Ketorolac

NSAID·Analgesia - Simple & NSAIDs

Short-term (≤ 5 days) management of moderately severe acute pain requiring analgesia at the opioid level

NSAIDToradolS4TGA

Max Dose

90 mg/day (IV)

Max Duration

5 DAYS

GI Bleed

CRITICAL RISK

Renal Risk

CRITICAL

Rapid Summary

Overview

Intravenously active, aggressively potent NSAID. Provides opioid-level pain relief (equivalent to ~10mg IV Morphine) for severe acute pain (e.g., kidney stones, post-op pain).

Maximum Dose

Max 90 mg/day (IV/IM) or 40 mg/day (PO).

Clinical Focus

Black Box Warning: MUST NOT BE USED FOR MORE THAN 5 DAYS TOTAL across all routes. Day 6 carries an unacceptable risk of catastrophic GI hemorrhage and acute renal failure.

Bottom Line

Ketorolac is the most potent injectable NSAID for acute pain, but must be limited to 5 days maximum due to high GI bleeding and renal toxicity risk.

Formulation & Access

Brand Names

Toradol

Parenteral

Ampoules (10, 30 mg/1 mL) for IV or deep IM injection.

Oral Routes

Tablets (10 mg) — rarely used, IV is preferred.

Prescribing & PBS

Hospital/OT/ED supply. S4.

Indications & Use

Primary

TGA

Short-term (≤ 5 days) management of moderately severe acute pain requiring analgesia at the opioid level.

Clinical Place

The absolute gold standard non-opioid 'nuke' in the Emergency Department for renal colic (kidney stones) and severe biliary colic.

Quick reference

Class & Role

NSAID — Intravenously active, aggressively potent NSAID.

Route / Formulation

Ampoules (10, 30 mg/1 mL) for IV or deep IM injection. (Toradol)

Usual Dose & Max

IV 30 mg STAT (pushed over 15 seconds) or IM 30 mg. May repeat 15-30 mg q6h. Max 90 mg/day.

Key Indication Doses

Acute Severe Pain / Renal Colic: IV 30 mg STAT (pushed over 15 seconds) or IM 30 mg. May repeat 15-30 mg q6h. Max 90 mg/day. Elderly (> 65 yrs) / < 50 kg: Max 60 mg/day. Start with 15 mg STAT. Renal Impairment: Avoid entirely in moderate-to-severe renal impairment (eGFR < 50) or in patients who are dehydrated post-op.

Best Uses

Ketorolac is the most potent injectable NSAID for acute pain, but must be limited to 5 days maximum due to high GI bleeding and renal toxicity risk.

Avoid / Cautions

Suspected/confirmed GI bleeding, active peptic ulcer disease, bleeding diathesis, CABG surgery, asthma triggered by aspirin (AERD). Pregnancy Category C. Do not use in 3rd trimester or during labor (stops uterine contractions and closes fetal ductus).

Key Risks

Gastrointestinal: Peptic ulceration, massive GI haemorrhage, and perforation (Risk skyrockets exponentially after 5 days of use). Renal: Acute Kidney Injury (AKI). Clamps the afferent arteriole shut. Haematological: Reversibly inhibits platelet aggregation. Do NOT use if surgery is imminent or if bleeding is a risk (e.g., suspected brain bleed).

Key Interactions

ACEi/ARB + Diuretic + Ketorolac = Renal Necrosis. Warfarin, DOACs, Prophylactic Heparin (Massive bleeding risk).

Monitoring

Ensure the patient is well-hydrated (IV fluids) before pushing the drug to protect the kidneys. Check eGFR prior to administration if clinically possible.

Clinical Pearl

For a patient writhing in agony from a kidney stone, Ketorolac works better than Morphine. Morphine just masks the pain in the brain. Ketorolac halts the local prostaglandin-driven inflammatory spasm in the ureter itself, attacking the root cause of the pain.

Access

Toradol10 mg tablet

Brand: Toradol
Formulation: Tablets (10 mg) — rarely used, IV is preferred

Ketorolac

NSAID·Analgesia - Simple & NSAIDs

Short-term (≤ 5 days) management of moderately severe acute pain requiring analgesia at the opioid level

NSAIDToradolS4TGA

Max Dose

90 mg/day (IV)

Max Duration

5 DAYS

GI Bleed

CRITICAL RISK

Renal Risk

CRITICAL

Rapid Summary

Overview

Intravenously active, aggressively potent NSAID. Provides opioid-level pain relief (equivalent to ~10mg IV Morphine) for severe acute pain (e.g., kidney stones, post-op pain).

Maximum Dose

Max 90 mg/day (IV/IM) or 40 mg/day (PO).

Clinical Focus

Black Box Warning: MUST NOT BE USED FOR MORE THAN 5 DAYS TOTAL across all routes. Day 6 carries an unacceptable risk of catastrophic GI hemorrhage and acute renal failure.

Bottom Line

Ketorolac is the most potent injectable NSAID for acute pain, but must be limited to 5 days maximum due to high GI bleeding and renal toxicity risk.

Formulation & Access

Brand Names

Toradol

Parenteral

Ampoules (10, 30 mg/1 mL) for IV or deep IM injection.

Oral Routes

Tablets (10 mg) — rarely used, IV is preferred.

Prescribing & PBS

Hospital/OT/ED supply. S4.

Indications & Use

Primary

TGA

Short-term (≤ 5 days) management of moderately severe acute pain requiring analgesia at the opioid level.

Clinical Place

The absolute gold standard non-opioid 'nuke' in the Emergency Department for renal colic (kidney stones) and severe biliary colic.

Quick reference

Class & Role

NSAID — Intravenously active, aggressively potent NSAID.

Route / Formulation

Ampoules (10, 30 mg/1 mL) for IV or deep IM injection. (Toradol)

Usual Dose & Max

IV 30 mg STAT (pushed over 15 seconds) or IM 30 mg. May repeat 15-30 mg q6h. Max 90 mg/day.

Key Indication Doses

Best Uses

Ketorolac is the most potent injectable NSAID for acute pain, but must be limited to 5 days maximum due to high GI bleeding and renal toxicity risk.

Avoid / Cautions

Key Risks

Key Interactions

ACEi/ARB + Diuretic + Ketorolac = Renal Necrosis. Warfarin, DOACs, Prophylactic Heparin (Massive bleeding risk).

Monitoring

Ensure the patient is well-hydrated (IV fluids) before pushing the drug to protect the kidneys. Check eGFR prior to administration if clinically possible.

Clinical Pearl

Access

Toradol10 mg tablet

Brand: Toradol
Formulation: Tablets (10 mg) — rarely used, IV is preferred