Ketorolac IM Dosing
For intramuscular ketorolac, administer 60 mg as a single dose for patients under 65 years old, or 30 mg for patients 65 years or older, those with renal impairment, or those weighing less than 50 kg (110 lbs). 1
Single-Dose Regimen
For one-time administration only:
The analgesic effect begins in approximately 30 minutes with maximum effect at 1-2 hours, lasting 4-6 hours 1.
Multiple-Dose Regimen
If repeated dosing is required:
- Patients <65 years: 30 mg IM every 6 hours (maximum 120 mg/day) 1
- Patients ≥65 years, renally impaired, or <50 kg: 15 mg IM every 6 hours (maximum 60 mg/day) 1
Critical limitation: Treatment must not exceed 5 days 1. This is an FDA-mandated restriction due to risks of gastrointestinal bleeding, renal toxicity, and cardiovascular events with prolonged use.
Administration Technique
Inject slowly and deeply into the muscle 1. The FDA label specifically emphasizes slow administration to minimize injection site reactions.
Clinical Context from Guidelines
The migraine guideline 2 lists ketorolac 60 mg IM every 15-30 minutes with a maximum of 120 mg per day, though this appears to be an older recommendation. The current FDA-approved dosing is more conservative and should take precedence.
For cancer pain management 3, short-term ketorolac use at 15-30 mg IV every 6 hours for a maximum of 5 days is recommended, reinforcing the time limitation.
Important Caveats
- Contraindications: Aspirin/NSAID-induced asthma, pregnancy, cerebrovascular hemorrhage 2
- Correct hypovolemia before administration to reduce renal risk 1
- For breakthrough pain, do not increase dose or frequency; consider supplementing with low-dose opioids instead 1
- Lower doses (15-20 mg IM) may be non-inferior to higher doses (30-60 mg) for acute pain based on recent evidence 4, 5, though the FDA label remains the authoritative source for dosing