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ketorolac

ketorolac
Brand names: Toradol
Form Strength
SOLUTION, INJECTABLE 15 mg/1 mL; 30 mg/1 mL; 60 mg/2 mL
TABLET, ORAL 10 mg
Display Other Nonsteroidal Anti-inflammatory Agents Class: 28080492
Medication comments:
Note: ketorolac for IV max dose = 30 mg, 60 mg is IM ONLY!.
Note: ketorolac for IV or PO use is limited to 5 days per policy.
Per policy, these drugs are subject to renal dosing adjustments by pharmacy. 
Generic + Route
(Brand)
• Indications		 Usual Adult Dose
Comments		 Renal Dosage Adjustments
ketorolac IV/IM
(Toradol©)		 15-30 mg q6h, 15 mg dose for pts ≥ 65 yrs.
max 120 mg per day
(max 60 mg per day
with renal impairment)
Single doses of ketorolac > 30 mg are discouraged due to increased risk for nephrotoxicity.		 eGFR > 50 mL/min/1.73m2:
no adjustment necessary
eGFR < 50 mL/min/1.73m2:
7.5-15 mg q6h
eGFR < 30 mL/min/1.73m2:
avoid using all NSAIDS
eGFR < 10 mL/min/1.73m2: Contraindicated
ketorolac PO
(Toradol©)		 10 mg q4-6h
max 40 mg per day		 eGFR > 50 mL/min/1.73m2:
no adjustment necessary
eGFR < 50 mL/min/1.73m2:
10 mg q4-6h (max 40 mg/day)
eGFR < 30 mL/min/1.73m2:
avoid using all NSAIDS
eGFR < 10 mL/min/1.73m2: Contraindicated
Per policy, orders for these non-formulary agents will be changed to formulary equivalents.
Non-Formulary Agent Formulary Equivalent
ketorolac (Toradol) if ≥ 65 years old IM: 30 mg x1 or 15 mg q6h (max of 60 mg/day)
IV: 15 mg q6h (max of 60 mg/day)
PO: 10 mg q4-6h prn (max of 40 mg/day)
Anticoagulant / Antiplatelet Stoppage For Procedures
generic (Brand) Dept. Procedure Type
(hover over entry for examples)		 Stop Medication Prior To Procedure Restart after:
ketorolac
(Toradol)		 Anesthesia High-risk 24 hours Restart after 24 hours
Intermediate-risk No hold Restart after 24 hours
Low-risk No hold Restart after 24 hours
Patients with high risk of bleeding (eg, old age, history of bleeding tendency, concurrent uses of other anticoagulants/antiplatelets, liver cirrhosis or advanced liver disease, and advanced renal disease) undergoing low- or intermediate-risk procedures should be treated as intermediate or high risk, respectively.
Radiology
 Invasive Procedures 24 hours
Paracentesis/Thoracentesis No hold
Surgery High-risk 7 days Restart after 24 hours
Low-risk No Hold Restart after 24 hours
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: ketorolac (Toradol)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Comments oral and parenteral
Drug(s) ketorolac
Rationale Inreased risk of GI bleeding/peptic ulcer disease and acute kidney injury in older adults. Of all the NSAIDs, indomethacin has the most adverse effects, including a higher risk of adverse CNS effects.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) non-COX-2-selective NSAIDs, oral
Rationale Increased risk of GI bleeding or peptic ulcer disease in high-risk groups, including those >75 years old or taking oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents; use of proton-pump inhibitor or miSOPROStol reduces but does not eliminate risk. Upper GI ulcers, gross bleeding or perforation caused by NSAIDs occur in ~1% of patients treated for 3-6 months and in ~2%-4% of patients treated for 1 year; these trends continue with longer duration of use. Also can increase blood pressure and induce kidney injury. Risks are dose-related.
Recommendation Avoid chronic use unless other alternatives are not effective and the patient can take a gastroprotective agent (proton-pump inhibitor or miSOPROStol).
Avoid short-term scheduled use in combination with oral or parenteral corticosteroids, anticoagulants or antiplatelet agents unless other alternatives are not effective and the patient can take a gastroprotective agent (proton-pump inhibitor or miSOPROStol).
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome NSAIDs and COX-2 inhibitors ⇄ Heart failure
Rationale Potential to promote fluid retention and/or exacerbate heart failure.
Recommendation Use with caution in patients with heart failure who are asymptomatic; avoid in patients with symptomatic heart failure.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome non-COX-2 selective NSAIDs ⇄ History of gastric or duodenal ulcers
Rationale May exacerbate existing ulcers or cause new/additional ulcers
Recommendation Avoid unless other alternatives are not effective and the patient can take a gastroprotective agent (i.e., proton-pump inhibitor or miSOPROStol).
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 5: medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults. (Table 6)
CrCl (mL/min) at which action is required <30
Rationale NSAIDs (oral and parenteral) may increase the risk of acute kidney injury and a further decline in kidney function.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
Last updated: Sep. 19, 2025
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