Ketorolac Dosage Recommendations for Pain Management
For adult pain management, ketorolac should be dosed at 15-30 mg IV/IM every 6 hours (initial dose) followed by 10 mg PO every 4-6 hours (maintenance), with treatment duration not exceeding 5 days and maximum daily doses of 120 mg IV/IM or 40 mg PO. 1, 2
Adult Dosing Algorithm
Initial Dosing (IV/IM)
- Ages 17-64 years: 30 mg IV/IM every 6 hours
- Ages ≥65 years, renally impaired, or <50 kg: 15 mg IV/IM every 6 hours
Maximum Daily IV/IM Dose
- Ages 17-64 years: 120 mg
- Ages ≥65 years, renally impaired, or <50 kg: 60 mg
Transition to Oral Therapy
- Ages 17-64 years: 20 mg PO once, then 10 mg PO every 4-6 hours
- Ages ≥65 years, renally impaired, or <50 kg: 10 mg PO once, then 10 mg PO every 4-6 hours
Maximum Daily Oral Dose
- All adults: 40 mg
Key Administration Guidelines
- Oral ketorolac should only be used as continuation therapy after IV/IM dosing, never as initial therapy 2
- Use the lowest effective dose for the shortest duration possible 1, 2
- Total combined duration of IV/IM and oral therapy must not exceed 5 days 1, 2
Pediatric Dosing
- Not FDA approved for oral use in children under 17 years 1
- 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 1, 3
- Maximum daily dose: 90 mg
- Maximum duration: 48 hours
Important Considerations
Efficacy
- Recent evidence suggests that lower doses of ketorolac (10-15 mg) may be as effective as higher doses (≥30 mg) for acute pain management in emergency settings, which could reduce adverse effects while maintaining analgesic efficacy 4, 5
- Ketorolac has demonstrated similar efficacy to opioids for acute pain management, including postoperative and low back pain 6, 7
Safety Precautions
Contraindicated in patients with:
- History of peptic ulcer disease
- GI bleeding or perforation
- Advanced renal impairment
- Cerebrovascular bleeding
- Coagulation disorders
- Pregnancy
- Concurrent use with aspirin or other NSAIDs 1
Monitor for:
- Blood pressure changes
- Renal function (BUN, creatinine)
- Liver function
- Complete blood count
- Coagulation profile 1
Common adverse effects include GI upset, bleeding, edema, drowsiness, and dizziness
Serious adverse effects include acute renal failure and increased bleeding time 1
Special Population Considerations
- Elderly patients (≥65 years) require reduced dosing due to higher risk of adverse effects
- Patients with renal impairment need dose reduction to prevent acute renal failure
- Patients <50 kg require lower doses
- Patients with cardiovascular disease have increased risk of thrombotic events
- Patients on anticoagulants have increased bleeding risk 1
Ketorolac has a ceiling analgesic effect, meaning doses above recommendations do not provide additional pain relief but increase adverse effect risks 1. When used appropriately with attention to dosing limitations and contraindications, ketorolac provides effective non-opioid analgesia for acute pain management.