What is the safe dose of Ketorolac (NSAID) per day?

Safe Dosage of Ketorolac Per Day

The maximum safe dose of ketorolac is 120 mg per day, with treatment not to exceed 5 days total duration. 1

Dosing Guidelines by Route and Patient Factors

Oral Administration (as continuation therapy only)

• Ages 17-64 years: 20 mg PO once, followed by 10 mg every 4-6 hours as needed, not exceeding 40 mg/day 2
• Ages ≥65 years, renally impaired, or weight <50 kg: 10 mg PO once, followed by 10 mg every 4-6 hours as needed, not exceeding 40 mg/day 2

Parenteral Administration

• Intramuscular: 60 mg IM every 15-30 minutes, not exceeding 120 mg per day 1
• Intravenous:
  • Standard dosing: Similar to IM dosing
  • Recent evidence suggests lower doses (10 mg IV) may be as effective as higher doses (15-30 mg IV) for acute pain management 3, 4

Important Safety Considerations

Duration Limitations

• Treatment with ketorolac must not exceed 5 days total duration (combined parenteral and oral) 2
• Exceeding this duration significantly increases risk of adverse effects 5

Contraindications

• Aspirin/NSAID-induced asthma
• Pregnancy
• Cerebrovascular hemorrhage
• History of or current risk of gastrointestinal bleeding
• Risk of renal failure
• Compromised hemostasis
• Hypersensitivity to aspirin or other NSAIDs 1, 5

High-Risk Populations

1. Elderly patients (≥65 years)
2. Renally impaired patients
3. Low body weight (<50 kg)
4. Patients with pre-existing conditions:
   • Peptic ulcer disease
   • Bleeding disorders
   • Cardiovascular disease
   • Hepatic dysfunction

Monitoring for Toxicity

• Baseline assessment of:
  • Blood pressure
  • BUN and creatinine
  • Liver function tests
  • CBC and fecal occult blood
• Repeat every 3 months during long-term therapy 1
• Discontinue immediately if:
  • Renal function tests double
  • Hypertension develops or worsens
  • Liver function studies increase beyond normal limits 1

Clinical Pearls

• Use the lowest effective dose for the shortest duration to minimize adverse effects 2
• Recent research suggests that lower doses (10 mg IV) provide similar analgesic efficacy to higher doses (30 mg IV) while potentially reducing risk of adverse effects 3, 4
• Oral ketorolac should only be used as continuation therapy following IV or IM administration, never as initial therapy 2
• The combined duration of IV/IM and oral therapy must not exceed 5 days 2
• Consider alternative analgesics in high-risk patients, particularly those with renal impairment or at risk for GI bleeding

By adhering to these dosing guidelines and safety precautions, ketorolac can be used effectively while minimizing the risk of serious adverse effects.