Recommended Dosage of Ketorolac for Pain Management
The recommended dose of ketorolac for pain management is 15-30 mg IV/IM every 6 hours for acute pain, with a maximum daily dose of 120 mg and treatment duration not exceeding 5 days. 1, 2
Dosing Guidelines by Route of Administration
Parenteral (IV/IM) Dosing
- Initial dose:
- Ages 17-64: 30 mg IV/IM
- Ages ≥65, renally impaired, or weight <50 kg: 15 mg IV/IM
- Maintenance dose:
- Ages 17-64: 30 mg IV/IM every 6 hours (maximum 120 mg/day)
- Ages ≥65, renally impaired, or weight <50 kg: 15 mg IV/IM every 6 hours (maximum 60 mg/day)
Oral Dosing (only as continuation therapy after IV/IM dosing)
- Initial oral dose:
- Ages 17-64: 20 mg PO once
- Ages ≥65, renally impaired, or weight <50 kg: 10 mg PO once
- Maintenance oral dose:
- Ages 17-64: 10 mg PO every 4-6 hours (maximum 40 mg/day)
- Ages ≥65, renally impaired, or weight <50 kg: 10 mg PO every 4-6 hours (maximum 40 mg/day)
Evidence for Optimal Dosing
Recent research indicates that lower doses of ketorolac may be as effective as higher doses. A 2023 systematic review found that low-dose parenteral ketorolac (15-20 mg) compared to high-dose ketorolac (≥30 mg) showed no significant difference in pain scores (mean difference 0.05 mm lower on 100 mm visual analog scale) 3. Similarly, a 2017 randomized controlled trial demonstrated that 10 mg IV ketorolac provided similar analgesic efficacy to 15 mg and 30 mg doses in emergency department patients with moderate to severe pain 4.
Special Populations
Elderly Patients (≥65 years)
- Use reduced dosing (15 mg IV/IM initially, then 15 mg every 6 hours)
- Maximum daily dose: 60 mg
- Higher risk of adverse effects 5
Patients with Renal Impairment
- Use reduced dosing (15 mg IV/IM initially, then 15 mg every 6 hours)
- Maximum daily dose: 60 mg
- Monitor renal function tests (BUN, creatinine) 5
Patients <50 kg
Children
- Not FDA approved for children under 17 years for oral formulation
- For postoperative pain in children ≥1 year: 0.5 mg/kg IV initially, followed by either:
- 1.0 mg/kg IV every 6 hours, or
- 0.17 mg/kg/hour IV infusion
- Maximum daily dose: 90 mg
- Maximum duration: 48 hours 6
Contraindications
Ketorolac is contraindicated in patients with:
- History of peptic ulcer disease
- GI bleeding or perforation
- Advanced renal impairment or risk of renal failure
- Cerebrovascular bleeding
- Hemorrhagic diathesis/coagulation disorders
- Pregnancy
- Concurrent use with aspirin or other NSAIDs 5, 7
Monitoring and Adverse Effects
- Baseline monitoring: Blood pressure, renal function tests, liver function tests, complete blood count, coagulation profile, and fecal occult blood test 5
- Common adverse effects: GI upset, bleeding, perforation (risk increases with higher doses and longer duration), edema, drowsiness, dizziness 5, 7
- Serious adverse effects: Acute renal failure (usually reversible upon discontinuation), inhibition of platelet aggregation, increased bleeding time 5
Key Recommendations for Safe Use
- Use the lowest effective dose for the shortest duration possible
- Combined duration of IV/IM and oral ketorolac should not exceed 5 days
- Oral formulation should not be given as an initial dose (only as continuation therapy after IV/IM dosing)
- For acute pain management, lower doses (10-15 mg IV) may be as effective as higher doses (30 mg IV) with potentially fewer adverse effects 4, 3
- Monitor closely for toxicities in patients receiving chemotherapy due to potential additive nephrotoxicity 5
Remember that ketorolac has a ceiling analgesic effect, meaning that doses above the recommended amount do not provide additional pain relief but may increase the risk of adverse effects 4.