Oral Ketorolac (Toradol) Dosing for Adults
For adults with moderate to severe acute pain, oral ketorolac should be dosed at 20 mg once as an initial dose (for patients age 17-64 years), followed by 10 mg every 4-6 hours as needed, not exceeding 40 mg per day, and oral ketorolac must only be used as continuation therapy after IV or IM ketorolac administration, with total combined treatment duration not exceeding 5 days. 1
Critical Prescribing Requirements
Oral ketorolac is NOT approved as initial therapy - it can only be prescribed as continuation after parenteral (IV or IM) ketorolac has been initiated. 1 This is a fundamental FDA requirement that distinguishes ketorolac from other NSAIDs.
Standard Adult Dosing (Ages 17-64)
- Initial oral dose: 20 mg once 1
- Maintenance dose: 10 mg every 4-6 hours as needed 1
- Maximum daily dose: 40 mg 1
- Do not shorten the 4-6 hour dosing interval 1
Reduced Dosing for High-Risk Patients
For patients ≥65 years, renally impaired, or weighing <50 kg (110 lbs): 1
- Initial oral dose: 10 mg once 1
- Maintenance dose: 10 mg every 4-6 hours as needed 1
- Maximum daily dose: 40 mg 1
Duration Limits
The combined duration of IV/IM and oral ketorolac must not exceed 5 days in adults. 1 This is a hard stop mandated by the FDA due to increased risk of serious adverse events with prolonged use. 1
Absolute Contraindications
Avoid oral ketorolac in patients with: 2
- Active peptic ulcer disease or GI bleeding 2
- Aspirin/NSAID-induced asthma 3, 2
- Pregnancy 3, 2
- Cerebrovascular hemorrhage 3, 2
High-Risk Populations Requiring Caution
Use with extreme caution (or avoid) in: 2
- Patients ≥60 years old 2
- Compromised fluid status or dehydration 2
- Concurrent nephrotoxic drug use 2
- Cardiovascular disease or congestive heart failure 4
- Moderate to severe renal impairment (CrCl <30 mL/min) 4
- Concurrent anticoagulant use (significantly increases bleeding risk) 4
Required Monitoring
For any extended use (approaching the 5-day limit), monitor: 2
- Baseline and repeat (every 3 months if somehow continued beyond acute use): blood pressure, kidney function (BUN/creatinine), liver function tests, complete blood count, and fecal occult blood 2
- Discontinue immediately if: BUN or creatinine doubles, liver enzymes increase to 3× upper limit of normal, GI bleeding occurs, or hypertension develops/worsens 4
Common Adverse Effects
Expect potential side effects including: 3
Clinical Context: Efficacy Evidence
Research demonstrates that lower doses of ketorolac (10 mg IV) provide equivalent analgesia to higher doses (15 mg and 30 mg IV), suggesting an analgesic ceiling effect. 5 This supports the FDA's conservative oral dosing of 10 mg for maintenance therapy. 1 Ketorolac provides analgesia comparable to morphine for postoperative pain while avoiding opioid-related side effects like respiratory depression, nausea, and ileus. 6, 7
Key Pitfall to Avoid
The most common prescribing error is using oral ketorolac as initial therapy without prior parenteral administration. 1 This violates FDA labeling and is not approved. Oral ketorolac is strictly a continuation/transition medication after IV or IM dosing has been started. 1