Toradol (Ketorolac) 10mg Tablet Dosing in Adults
For adults aged 17-64 years with normal renal function, Toradol 10mg tablets are dosed as 10mg every 4-6 hours as needed, not exceeding 40mg per day, and only as continuation therapy following initial IV or IM ketorolac administration, with total treatment duration (IV/IM plus oral) not exceeding 5 days. 1
Standard Adult Dosing (Ages 17-64, Normal Renal Function)
- Initial oral dose: 20mg once (following IV/IM ketorolac) 1
- Maintenance dose: 10mg every 4-6 hours as needed 1
- Maximum daily dose: 40mg 1
- Minimum dosing interval: 4-6 hours (do not shorten) 1
- Maximum treatment duration: 5 days total (combined IV/IM and oral) 1
Critical restriction: Oral ketorolac should never be given as initial therapy—it must follow IV or IM ketorolac administration 1
Modified Dosing for High-Risk Populations
Elderly Patients (≥65 years), Renal Impairment, or Weight <50kg (110 lbs)
- Initial oral dose: 10mg once (following IV/IM ketorolac) 1
- Maintenance dose: 10mg every 4-6 hours as needed 1
- Maximum daily dose: 40mg 1
- Maximum treatment duration: 5 days total (combined IV/IM and oral) 1
The reduced initial dose in these populations reflects increased risk of adverse events, particularly gastrointestinal bleeding and renal complications 1, 2
Renal Impairment Considerations
- Ketorolac clearance is significantly reduced in renal impairment, with half-life extending from 5-6 hours to 6-19 hours depending on severity 1
- Area under the curve (AUC) increases approximately 100% in patients with renal disease compared to healthy volunteers 1
- Volume of distribution doubles for the S-enantiomer in renal disease 1
- Contraindicated in patients at risk for renal failure 2
Gastrointestinal Risk Management
- Risk of serious GI bleeding increases markedly with high doses used for >5 days, especially in elderly patients 3, 2
- Overall risk of GI or operative site bleeding with ketorolac is only slightly higher than opioids when used according to current guidelines 3, 2
- Contraindicated in patients with history of or current risk of GI bleeding 2
Absolute Contraindications
- History of or current risk of gastrointestinal bleeding 2
- Risk of renal failure or significant renal impairment 2, 4
- Compromised hemostasis or active bleeding 2, 4
- Hypersensitivity to aspirin or other NSAIDs 2, 4
- Concurrent use with other NSAIDs 4
- Pregnancy, labor, delivery, and nursing 2
- History of complications related to NSAIDs 4
Key Clinical Pitfalls to Avoid
- Never use ketorolac as initial oral therapy—it must follow parenteral administration 1
- Never exceed 5 days total duration (IV/IM plus oral combined) 1, 4
- Never shorten the 4-6 hour dosing interval 1
- Never use prophylactically to prevent anticipated pain 4
- Never combine with other NSAIDs due to additive toxicity risk 4
- Never use higher doses in elderly or renally impaired patients—start at 10mg, not 20mg 1
Hemostatic Effects
- Ketorolac reversibly inhibits platelet aggregation and increases bleeding time, though usually within normal limits 5
- Platelet function returns to normal after drug discontinuation 3
- Risk of surgical site bleeding is controversial for tonsillectomy but not significantly increased for most other surgeries 5