What is the recommended dosing frequency for intramuscular (IM) toradol (ketorolac) in an adult patient with impaired renal function?

IM Ketorolac Dosing Frequency in Renal Impairment

For adults with impaired renal function, IM ketorolac should be administered at 15 mg every 6 hours, with a maximum daily dose of 60 mg and treatment duration not exceeding 5 days. 1

Standard Dosing Parameters

The FDA-approved dosing for IM ketorolac distinguishes clearly between patients with and without renal impairment 1:

Multiple-Dose Regimen (IM Administration)

Patients with renal impairment:

• Dose: 15 mg every 6 hours 1
• Maximum daily dose: 60 mg 1
• Maximum treatment duration: 5 days 2, 1

Patients <65 years without renal impairment:

• Dose: 30 mg every 6 hours 1
• Maximum daily dose: 120 mg 1

Critical Safety Considerations

The 5-day maximum duration is non-negotiable because cumulative risks of gastrointestinal bleeding, renal impairment, and operative site bleeding increase substantially with prolonged therapy 2. This applies to all patients regardless of renal function.

Additional High-Risk Factors Requiring Dose Reduction

Beyond renal impairment, the following populations also require the reduced 15 mg every 6 hours dosing 1:

• Age ≥65 years 1
• Body weight <50 kg (110 lbs) 1

Contraindications in Renal Disease

Ketorolac should be avoided entirely in patients with 3:

• Severe renal impairment
• Compromised fluid status (hypovolemia must be corrected before administration) 1

Practical Implementation

Timing and administration:

• Administer slowly and deeply into the muscle 1
• Analgesic effect begins in approximately 30 minutes 1
• Maximum effect occurs 1-2 hours after dosing 1
• Duration of analgesic effect is typically 4-6 hours 1

For breakthrough pain: Do not increase the dose or frequency of ketorolac 1. Instead, consider supplementing with low doses of opioids unless contraindicated 1.

Common Pitfalls to Avoid

1. Do not exceed 5 days of treatment - Risk of serious adverse events increases markedly with longer duration, especially in elderly patients 4

2. Do not use higher doses in renal impairment - The 15 mg every 6 hours dose is already adjusted for reduced clearance 5

3. Monitor for acute renal failure - While usually reversible on drug discontinuation, this is a known risk with ketorolac 4

4. Assess bleeding risk - Ketorolac has reversible antiplatelet effects and the risk of gastrointestinal or operative site bleeding increases with high dosages used beyond 5 days 4