Current FDA dosing for Toradol is 30mg IV and 60mg IM in patients < 65 years old.  But is that necessary?

Let’s look at this randomized controlled trial:

Motov S et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med 2016. PMID 27993418.

Study: single-center, randomized, double-blind trial at a large urban ED; patients 18-65yo with acute flank pain, abd pain, MSK pain, headache >=5 on a 1- point scale in whom the attending physician thought toradol was an appropriate analgesic.

Intervention: 10mg, 15mg, 30mg IV toradol

Primary outcome: pain reduction at 30 minutes

Results: no significant difference in pain scale between the three doses at 30 mins.

Take home point: Toradol has a ceiling effect at 10mg IV so stop ordering 30mg IV!