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NSAID — Parenteral Analgesic Pregnancy: Contraindicated in third trimester; avoid in first and second trimesters unless clearly necessary

Ketorolac Trometamol

Brand names: Toradol

Adult dose

Dose: 10-30 mg IV/IM every 4-6 hours
Route: Intravenous / Intramuscular
Frequency: Every 4-6 hours
Max: 90 mg/day (under 65); 60 mg/day (over 65 or renal impairment); maximum 5 days total
Restrict to maximum 5 days — GI and renal risks increase with duration. First dose IV: 30 mg; then 10-30 mg every 4-6 hours. Transition to oral NSAID as soon as possible

Paediatric dose

Dose: 0.5 mg/kg IV (max 15 mg per dose) mg/kg
Route: IV / IM
Frequency: Every 6 hours
Max: 60 mg/day
Child 16 years and over only — not licensed under 16. Seek specialist opinion for younger patients

Dose adjustments

Renal

Reduce to 10-15 mg every 4-6 hours (max 60 mg/day) in mild-moderate impairment; avoid if eGFR under 30

Hepatic

Use with caution in hepatic impairment

Paediatric weight-based calculator

Child 16 years and over only — not licensed under 16. Seek specialist opinion for younger patients

Clinical pearls

  • Potent parenteral NSAID — equivalent analgesia to 6-12 mg morphine IM at a 30 mg dose, without opioid side effects; valuable opioid-sparing agent in perioperative care
  • Maximum 5 days duration — GI and renal toxicity accumulate with duration; FDA and MHRA restrict duration; oral ibuprofen or diclofenac for continuation
  • Platelet inhibition: reversible COX-1 inhibition — caution in procedures with bleeding risk; avoid in tonsillectomy (increased post-operative bleeding risk in children)
  • Hypovolaemia is a contraindication — prostaglandin-dependent renal blood flow is critical in volume-depleted patients; ensure adequate hydration before and during use
  • Strong evidence base for multimodal analgesia — combining ketorolac + paracetamol + opioid reduces morphine consumption by 30-50% post-operatively

Contraindications

  • Active GI ulceration or bleeding
  • Renal impairment (eGFR under 30)
  • Coagulation disorders or anticoagulant use
  • Hypovolaemia
  • Established cardiovascular disease
  • Third trimester of pregnancy

Side effects

  • GI ulceration and bleeding (higher risk than other NSAIDs at analgesic doses)
  • Renal impairment (AKI)
  • Platelet inhibition and bleeding
  • Hypersensitivity (aspirin-exacerbated respiratory disease)

Interactions

  • Anticoagulants (significantly increased bleeding risk)
  • Other NSAIDs (additive GI and renal toxicity)
  • ACEi + diuretics (triple whammy AKI risk)
  • Lithium (increased levels)
  • Methotrexate (increased toxicity)

Monitoring

  • Renal function (U&E)
  • Signs of GI bleeding
  • Blood pressure
  • Fluid status

Reference: BNFc; BNF 90; Toradol SPC; PROSPECT Guidelines; MHRA 5-day restriction guidance. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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