Can ketorolac (Nonsteroidal Anti-Inflammatory Drug (NSAID)) be administered intravenously (IV)?

Ketorolac Can Be Administered Intravenously

Yes, ketorolac can be administered intravenously (IV) for short-term management of moderately severe acute pain requiring opioid-level analgesia. 1

Administration Routes and Dosing

• Ketorolac is available for both intravenous (IV) and intramuscular (IM) administration in formulations of 15 mg in 1 mL (1.5%) and 30 mg in 1 mL (3%) in sterile solution 1
• For adults aged 17-64 years, the recommended IV dosage is 15-30 mg every 6 hours, with a maximum daily dose of 120 mg 2
• Treatment duration should not exceed 5 days to minimize risk of adverse effects 1
• The 60 mg in 2 mL (3%) formulation is available for intramuscular administration only 1

Clinical Applications

• IV ketorolac is indicated for the short-term management of moderately severe acute pain that requires analgesia at the opioid level 1
• IV ketorolac is particularly useful in emergency department settings for conditions such as renal colic, migraine headache, musculoskeletal pain, and postoperative pain 3
• In emergency department management of cyclic vomiting syndrome, IV ketorolac is suggested as a first-line, non-narcotic analgesic 4
• For postoperative pain management, ketorolac has been shown to be effective in reducing both pain and opioid requirements 4

Efficacy Considerations

• Research shows that IV ketorolac at doses of 10,15, and 30 mg provides similar analgesic efficacy, suggesting that the analgesic ceiling dose may be as low as 10 mg 5
• IV ketorolac has been demonstrated to be effective for treating renal colic, with significant pain reduction within 10-20 minutes after administration 6
• When used for postoperative pain, IV ketorolac provides analgesia equivalent to commonly used doses of meperidine and morphine 7

Safety Considerations and Contraindications

• IV ketorolac is contraindicated in patients with:

  • Active peptic ulcer disease or history of GI bleeding/perforation 1
  • Advanced renal impairment or risk for renal failure due to volume depletion 1
  • Suspected or confirmed cerebrovascular bleeding 1
  • Hemorrhagic diathesis or incomplete hemostasis 1
  • Hypersensitivity to ketorolac, aspirin, or other NSAIDs 1
  • During coronary artery bypass graft (CABG) surgery 1

• Use IV ketorolac with caution in:

  • Elderly patients (≥60 years) 2
  • Patients with compromised fluid status 4
  • Patients with interstitial nephritis or papillary necrosis 2
  • Patients on concomitant nephrotoxic drugs 2

Monitoring Recommendations

• Monitor baseline blood pressure, BUN, creatinine, liver function tests, CBC, and fecal occult blood when initiating therapy 4
• Be vigilant for signs of GI bleeding, renal dysfunction, or cardiovascular events 4
• The risk of acute kidney injury is particularly high in patients with marginal kidney function 3

Pediatric Considerations

• Ketorolac can be administered intravenously in children at doses of 0.5-1 mg/kg 3
• In pediatric patients, IV ketorolac has been shown to decrease postoperative opioid requirements 4
• The recommended IV dosage in children is 0.5 mg/kg, followed by either bolus injections of 1.0 mg/kg every 6 hours or an IV infusion of 0.17 mg/kg/h 8

IV ketorolac provides an effective non-opioid option for acute pain management when oral administration is not feasible or when rapid analgesia is required. However, its use should be limited to short-term therapy (≤5 days) to minimize the risk of serious adverse effects.