How many days per month can an adult without contraindications take ketorolac (Toradol)?

Maximum Duration of Ketorolac Use Per Month

Ketorolac should not be used for more than 5 consecutive days in any circumstance, and this 5-day maximum applies to the combined duration of all routes of administration (IV, IM, and oral). 1, 2, 3, 4, 5

Critical Duration Limits

• The absolute maximum treatment duration is 5 days total, regardless of route of administration 1, 2, 3, 4
• This 5-day limit is not "per month"—it represents the maximum continuous treatment period 1, 4
• There is no established safe interval for repeat courses of ketorolac within the same month 2, 4

Why the 5-Day Limit Exists

The strict 5-day maximum was established because:

• Risk of serious adverse events increases markedly after 5 days of therapy, particularly gastrointestinal bleeding, renal failure, and cardiovascular complications 6, 7
• Retrospective surveillance data from over 20,000 patients demonstrated that gastrointestinal and operative site bleeding risk increased substantially when ketorolac was used beyond 5 days 7
• The risk is especially pronounced in elderly patients (>60 years) and those receiving high doses (>90-120 mg/day) 6, 7, 8

Clinical Implications for Monthly Use

In practical terms, ketorolac should be reserved for short-term management of acute pain episodes and should not be used as a recurring monthly medication. 2, 5 The evidence does not support:

• Repeated 5-day courses within the same month
• Chronic or intermittent monthly use patterns
• "Cycling" on and off the medication

High-Risk Populations Requiring Extra Caution

Even within the 5-day limit, certain patients face elevated risks:

• Patients ≥60 years of age have significantly higher rates of serious adverse events 2, 6, 7
• Those with compromised fluid status, renal impairment, or on nephrotoxic drugs are at increased risk for acute renal failure 2, 9
• Patients with cardiovascular disease, hypertension, or heart failure face elevated cardiovascular risks 2
• Those with history of peptic ulcer disease or gastrointestinal bleeding should not receive ketorolac at all 2

Monitoring Requirements During the 5-Day Period

If ketorolac is used, baseline and periodic monitoring should include:

• Blood pressure, BUN, and creatinine 2, 3
• Liver function tests and complete blood count 2, 3
• Fecal occult blood testing 2, 3
• Immediate discontinuation if liver enzymes increase, BUN/creatinine doubles, or hypertension develops or worsens 2, 4

Safer Alternatives for Recurrent Pain

For patients requiring pain management beyond 5 days or on a recurring basis:

• Consider acetaminophen (up to 4g daily), which has a more favorable safety profile for longer-term use 1
• Oral NSAIDs with better safety profiles (ibuprofen, naproxen) may be more appropriate for subacute pain 1
• Non-pharmacological interventions should be prioritized when feasible 2