From the FDA Drug Label
The total combined duration of use of oral ketorolac tromethamine and intravenous or intramuscular dosing of ketorolac tromethamine is not to exceed 5 days in adults. Ketorolac tromethamine can cause serious GI adverse events including bleeding, ulceration and perforation, of the stomach, small intestine, or large intestine, which can be fatal.
The FDA drug label does not answer the question.
From the Research
A single intramuscular (IM) injection of ketorolac causes minimal gastric mucosa irritation when used appropriately. Ketorolac is a potent non-steroidal anti-inflammatory drug (NSAID) that can be administered as a one-time 30-60 mg IM dose for acute pain management. While all NSAIDs carry some risk of gastric irritation due to their inhibition of prostaglandin synthesis which protects the gastric mucosa, a single IM dose presents significantly less risk than oral administration or prolonged use. The reduced gastric irritation with IM administration occurs because the medication bypasses direct contact with the gastric mucosa during first-pass metabolism. However, patients with pre-existing peptic ulcer disease, history of gastrointestinal bleeding, advanced age, or those taking other medications that may increase bleeding risk (such as anticoagulants or corticosteroids) should still be monitored carefully. For these high-risk patients, considering gastroprotective agents like proton pump inhibitors may be prudent even with a single dose. The duration of therapy should be limited, with transition to oral analgesics as soon as possible, as prolonged ketorolac use significantly increases the risk of gastrointestinal complications, as reported in studies such as 1 and 2.
Some key points to consider when administering ketorolac include:
- Monitoring for gastrointestinal adverse effects, especially in high-risk patients 3
- Limiting the duration of therapy to minimize the risk of gastrointestinal complications 3
- Considering alternative analgesics or gastroprotective agents in patients with a history of peptic ulcer disease or gastrointestinal bleeding 4
- Being aware of the potential for increased bleeding risk, especially in patients taking anticoagulants or corticosteroids 5
It's also important to note that the risk of gastrointestinal complications associated with ketorolac use can be minimized by careful patient selection and monitoring, as well as adherence to recommended dosage guidelines, as outlined in studies such as 1 and 3.