Clinical Pearls for Toradol (Ketorolac)

Short-term NSAID for moderate–severe acute pain: follow strict 5-day limit, use lowest effective dose, and guard against renal, GI, and bleeding risks—especially in older adults or those on anticoagulants/SSRIs/diuretics.

1. Indication & Role in Therapy
  • Potent NSAID for short-term (≤5 days) management of moderate–severe acute pain.
  • Not for mild pain or chronic conditions.
  • Opioid-sparing; useful peri-op and in ED.
2. Duration & Safety Limits
  • Maximum total duration across all routes: 5 days.
  • Longer use ↑ GI bleeding, renal injury, and CV risk.
  • Avoid pre-op CABG; avoid active ulcer or recent GI bleed.
3. Dosing (Use Lowest Effective)
  • IV/IM: 15–30 mg q6h PRN. Typical max 60 mg/day (≥65 yrs, low weight, or renal risk) or 120 mg/day (younger/healthy).
  • PO: 10 mg q6h PRN; max 40 mg/day.
  • Prefer to avoid overlap with other NSAIDs.
4. Age, Renal, & Hepatic Adjustments
  • Avoid if CrCl < 30 mL/min or in AKI/advanced CKD.
  • Elderly: start low (e.g., 15 mg IV/IM) and limit total daily dose.
  • Hepatic disease: use caution; monitor symptoms/LFTs (avoid beyond 5 days).
5. Major Drug Interactions
  • Bleeding risk: anticoagulants, antiplatelets, SSRIs/SNRIs, corticosteroids.
  • Renal risk: ACEi/ARBs, diuretics, calcineurin inhibitors, other nephrotoxins.
  • Avoid combination with other NSAIDs or aspirin for analgesia.
6. Clinical Application Pearls
  • Consider single IV dose in ED for renal colic, MSK injury, post-op pain, migraine (with anti-emetic), when opioid-sparing desired.
  • Hydrate patients at renal risk; reassess pain at 30–60 min.
  • Document start/stop dates to enforce 5-day limit.
7. Transition After Ketorolac
  • For continued analgesia after day 5: switch to acetaminophen or a different NSAID if appropriate risk profile.
  • Avoid overlapping NSAIDs; consider GI protection in high-risk patients.
8. Adverse Effects & Monitoring
  • GI: dyspepsia, ulcer, bleed—consider PPI if risk ↑ (age ≥65, anticoagulants, prior ulcer).
  • Renal: rising SCr, ↓ urine output—hold if AKI suspected.
  • CV/Fluid: edema, HTN exacerbation—monitor BP/weight in CHF.
Quick Dosing Reference
Route Typical Dose Max/Day Special Notes
IV/IM 15–30 mg q6h PRN 60 mg (elderly/renal risk) or 120 mg (younger/healthy) Start low in ≥65 yrs or low body weight; reassess after first dose.
Oral 10 mg q6h PRN 40 mg Use only as continuation after parenteral or as short oral course ≤5 days.

All routes combined must not exceed 5 total treatment days.

This quick reference is for clinicians and does not replace full prescribing information or institutional policy.