following IV or IM ketorolac 1
• It should never be given as the first dose 1

Minimum Dosing Interval

• Do not shorten the 4-6 hour dosing interval 1
• Use the minimum effective dose for each individual patient 1

Absolute Contraindications

Do not prescribe oral ketorolac in patients with 2, 5:

• Aspirin/NSAID-induced asthma 2, 5
• Active peptic ulcer disease or GI bleeding 2
• Cerebrovascular hemorrhage 2, 5
• Severe renal impairment 2
• Concurrent anticoagulant therapy 2, 5
• Pregnancy 5

Dangerous Drug Interactions to Avoid

Never Combine with Other NSAIDs

• Wait 6-8 hours after last ibuprofen dose before giving ketorolac 4
• Concurrent NSAID use increases GI bleeding, renal toxicity, and cardiovascular complications without additional analgesic benefit 4
• The toxicities are additive, not synergistic 4

Other High-Risk Combinations

• Avoid with SSRIs/SNRIs due to elevated bleeding risk 2
• Do not combine with other NSAIDs 2, 4

Mandatory Monitoring Requirements

Baseline Assessment (Before First Dose)

Obtain the following 2, 4:

• Blood pressure 2, 4
• BUN and creatinine 4
• Liver function tests 4
• Complete blood count 2, 4
• Fecal occult blood 2, 4

Discontinuation Criteria

Stop ketorolac immediately if 4:

• BUN or creatinine doubles 4
• Hypertension develops or worsens 4
• Liver function tests increase >3× upper limit of normal 4
• Gastrointestinal bleeding occurs 4

Common Pitfall: Exceeding 5-Day Limit

The most dangerous error is continuing ketorolac beyond 5 days 1, 3. The risk of serious gastrointestinal bleeding and renal failure increases markedly with prolonged use, especially in elderly patients 6. Always count the total days of IV/IM plus oral therapy—they must sum to ≤5 days. 1