How to Administer Ketorolac (Elaxim) Injection
For intramuscular administration of ketorolac (Elaxim), inject slowly and deeply into the muscle. The injection should be given over no less than 15 seconds to minimize injection site pain. 1
Dosage Guidelines
Single-Dose Treatment
- Patients <65 years of age: One dose of 60 mg IM 1
- Patients ≥65 years of age, renally impaired, or <50 kg (110 lbs): One dose of 30 mg IM 1
Multiple-Dose Treatment
- Patients <65 years of age: 30 mg every 6 hours (maximum daily dose: 120 mg) 1
- Patients ≥65 years of age, renally impaired, or <50 kg: 15 mg every 6 hours (maximum daily dose: 60 mg) 1
- Maximum duration: Treatment should not exceed 5 days 1
Administration Technique
Preparation
- Verify the medication label before administration to avoid medication errors 2
- Ensure hands and injection site are clean 2
- Inspect the solution for particulate matter and discoloration before administration 1
Injection Procedure
- Draw up the prescribed dose into the syringe 2
- Select an appropriate injection site (typically gluteal muscle) 2
- Clean the injection site with an antiseptic solution and allow to dry completely 2
- Insert the needle using a smooth motion to minimize pain 2
- Inject 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
Important Considerations
Contraindications
- Do not mix ketorolac in a small volume (e.g., in a syringe) with morphine sulfate, meperidine hydrochloride, promethazine hydrochloride, or hydroxyzine hydrochloride as this will result in precipitation 1
- Hypovolemia should be corrected prior to administration 1
Safety Precautions
- Use needles of shorter length and smaller diameter to minimize pain 2
- For pediatric patients, the recommended intravenous dosage is 0.5 mg/kg, followed by either bolus injections of 1.0 mg/kg every 6 hours or an intravenous infusion of 0.17 mg/kg/h 3
- Maximum daily dosage for children is 90 mg, with maximum treatment duration of 48 hours 3
- Ketorolac is not recommended for use in infants aged <1 year 3
Monitoring
- Monitor for potential adverse effects including gastrointestinal, renal, or hematological complications 4
- Recent evidence suggests that lower doses (15 mg IV or 30 mg IM) may provide similar pain relief to higher doses (30 mg IV or 60 mg IM) in elderly patients, with potentially fewer side effects 5
Patient Education
- Inform patients about potential side effects and when to seek medical attention 2
- Advise patients that ketorolac may increase risk of bleeding, especially when combined with other medications affecting coagulation 2
- Instruct patients to report any signs of gastrointestinal bleeding, kidney problems, or allergic reactions 2