From the Guidelines
For elderly patients with normal renal function, ketorolac should be dosed at a reduced amount compared to younger adults, with a recommended dosing of 15 mg IV/IM every 6 hours and a maximum daily dose of 60 mg. The recommended dosing for oral ketorolac in this population is 10 mg every 4-6 hours, with the same maximum daily dose and duration limitations of 5 days 1. Even with normal renal function, elderly patients have age-related physiological changes that affect drug metabolism and clearance, including decreased hepatic blood flow and reduced drug-binding proteins. These patients are also at higher risk for ketorolac's adverse effects, particularly:
- Gastrointestinal bleeding
- Renal impairment
- Cardiovascular events It is essential to monitor these patients closely for signs of toxicity, ensure adequate hydration, consider gastroprotection with a proton pump inhibitor, and use the medication for the shortest duration possible to minimize risks while achieving pain control 1. Key considerations for ketorolac dosing in elderly patients with normal renal function include:
- Reduced hepatic blood flow
- Decreased drug-binding proteins
- Increased risk of adverse effects
- Need for close monitoring and potential gastroprotection.
From the FDA Drug Label
Patients age ≥ 65, renally impaired, and/or weight < 50 kg (110 lbs): 10 mg PO once followed by 10 mg q4 to 6 hours prn not > 40 mg/day The dosing for ketorolac in elderly patients with normal renal function is not explicitly stated, but based on the information provided, it can be inferred that the dose for patients age ≥ 65 is 10 mg PO once followed by 10 mg q4 to 6 hours prn not to exceed 40 mg/day. However, this dose is also indicated for renally impaired patients and/or those with weight < 50 kg.
- The lowest effective dose should be used for the shortest duration consistent with individual patient treatment goals 2.
- The total duration of treatment should not exceed 5 days.
- It is essential to use the minimum effective dose for the individual patient and not shorten the dosing interval of 4 to 6 hours.
From the Research
Dosing Ketorolac in Elderly with Normal Renal Function
- The study 3 found that parenteral ketorolac doses of 15 mg IV or 30 mg IM did not demonstrate a greater need for rescue analgesia compared to doses of 30 mg IV or 60 mg IM in patients 65 years and older.
- However, the study 4 suggested that ketorolac may be associated with an elevated rate of acute renal failure when administered for more than 5 days.
- Another study 5 found that the use of single doses of parenteral ketorolac for analgesia management was not associated with an increased incidence of adverse cardiovascular, gastrointestinal, or renal adverse outcomes in a select group of older adults.
- It is essential to consider the potential risks and benefits of ketorolac in elderly patients, especially when it comes to renal function, as chronic kidney disease is a common disorder in this population 6.
- The pharmacodynamic and pharmacokinetic properties of ketorolac suggest that it is a potent analgesic and moderate anti-inflammatory agent, but its use requires careful consideration of the potential risks and benefits 7.
Key Considerations
- The dosage of ketorolac in elderly patients with normal renal function should be carefully considered, taking into account the potential risks and benefits.
- The study 3 suggests that lower doses of ketorolac (15 mg IV or 30 mg IM) may be effective for acute pain relief in elderly patients.
- However, the study 4 highlights the importance of monitoring renal function in elderly patients receiving ketorolac, especially when administered for extended periods.
- The study 5 provides reassurance that single doses of parenteral ketorolac are not associated with an increased incidence of adverse outcomes in older adults.