Recommended Dosage for Intramuscular Ketorolac
The recommended intramuscular (IM) dosage for ketorolac is 60 mg as a single dose for patients under 65 years of age, and 30 mg as a single dose for patients 65 years or older, renally impaired, or weighing less than 50 kg (110 lbs). 1
Dosing Guidelines
Single-Dose Treatment
- Patients <65 years of age: One dose of 60 mg IM 1
- Patients ≥65 years of age, renally impaired, and/or <50 kg: One dose of 30 mg IM 1
Multiple-Dose Treatment
- Patients <65 years of age: 30 mg IM every 6 hours with maximum daily dose not exceeding 120 mg 1, 2
- Patients ≥65 years of age, renally impaired, and/or <50 kg: 15 mg IM every 6 hours with maximum daily dose not exceeding 60 mg 1
- Treatment duration: Not to exceed 5 days 1, 2
Administration Considerations
- Administer slowly and deeply into the muscle 1
- Onset of analgesic effect begins in approximately 30 minutes 1
- Maximum effect occurs in 1-2 hours after dosing 1
- Duration of analgesic effect is usually 4-6 hours 1
Special Populations
Pediatric Dosing
- Not recommended for infants under 1 year of age 3
- For children: 0.5 mg/kg IV loading dose, followed by 1.0 mg/kg every 6 hours 3
- Maximum daily pediatric dose: 90 mg 3
- Maximum duration for pediatric treatment: 48 hours 3
Elderly Patients
- Lower doses are recommended (30 mg single dose or 15 mg every 6 hours for multiple dosing) 1, 4
- Recent evidence suggests that 15 mg IM is non-inferior to higher doses for pain relief in elderly patients 4
Contraindications
- Aspirin/NSAID-induced asthma 2
- Pregnancy 2
- Cerebrovascular hemorrhage 2
- Active peptic ulcer disease or GI bleeding 2
Precautions and Monitoring
- Hypovolemia should be corrected prior to administration 1
- Use with caution in patients with renal impairment 1
- Monitor for adverse effects including:
Clinical Pearls
- Lower doses (15 mg IM) may be as effective as higher doses (60 mg IM) for acute musculoskeletal pain, with fewer adverse effects 5
- When combined with opioids, ketorolac exhibits marked opioid-sparing effects 3
- For breakthrough pain, do not increase the dose or frequency; consider supplementing with low doses of opioids if not contraindicated 1
Recent Evidence
- A 2021 study found that 15 mg IM ketorolac was non-inferior to 60 mg IM for acute musculoskeletal pain in adults, with fewer adverse effects reported in the lower-dose group 5
- A 2023 study in elderly patients (≥65 years) found that lower doses (15 mg IV or 30 mg IM) did not demonstrate a greater need for rescue analgesia compared to higher doses (30 mg IV or 60 mg IM) 4