NSAID — Parenteral Analgesic Pregnancy: Contraindicated during pregnancy, labour and delivery, and during lactation (§4.3, §4.6). NSAID effects on the foetal cardiovascular system (risk of closure of the ductus arteriosus); from the 20th week of pregnancy onward may cause oligohydramnios from foetal renal dysfunction.

Ketorolac Trometamol

Brand names: Toradol

Ketorolac trometamol is a potent injectable NSAID used for the short-term management of moderate to severe acute post-operative pain, given parenterally as an opioid-sparing analgesic.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Initial dose 10 mg, followed by 10 to 30 mg every four to six hours as required

Route: Intramuscular or bolus intravenous injection (bolus IV doses given over no less than 15 seconds). Not for epidural or spinal (neuraxial) administration.

Frequency: Every 4 to 6 hours as required; in the initial post-operative period may be given as often as every 2 hours if needed

Max: Total daily dose 90 mg (non-elderly); 60 mg for the elderly, renally-impaired patients and patients less than 50 kg. Maximum duration of treatment 2 days.

Source: UK SPC for Toradol 30 mg/ml solution for injection (§4.2). Dosage should be adjusted according to severity of pain and patient response; the lowest effective dose for the shortest duration should be used. Continuous multiple daily IM/IV doses should not exceed two days. Reduce dosage in patients under 50 kg. Onset of analgesia approximately 30 minutes after IV or IM, maximum analgesia within one to two hours, median duration four to six hours. Opioid analgesics (e.g. morphine, pethidine) may be used concomitantly and may be required for optimal analgesia early post-operatively; the daily opioid dose required is usually less, but opioid side-effects still apply, especially in day-case surgery. Elderly: lowest effective dose for the shortest possible duration, total daily dose not to exceed 60 mg, longer dosing interval advisable (increased plasma half-life and reduced clearance). Paediatric population: safety and efficacy in children have not been established and Toradol is not recommended for use in children under 16 years of age (§4.2); children under 16 years are a contraindication (§4.3) — verify any paediatric use against a children's formulary. IMPORTANT: the SPC contraindicates ketorolac as prophylactic analgesia before surgery and intra-operatively because of platelet inhibition and increased bleeding risk.

Dose adjustments

Renal

Contraindicated in moderate to severe renal impairment (serum creatinine >160 micromol/l); reduce dosage in lesser impairment, not exceeding 60 mg/day IV or IM (§4.2, §4.3).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to ketorolac, any of its excipients or other NSAIDs; patients in whom aspirin or other prostaglandin synthesis inhibitors induce allergic reactions (asthma, rhinitis, angioedema or urticaria)
History of asthma
Children under 16 years of age
Active peptic ulcer, or any history of gastrointestinal bleeding, ulceration or perforation
Severe heart failure, hepatic failure and renal failure
Moderate or severe renal impairment (serum creatinine >160 micromol/l), or patients at risk of renal failure due to volume depletion or dehydration
Pregnancy, labour, delivery or lactation
As prophylactic analgesia before surgery, and intra-operatively, because of platelet inhibition and increased risk of bleeding
Suspected or confirmed cerebrovascular bleeding; patients who have had operations with a high risk of haemorrhage or incomplete haemostasis; those at high risk of bleeding such as haemorrhagic diatheses including coagulation disorders
Patients on anticoagulants, including warfarin and low dose heparin (2500-5000 units 12 hourly)
Patients currently receiving aspirin or other NSAIDs (including cyclooxygenase-2 selective inhibitors)
Neuraxial (epidural or intrathecal) administration of the solution for injection, due to its alcohol content
Concurrent treatment with oxpentifylline, probenecid or lithium salts
Complete or partial syndrome of nasal polyps, angioedema or bronchospasm

Side effects

Gastrointestinal: peptic ulcers, ulceration, perforation or GI bleeding (sometimes fatal, particularly in the elderly); nausea, vomiting, diarrhoea, constipation, dyspepsia, abdominal pain, melaena, haematemesis
Renal: acute renal failure, interstitial nephritis, oliguria, urinary retention; elevations of creatinine and potassium can occur after one dose
Blood/bleeding: thrombocytopenia, purpura, haematoma, postoperative wound haemorrhage
Immune: anaphylaxis and anaphylactoid reactions (may be fatal), bronchospasm, flushing, rash, hypotension, laryngeal oedema
Nervous system/cardiovascular: headache, dizziness, drowsiness, convulsions, paraesthesia; hypertension, hypotension, palpitations, bradycardia, cardiac failure

Interactions

Anticoagulants including warfarin and low dose heparin — contraindicated (SPC §4.3)
Aspirin or other NSAIDs including COX-2 selective inhibitors — concurrent use contraindicated (§4.3); concomitant NSAID use should be avoided (§4.4)
Oxpentifylline — combination contraindicated (§4.3)
Probenecid or lithium salts — concurrent treatment contraindicated (§4.3)
Opioid analgesics (e.g. morphine, pethidine) may be used concomitantly; ketorolac does not interfere with opioid binding and does not exacerbate opioid-related respiratory depression or sedation, and the opioid dose required is usually less (§4.2)
Concomitant low dose aspirin or other drugs likely to increase gastrointestinal risk — consider combination therapy with protective agents such as misoprostol or a proton pump inhibitor (§4.4)

Clinical monograph

How it works

It non-selectively inhibits cyclo-oxygenase, reducing prostaglandin synthesis to produce marked analgesic and anti-inflammatory effects.

Prescribing in practice

Restrict to the shortest possible course because ketorolac carries a high risk of serious gastrointestinal bleeding and ulceration, acute kidney injury and platelet inhibition — avoid in renal impairment, hypovolaemia, bleeding risk and active peptic ulceration.
It is for short-term use only and the maximum combined parenteral-plus-oral duration is strictly limited; reduce exposure further in older and lower-weight patients.
Do not use where there is high surgical bleeding risk, and ensure adequate hydration; co-prescribe gastroprotection where indicated.

Monitoring

Monitor renal function, fluid balance, blood pressure and for any gastrointestinal or surgical-site bleeding throughout the brief course.

Counselling the patient

Explain this is a strong anti-inflammatory injection used only for a short time to control pain after surgery.
Report stomach pain, black stools, unusual bleeding or reduced urine output.

Evidence & guidelines

Ketorolac is an established short-term parenteral analgesic; the SPC and MHRA advice stress strict duration limits and contraindications owing to its gastrointestinal, renal and bleeding risks.

Reference: Toradol SPC; PROSPECT Guidelines; MHRA 5-day restriction guidance; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Numeric Rating Scale (NRS) Pain Assessment and Management · Pain Management

Pathways