What is the frequency of Toradol (Ketorolac) injections?

From the Guidelines

Toradol shots should be limited to a maximum dosage of 120 mg per day, with a treatment duration not to exceed five days, as indicated by the study published in the American Family Physician in 2002 1. The recommended dosing is 60 mg IM every 15 to 30 minutes, with a maximal dosage of 120 mg per day. Key considerations for the use of Toradol include:

• Contraindications such as aspirin/NSAID-induced asthma, pregnancy, and cerebrovascular hemorrhage
• Potential adverse reactions like edema, drowsiness, dizziness, GI upset, and increased diaphoresis
• Limitations on use, including a maximum treatment duration of five days and careful monitoring to minimize risks. It is essential to weigh the benefits of Toradol against its significant risk profile, which includes gastrointestinal bleeding, kidney damage, and cardiovascular events, and to consider alternative pain management options when possible 1.

From the FDA Drug Label

KETOROLAC TROMETHAMINE INJECTION Ketorolac tromethamine injection may be used as a single or multiple dose on a regular or “prn” schedule for the management of moderately severe, acute pain that requires analgesia at the opioid level, usually in a postoperative setting. Multiple-Dose Treatment (Intravenous or Intramuscular) Patients <65 years of age: The recommended dose is 30 mg ketorolac tromethamine injection every 6 hours. The maximum daily dose for these populations should not exceed 120 mg For patients ≥65 years of age, renally impaired patients (see WARNINGS), and patients less than 50 kg (110 lbs): The recommended dose is 15 mg ketorolac tromethamine injection every 6 hours. The maximum daily dose for these populations should not exceed 60 mg.

The recommended frequency for a Toradol shot is every 6 hours. The maximum daily dose is:

• 120 mg for patients less than 65 years of age
• 60 mg for patients 65 years of age or older, renally impaired, or less than 50 kg (110 lbs) 2

From the Research

Toradol Shot Frequency

The frequency of Toradol shots is a critical consideration due to the potential for adverse effects associated with its use.

• The risk of gastrointestinal bleeding and operative site bleeding increases with high doses and prolonged therapy (>5 days) 3, 4, 5.
• Studies suggest that the overall risk of gastrointestinal or operative site bleeding related to ketorolac therapy is only slightly higher than with opioids, but this risk increases in vulnerable patients, such as the elderly 3, 5.
• The incidence of serious adverse events, including gastrointestinal bleeding and renal impairment, has declined since dosage guidelines were revised 3.
• Ketorolac should be prescribed at the lowest dosage necessary to control pain, and the duration of therapy should be limited to as few days as possible 3.

Factors Influencing Toradol Shot Frequency

Several factors can influence the frequency of Toradol shots, including:

• Dose: Higher daily doses of ketorolac are associated with an increased risk of gastrointestinal bleeding and operative site bleeding 4, 5.
• Duration of therapy: Prolonged therapy (>5 days) increases the risk of adverse events, including gastrointestinal bleeding and renal impairment 3, 5.
• Patient characteristics: Older patients (≥75 years) are at higher risk of gastrointestinal bleeding and operative site bleeding 5.
• Concomitant medications: The use of antiplatelet drugs or other NSAIDs may increase the risk of gastrointestinal bleeding 6.

Guidelines for Toradol Shot Frequency

Based on the available evidence, the following guidelines can be suggested:

• Limit the duration of ketorolac therapy to 5 days or less whenever possible 5.
• Use the lowest effective dose of ketorolac to minimize the risk of adverse events 3.
• Monitor patients closely for signs of gastrointestinal bleeding or operative site bleeding, especially in vulnerable populations 3, 5.