What is the recommended dosing frequency for intramuscular (IM) ketorolac injection?

Ketorolac IM Dosing Frequency

Administer ketorolac IM every 6 hours, with a maximum treatment duration of 5 days. 1

Standard Dosing Regimen

For patients under 65 years of age:

• 30 mg IM every 6 hours 1
• Maximum daily dose: 120 mg 2, 1
• Treatment duration: Not to exceed 5 days 2, 1

For patients 65 years and older, renally impaired, or weighing less than 50 kg:

• 15 mg IM every 6 hours 1
• Maximum daily dose: 60 mg 3, 1
• Treatment duration: Not to exceed 5 days 2, 1

Administration Technique

• Inject slowly and deeply into the muscle 1
• The analgesic effect begins in approximately 30 minutes with maximum effect at 1-2 hours 1
• Duration of analgesic effect is typically 4-6 hours 1

Critical Safety Considerations

Before administering ketorolac:

• Correct hypovolemia prior to administration 1
• Verify no contraindications exist (aspirin/NSAID-induced asthma, active peptic ulcer disease, GI bleeding, cerebrovascular hemorrhage, severe renal impairment) 2, 3

For breakthrough pain:

• Do not increase the dose or frequency of ketorolac 1
• Consider supplementing with low-dose opioids as needed unless contraindicated 1
• Switch to alternative analgesics as soon as clinically appropriate 1

High-Risk Population Adjustments

Elderly patients (≥60 years) require:

• Reduced dosing (15 mg every 6 hours, maximum 40-60 mg daily) 3, 1
• Baseline monitoring: blood pressure, BUN, creatinine, liver function tests, CBC, fecal occult blood 3
• Repeat monitoring every 3 months if extended use is considered (though duration should not exceed 5 days) 3

Avoid concurrent use with:

• Other NSAIDs (including ibuprofen) due to additive toxicity without additional analgesic benefit 4
• Wait 6-8 hours after last ibuprofen dose before administering ketorolac 4

Common Pitfalls to Avoid

• Never exceed 5 days of treatment - this is a hard stop regardless of pain control 2, 1
• Never mix ketorolac in a syringe with morphine, meperidine, promethazine, or hydroxyzine - this causes precipitation 1
• Never increase frequency beyond every 6 hours - consider alternative or adjunctive analgesics instead 1
• Never use in patients with active bleeding or coagulopathy - ketorolac has reversible antiplatelet effects 2, 3