Uses
Pain
Consider potential benefits and risks of ketorolac therapy as well as alternative therapies before initiating therapy with the drug. Use lowest effective dosage and shortest duration of therapy consistent with the patient's treatment goals.
Short-term (i.e., up to 5 days) management of moderately severe, acute pain that requires analgesia at opiate level in adults; mainly used in the postoperative setting.
Management of moderately severe, acute pain in children 2–16 years of age (single IV or IM dose); studies usually have evaluated pain in the postoperative setting (e.g., pain following tonsillectomy). Limited data available to support administration of >1 parenteral dose in pediatric patients.
Parenteral ketorolac has been used concomitantly with opiate agonist analgesics (e.g., meperidine, morphine) for the management of moderate to severe postoperative pain without apparent adverse drug interactions. Combined use can result in reduced opiate analgesic requirements. (See Syringe Compatibility under Stability.)
Dosage and Administration
General
- Current principles of pain management indicate that analgesics, including ketorolac, should be administered at regularly scheduled intervals, although the drug also has been administered on an as-needed basis (i.e., withholding subsequent doses until pain returns).
- Consider potential benefits and risks of ketorolac therapy as well as alternative therapies before initiating therapy with the drug.
Administration
Administer IV, IM, or orally in adults; administer IV or IM in children 2–16 years of age.
Initiate therapy in adults with parenteral (IV or IM) ketorolac; oral formulation is used as continuation therapy, as required. Administer IV or IM as a single dose or every 6 hours; administer orally every 4–6 hours.
In children 2–16 years of age, administer as a single IV or IM dose.
Switch patients to alternate analgesic therapy as soon as clinically possible.
Oral Administration
Manufacturer makes no specific recommendations regarding administration with meals; high-fat meal may decrease rate but not extent of absorption and reduce peak plasma concentrations.
IV Administration
For solution and drug compatibility information, see Compatibility under Stability.
Rate of Administration
Administer over ≥15 seconds.
IM Administration
Administer IM slowly and deeply into the muscle.
For drug compatibility information, see Compatibility under Stability.
Dosage
Available as ketorolac tromethamine; dosage expressed in terms of the salt.
To minimize the potential risk of adverse cardiovascular and/or GI events, use lowest effective dosage and shortest duration of therapy consistent with the patient's treatment goals. Adjust dosage based on individual requirements and response; attempt to titrate to the lowest effective dosage.
For breakthrough pain, supplement with low doses of opiate analgesics (unless contraindicated) as needed rather than higher or more frequent doses of ketorolac.
Pediatric Patients
Pain
Single Dose
IV
Children 2–16 years of age: One dose of 0.5 mg/kg (maximum 15 mg).
IM
Children 2–16 years of age: One dose of 1 mg/kg (maximum 30 mg).
Adults
Pain
Oral
When switching from parenteral to oral therapy, the first oral dose is 20 mg, followed by 10 mg every 4–6 hours (maximum 40 mg in a 24-hour period).
Weight <50 kg: When switching from parenteral to oral therapy, 10 mg every 4–6 hours (maximum 40 mg in a 24-hour period).
Single Dose
IV
30 mg.
Weight <50 kg: 15 mg.
IM
60 mg.
Weight <50 kg: 30 mg.
Multiple Dose
IV or IM
30 mg every 6 hours.
Weight <50 kg: 15 mg every 6 hours.
Prescribing Limits
Pediatric Patients
Pain
Only a single parenteral dose is recommended.
Single Dose
IV
15 mg.
IM
30 mg.
Adults
Pain
Total combined duration of parenteral and oral therapy should not exceed 5 days.
Oral
All adults: Maximum 40 mg in a 24-hour period.
Multiple Dose
IV or IM
Maximum 120 mg in a 24-hour period.
Weight <50 kg: Maximum 60 mg in a 24-hour period.
Special Populations
Dosage in Hepatic Impairment
Need for dosage adjustment not fully established; evidence in patients with cirrhosis suggests that dosage adjustment may not be necessary.
Dosage in Renal Impairment
Pain
Safety not established in patients with Scr >5 mg/dL and/or those undergoing dialysis.
Oral
When switching from parenteral to oral therapy, 10 mg every 4–6 hours (maximum 40 mg in a 24-hour period).
Single Dose
IV
15 mg.
IM
30 mg.
Multiple Dose
IV or IM
15 mg every 6 hours. Maximum 60 mg in a 24-hour period.
Geriatric Patients
Dosage recommendations are the same as those for patients with moderately increased Scr or for those weighing <50 kg.
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