Ketorolac Dosing for Children
The recommended intravenous dosage of ketorolac in children is 0.5 mg/kg, followed either by bolus injections of 0.5 mg/kg every 6 hours or an intravenous infusion of 0.17 mg/kg/h, with a maximum daily dosage of 90 mg and maximum treatment duration of 48 hours. 1
Age-Specific Dosing Guidelines
Intravenous (IV) Administration
- Children ≥1 year: 0.5 mg/kg IV per dose every 6 hours 1, 2
- Maximum single dose: Not to exceed 30 mg
- Maximum daily dose: 90 mg 1
- Maximum duration: 48 hours for IV therapy 1
Oral Administration
- Children ≥1 year: 0.25 mg/kg orally per dose (up to 1.0 mg/kg/day) 1
- Maximum duration: 7 days for oral therapy 1
Important Considerations
Age Restrictions
- Not recommended for infants <1 year of age 1
- Pharmacokinetic studies show a trend toward lower clearance in younger patients 3
Route of Administration
- IV route is preferred during the immediate postoperative period
- Transition to oral medication when the patient can tolerate it
- IM injections are not recommended in children unless IV access is unavailable 1
Safety Profile
Unlike opioids, ketorolac does not cause:
- Respiratory depression
- Nausea and vomiting
- Urinary retention
- Sedation 1
When combined with opioids, ketorolac:
- Exhibits marked opioid-sparing effects
- Improves pain relief quality
- Reduces opioid-related adverse effects 1
Pharmacokinetics in Children
- Children have a 2-fold increase in volume of distribution compared to adults
- Plasma clearance is higher in children due to lower protein binding
- Despite these differences, elimination half-life is similar to adults 1
- In children 2 months to 16 years, clearance (expressed as L/h/kg) decreases with age from infancy 2
Monitoring and Precautions
Bleeding Risk
- Ketorolac reversibly inhibits cyclooxygenase and has antiplatelet effects
- Bleeding time is usually slightly increased but remains within normal values for most patients
- Conflicting evidence exists regarding increased surgical-site bleeding after tonsillectomy 1
Renal Function
- Monitor renal function, especially in younger patients
- Studies in infants after cardiac surgery showed no clinically significant adverse renal effects 4
Duration Limitations
- Total combined duration of IV and oral ketorolac treatment should not exceed 5 days 5
Clinical Pearls
Dosing may need adjustment based on age:
- Older children may require somewhat lower dosages
- Infants and young children may require slightly higher dosages for equivalent pain relief 1
A dosing regimen of 0.5 mg/kg every 6 hours maintains effective analgesic concentrations in children 9 months to 16 years of age 2
Consider ketorolac as an alternative to opioids for postoperative pain management in children to reduce opioid-related side effects