L B M M C / P H A R M A C Y S E R V I C E S

M E D I C A T I O N A D M I N I S T R A T I O N

M A N U A L

Non-Critical Care Areas

All Critical Care Areas

KETOROLAC (TORADOL)
ROUTES OF ADMINISTRATION

Direct IV push, IM

METHODS FOR IV ADMINISTRATION AND DOSAGE

1. One-time dosing:

Patients <65 years

Patients >65 years, renally impaired or
weigh <50 kg (110 lbs)

IM Dosing

IV Dosing

60 mg
30 mg

30 mg
15 mg

2. Scheduled or PRN dosing (not to exceed 5 days of therapy):

Maintenance
IV/IM
Dose
Patients <65 years
30 mg q 6h
Patients >65 years, renally impaired or
15 mg q 6h
weigh <50 kg (110 lbs)

Maximum
Dose
120 mg
60 mg

3. Administer IV push over no less than 15 seconds. Should not be given via intermittent

infusion as it will likely delay onset and/or diminish effect.

INDICATIONS FOR IV USE

Ketorolac is indicated for the short-term treatment (up to 5 days) of moderately severe acute pain
that requires analgesia at the opioid level, usually in the postoperative setting.

POTENTIAL PROBLEMS WITH IV ADMINISTRATION

1. Immediate reactions:
IV administration generally will not cause any local vein irritation or pain on injection
Potential anaphylactoid reactions including bronchospasm, angioedema, and shock.
2. Delayed reactions:

GI reactions: nausea, pain, diarrhea, or rarely gastritis or bleeding

Increase in blood pressure, fluid retention, edema
Headache, drowsiness, and dizziness
Decrease in renal function, particularly in patients with preexisting impairment or volume
depletion.
Postoperative wound hemorrhage

TREATMENT OF ADVERSE SIDE EFFECTS

1. Appropriate supplies for treatment of hypersensitivity-like reactions such as epinephrine or

diphenhydramine should be available when administering the first dose of ketorolac.

2. Patients with volume depletion should have the volume deficit replaced prior to
administration of ketorolac.
KETOROLAC (TORADOL)

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L B M M C / P H A R M A C Y S E R V I C E S
M E D I C A T I O N A D M I N I S T R A T I O N

M A N U A L

3. Routine monitoring of blood pressure.

4. Notify physician of any signs that may be associated with significant GI effects (e.g.,

bleeding), decrease in renal function, significant fluid retention, or bleeding.

COMMENTS

1. Ketorolac has the following contraindications:

Active peptic ulcer disease (PUD) or GI bleeding, or history of PUD or GI bleeding
Advanced renal dysfunction or risk of renal failure due to volume depletion
Use in labor or delivery. Contraindicated for use in nursing mothers
History of hypersensitivity to aspirin, NSAIDs, or ketorolac
Prophylactic use prior to major surgery
Cerebrovascular bleeding
Impaired hemostasis
Concurrent use of aspirin or NSAIDs
Epidural or intrathecal administration
Concomitant administration with probenecid

COMMENTS

1. The same product is used for the IV or IM route of administration.

2. There is an automatic 72-hour stop order for ketorolac IV or IM. Continued therapy requires

a physician order to continue for up to an additional 48 hours.

3. Combined use of ketorolac injectable and oral therapy should not be given for more than 5

days total.

REFERENCES
1.
2.

Roche Laboratories. Toradol package insert. Nutley, NJ;1997 Aug.

American Hospital Formulary Service Drug Information 2001. American Society of Health Systems Pharmacists, Bethesda, MD.

KETOROLAC (TORADOL)

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