Oral Ibuprofen Equivalent of 30mg IV Ketorolac q6h
The oral ibuprofen equivalent of 30mg IV ketorolac every 6 hours is approximately 800mg oral ibuprofen every 6 hours. This is based on comparative analgesic efficacy studies and clinical guidelines for postoperative pain management.
Rationale for Equivalence
Ketorolac Dosing Information
- IV ketorolac 30mg q6h provides significant analgesia for moderate to severe pain
- Maximum safe dose of ketorolac is 120mg per day, with treatment not exceeding 5 days total duration 1
- Ketorolac is typically dosed at 0.5-1mg/kg IV (up to 30mg) for a single intraoperative dose, or 0.15-0.2mg/kg (max 10mg) every 6 hours for short-term therapy (maximum 48 hours) 2
Ibuprofen Dosing Information
- Intravenous ibuprofen 800mg q6h has been shown to be effective for postoperative pain management 3
- Oral ibuprofen 400mg has a duration of action of at least 6 hours, compared with 4-6 hours for ibuprofen 200mg 4
- The smallest clinically useful dose of ibuprofen is 200mg, with a clear dose-response relationship over the range of 50-400mg 4
Comparative Efficacy
Research comparing these medications shows:
- IV ibuprofen 800mg q6h has demonstrated significant reductions in morphine use and pain at rest and with movement compared to placebo in postoperative settings 3
- Ketorolac 10mg has been shown to be superior to ibuprofen-paracetamol combinations in postoperative pain 5
- Ketorolac has similar analgesic efficacy at IV doses of 10,15, and 30mg, suggesting that the analgesic ceiling dose may be around 10mg 6
Dosing Algorithm for Conversion
- Determine current ketorolac regimen: 30mg IV q6h = 120mg total daily dose
- Identify equivalent oral ibuprofen dose: 800mg q6h = 3200mg total daily dose
- Consider patient-specific factors:
- For elderly patients (≥65 years), renally impaired patients, or patients with low body weight (<50 kg), consider reducing the ibuprofen dose to 600mg q6h
- For patients with risk factors for GI bleeding, consider adding a proton pump inhibitor
Important Considerations and Precautions
Duration of therapy: Limit ketorolac to maximum 5 days of use; ibuprofen can be used for longer periods if needed but with appropriate monitoring
Contraindications: Both medications are contraindicated in patients with:
- Aspirin/NSAID-induced asthma
- History of or current risk of gastrointestinal bleeding
- Risk of renal failure
- Compromised hemostasis
- Hypersensitivity to aspirin or other NSAIDs 1
Monitoring: For patients requiring longer-term therapy with ibuprofen, monitor:
- Blood pressure
- Renal function (BUN and creatinine)
- Liver function tests
- CBC and fecal occult blood 1
Discontinuation criteria: Stop therapy immediately if:
- Renal function tests double
- Hypertension develops or worsens
- Liver function studies increase beyond normal limits 1
By using 800mg oral ibuprofen every 6 hours, you can achieve similar analgesic effects to 30mg IV ketorolac every 6 hours while potentially reducing the risk of adverse effects associated with ketorolac when longer-term therapy is required.