Moski asked
Is it acceptable to give 30 mg toradol IV with 30 mg IM toradol for severe pain in the hospital post op from an orthopedic surgery?
Answer
It would be unusual to give Toradol (ketorolac) in a combined single dose via both the IV route and the IM route as it goes against the guidelines set forth for the drug. The guidelines are as follows:
For Single Administration ONLY:
Intramuscular Injection
- Adults < 65: One 60 mg dose
- Adults > 65: One 30 mg dose
Intravenous Injection
- Adults < 65: One 30 mg dose
- Adults > 65: One 15 mg dose
There is no indicated use for the drug to be given via two different routes of administration as a single dose.
Having said that, drugs are used and administered off label fairly consistently and it is at the discretion of the prescriber. Very often, new information on drug uses/benefits does not have adequate time to be added to drug labeling. Also, the prescriber may have a large amount of experience with this specific protocol showing safe and effective use.
Toradol (ketorolac) can have very significant side effects if given in too high of a dose or for more than 5 days in a row. It is however a very effective drug to provide analgesia at an opioid level, especially postoperatively.
As a pharmacist, I would notice the somewhat unusual dosing and contact the prescriber to understand the rational behind using it before dispensing. If the drug was being prescribed in a manner in which it is known to cause harm (i.e. more than 5 days), I would most likely not dispense the medication.
If you have questions about a specific order, I would reach out to a pharmacist or prescriber at your location that can give you more information on this particular therapy.
