Ketorolac Dosing Schedule
Ketorolac should be administered every 6 hours for IV/IM dosing and every 4-6 hours for oral dosing, with the next dose after 10 PM being appropriate at 4 AM (IV/IM) or as early as 2 AM (oral). 1, 2
Dosing Recommendations by Route
IV/IM Administration
- Adults (17-64 years): 30 mg IV/IM every 6 hours, maximum daily dose of 120 mg 1
- Elderly (≥65 years), renally impaired, or <50 kg: 15 mg IV/IM every 6 hours, maximum daily dose of 60 mg 1
Oral Administration
- Adults (17-64 years): Initial dose 20 mg PO once, then 10 mg PO every 4-6 hours as needed, maximum daily dose of 40 mg 1, 2
- Elderly (≥65 years), renally impaired, or <50 kg: Initial dose 10 mg PO once, then 10 mg PO every 4-6 hours as needed, maximum daily dose of 40 mg 1, 2
Important Considerations
Duration Limitations
- Combined duration of IV/IM and oral ketorolac must not exceed 5 days 1, 2
- Oral formulation should not be given as an initial dose, but only as continuation therapy after IV/IM dosing 2
Safety Precautions
- Use the lowest effective dose for the shortest duration possible 2
- Do not shorten the dosing interval of 4-6 hours for oral administration 2
- Prescribe as needed rather than on a scheduled basis 3
Ceiling Effect
- Ketorolac has a ceiling analgesic effect - doses above recommended amounts do not provide additional pain relief but increase adverse effect risk 1
- Studies show that lower doses (7.5 mg every 6 hours) can be as effective as higher doses for pain management 4
Special Populations
Children
- Not FDA approved for oral formulation in children under 17 years 1
- For postoperative pain in children ≥1 year: 0.5 mg/kg IV initially, followed by 1.0 mg/kg IV every 6 hours 1, 5
Contraindications
- History of peptic ulcer disease, GI bleeding, advanced renal impairment, cerebrovascular bleeding, coagulation disorders, pregnancy, or concurrent use with aspirin or other NSAIDs 1
Monitoring
- Monitor for GI upset, bleeding, renal function changes, edema, and cardiovascular effects 1
- Consider as part of multimodal analgesia approach when appropriate 3
Remember that ketorolac is a potent NSAID with significant analgesic properties but should be used cautiously due to its potential for adverse effects, particularly with prolonged use beyond the recommended duration.