As a kid, I heard this corny dad-joke : How do you reduce side-effects of a pill ? : “You cut-off it’s sides” 🙄. When it comes to dosing any pharmaceutical drugs, I like to follow a Buddhist principle : Walk the middle way. After a certain “ceiling-dose”, the additional benefits of higher doses is minimal to none, while side-effects start becoming more severe & common.
This well-done, Randomized, Double-Blind, Case-Control Trial from 2017 caused a little stir after showing that in a ER study group of 240 patients presenting with acute moderate to severe pain, there was no significant difference in the efficacy of 10mg , 15mg and 30 mg doses of IV Ketorolac ! The author advises 10mg as the “ceiling-dose” for Ketorolac. Though the study did not evaluate patients for more than 120 minutes, pain scores were tracked at 15 mins, 30 mins, 60 mins, 90 mins and 120 mins, with no statistical difference in pain improvement at any time interval.
I barely use 30mg Toradol, but this post is to highlight a reason to always use 15mg dose first (10mg dose not available commercially I think) and if more pain control needed consider stacking on other analgesic options. Interestingly the side-effect profiles were similar for all three doses too , but again they were tracked only for 120 minutes and included dizziness, headache, GI upset.
💡 Knowing that the more serious side-effects of NSAIDs including GI ulcers, bleeds, AKI and MI can take longer time to manifest, I rather use the smallest dose possible to achieve the analgesic result while minimizing risk of adverse effects to patients.
