Safe Frequency for Ketorolac Injections
Ketorolac injections should not exceed 5 days of continuous use due to significant risks of adverse effects, with the maximum daily dose being 120 mg for patients under 65 years and 60 mg for patients 65 years and older or those with renal impairment. 1
Dosing Guidelines
Maximum Duration
- Ketorolac injection therapy should never exceed 5 days of total use, regardless of indication 1
- Patients should be switched to alternative analgesics as soon as possible 1
Dosing Frequency
- For patients under 65 years:
- 30 mg every 6 hours (maximum 120 mg daily) 1
- For patients 65 years and older, renally impaired, or under 50 kg:
- 15 mg every 6 hours (maximum 60 mg daily) 1
- Single-dose treatment options are also available:
Safety Considerations
Major Risks
- Gastrointestinal bleeding and perforation 2
- Platelet inhibition with altered hemostasis 2
- Renal impairment 2
- Cardiovascular risks 3
Risk Factors That Require Caution
- Age over 60 years 3
- History of peptic ulcer disease 3
- Significant alcohol use (≥2 alcoholic beverages per day) 3
- Compromised fluid status 3
- Concomitant use of other nephrotoxic drugs 3
- History of cardiovascular disease 3
- Use with anticoagulants 3
Absolute Contraindications
- History of or current risk of gastrointestinal bleeding 2
- Risk of renal failure 2
- Compromised hemostasis 2
- Hypersensitivity to aspirin or other NSAIDs 2
- Labor, delivery, and nursing 2
Monitoring Requirements
Baseline Tests Before Starting Therapy
- Blood pressure 3
- BUN and creatinine 3
- Liver function tests (alkaline phosphatase, LDH, SGOT, SGPT) 3
- Complete blood count 3
- Fecal occult blood 3
Ongoing Monitoring
- Repeat tests every 3 months to ensure lack of toxicity 3
- Monitor for signs of renal toxicity (doubling of BUN or creatinine) 3
- Watch for development or worsening of hypertension 3
- Assess for GI upset, nausea, or signs of GI bleeding 3
Evidence on Dosing Efficacy
- Recent research suggests that lower doses (15 mg IV or 30 mg IM) may be as effective as higher doses (30 mg IV or 60 mg IM) in patients 65 years and older, with no significant difference in need for rescue analgesia 4
- Ketorolac exhibits a ceiling effect for analgesia, where doses above certain thresholds do not provide additional pain relief but may increase side effects 4
Clinical Pearls
- Ketorolac should be prescribed at the lowest effective dose necessary to control pain 2
- When administering IV, the bolus must be given over no less than 15 seconds 1
- IM administration should be given slowly and deeply into the muscle 1
- The analgesic effect begins in approximately 30 minutes with maximum effect in 1-2 hours 1
- Duration of analgesic effect is usually 4-6 hours 1
- Consider combination with low doses of opioids for breakthrough pain if not contraindicated 1
- Do not mix ketorolac in a syringe with morphine, meperidine, promethazine, or hydroxyzine as precipitation will occur 1