Ketorolac

Toradol

Non-selective NSAID (COX-1/COX-2 inhibitor)

Inhibits cyclooxygenase → ↓ prostaglandin synthesis → anti-inflammatory + analgesic + antipyretic.

Indications

Context	Adult	Pediatric
Adult IV/IM (<65 yo, normal renal)	30 mg IV/IM single dose; or 30 mg q6h (max 5 days)	—
Adult IV/IM (≥65 yo, <50 kg, or impaired renal)	15 mg IV/IM q6h	—
Pediatric (≥2 yo)	0.5 mg/kg IV q6h, max 30 mg/dose	—
Oral (after IV transition)	10 mg PO q4-6h, max 40 mg/day	—

Onset 10 min IV; peak analgesia ~2 hr; duration 4-6 hr; half-life 4-6 hr; renal excretion.

!GI bleed / ulceration (esp. if combined with steroids, anticoagulants, or alcohol)
!Acute kidney injury (esp. dehydration, ACEi/ARB, elderly, baseline CKD)
!Platelet dysfunction (reversible — duration 24-48 hr; impacts bleeding for surgical sites)
!Bronchospasm (aspirin-exacerbated respiratory disease)
!Increased CV risk (MI, CVA) with prolonged use

×Aspirin/NSAID allergy or AERD (Samter triad)
×Active GI bleed or peptic ulcer
×Renal impairment (CrCl <30) or volume depletion
×Pre-op or intraop with high bleeding-risk surgery (ENT, neurosurgery, plastic flap)
×Asthma with NSAID-sensitivity
×Late pregnancy (premature ductus closure)
×Anticoagulation (relative — discuss with surgeon)

★5-DAY MAXIMUM courtesy of FDA label: GI + renal toxicity climbs after that. Switch to oral NSAID or non-NSAID.
★OPIOID-SPARING: 30 mg ketorolac IV ≈ 12 mg morphine for many post-op surgeries; reduces opioid requirement 25-50%.
★BLEEDING SURGERY: surgeon discussion mandatory. Most ENT, plastic flap, and spine surgeons prefer no NSAID for 7-14 days. Cardiac surgery: avoid first 7 days.
★DEHYDRATED + ACEi PATIENT = TRIPLE-WHAMMY → AKI risk high. Hydrate well, hold ketorolac if creatinine bumps.
★ALTERNATIVES: IV acetaminophen (no bleeding/renal risk, weaker), celecoxib (less GI but same CV risk), gabapentinoids.

Standalone diagrams matched to this topic.

Panel 1 of CAPNOSYNTHESIS

CAPNOSYNTHESIS

Panel 1 of Opiod Equianalgesic Table

Opiod Equianalgesic Table

Browse all classes: /reference/drugs

Education only — confirm against current package inserts and institutional protocols. Doses assume normal organ function unless otherwise noted.

Context

Adult

Pediatric

Adult IV/IM (<65 yo, normal renal)

30 mg IV/IM single dose; or 30 mg q6h (max 5 days)

—

Adult IV/IM (≥65 yo, <50 kg, or impaired renal)

15 mg IV/IM q6h

—

Pediatric (≥2 yo)

0.5 mg/kg IV q6h, max 30 mg/dose

—

Oral (after IV transition)

10 mg PO q4-6h, max 40 mg/day

—

Side effects

!GI bleed / ulceration (esp. if combined with steroids, anticoagulants, or alcohol)
!Acute kidney injury (esp. dehydration, ACEi/ARB, elderly, baseline CKD)
!Platelet dysfunction (reversible — duration 24-48 hr; impacts bleeding for surgical sites)
!Bronchospasm (aspirin-exacerbated respiratory disease)
!Increased CV risk (MI, CVA) with prolonged use

Contraindications

×Aspirin/NSAID allergy or AERD (Samter triad)
×Active GI bleed or peptic ulcer
×Renal impairment (CrCl <30) or volume depletion
×Pre-op or intraop with high bleeding-risk surgery (ENT, neurosurgery, plastic flap)
×Asthma with NSAID-sensitivity
×Late pregnancy (premature ductus closure)
×Anticoagulation (relative — discuss with surgeon)

Clinical pearls

★5-DAY MAXIMUM courtesy of FDA label: GI + renal toxicity climbs after that. Switch to oral NSAID or non-NSAID.
★OPIOID-SPARING: 30 mg ketorolac IV ≈ 12 mg morphine for many post-op surgeries; reduces opioid requirement 25-50%.
★BLEEDING SURGERY: surgeon discussion mandatory. Most ENT, plastic flap, and spine surgeons prefer no NSAID for 7-14 days. Cardiac surgery: avoid first 7 days.
★DEHYDRATED + ACEi PATIENT = TRIPLE-WHAMMY → AKI risk high. Hydrate well, hold ketorolac if creatinine bumps.
★ALTERNATIVES: IV acetaminophen (no bleeding/renal risk, weaker), celecoxib (less GI but same CV risk), gabapentinoids.