Ketorolac IM Injection Dosing and Administration
The recommended dose of ketorolac tromethamine for IM injection is 30 mg every 6 hours for patients under 65 years of age, and 15 mg every 6 hours for patients 65 years or older, renally impaired, or weighing less than 50 kg, with a maximum daily dose of 120 mg and 60 mg respectively, and treatment duration not exceeding 5 days. 1
Dosing Guidelines
Single-Dose Treatment
- Patients <65 years of age: One dose of 60 mg IM
- Patients ≥65 years, renally impaired, or <50 kg: One dose of 30 mg IM
Multiple-Dose Treatment
- Patients <65 years of age: 30 mg IM every 6 hours (maximum daily dose: 120 mg)
- Patients ≥65 years, renally impaired, or <50 kg: 15 mg IM every 6 hours (maximum daily dose: 60 mg)
Administration Technique
- Administer slowly and deeply into the muscle 1
- Correct hypovolemia prior to administration
- Onset of analgesic effect begins in approximately 30 minutes
- Maximum effect occurs in 1-2 hours after dosing
- Duration of analgesic effect is usually 4-6 hours 1
Important Considerations
Maximum Duration
- Treatment with ketorolac should not exceed 5 days 2, 1
- Switch patients to alternative analgesics as soon as possible
Special Populations
- Elderly patients (≥65 years): Use reduced dose (15 mg IM every 6 hours)
- Renal impairment: Use reduced dose (15 mg IM every 6 hours)
- Low body weight (<50 kg): Use reduced dose (15 mg IM every 6 hours)
- Children: Not FDA approved for oral formulation in children under 17 years; for postoperative pain in children ≥1 year, dose is 0.5 mg/kg IV initially, followed by 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) 2
Monitoring and Safety
Contraindications
- 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 2
Baseline Monitoring
- Blood pressure
- Renal function tests (BUN, creatinine)
- Liver function tests
- Complete blood count
- Coagulation profile
- Fecal occult blood test 2
Common Adverse Effects
- GI upset, bleeding, perforation
- Edema
- Drowsiness and dizziness
Serious Adverse Effects
- Acute renal failure
- Inhibition of platelet aggregation
- Increased bleeding time 2
Clinical Pearls
- Ketorolac has a ceiling analgesic effect - doses above recommended amounts do not provide additional pain relief but increase risk of adverse effects 2
- For breakthrough pain, do not increase the dose or frequency; consider supplementing with low doses of opioids "prn" unless contraindicated 1
- Intramuscular injections are painful but have been traditionally used when IV access is unavailable 3
- Research has shown that lower doses (10 mg IV) may be as effective as higher doses (30 mg IV) with potentially fewer side effects 4
Remember that ketorolac is indicated for short-term management of moderately severe, acute pain that requires analgesia at the opioid level, usually in a postoperative setting.