What is the proper way to take Ketorol DT (Ketorolac Tromethamine)?

How to Take Ketorol DT (Ketorolac Tromethamine)

Ketorol DT tablets must only be used as continuation therapy after initial IV or IM ketorolac administration, not as a first-line oral medication. 1

Administration Instructions

Timing and Transition from Injectable Form

• Ketorol DT is specifically indicated only as continuation therapy following IV or IM ketorolac—it should never be given as an initial dose 1
• The oral tablet is taken after the injectable form has been administered first 1

Dosing Based on Patient Characteristics

For adults aged 17-64 years:

• Take 20 mg once as the first oral dose (after IV/IM administration) 1
• Follow with 10 mg every 4-6 hours as needed 1
• Maximum daily dose: 40 mg 1
• Do not shorten the 4-6 hour interval between doses 1

For adults ≥65 years, those with kidney impairment, or weight <50 kg (110 lbs):

• Take 10 mg once as the first oral dose (after IV/IM administration) 1
• Follow with 10 mg every 4-6 hours as needed 1
• Maximum daily dose: 40 mg 1

Critical Duration Limit

• The combined duration of IV/IM ketorolac plus oral Ketorol DT must not exceed 5 days total 1
• This strict 5-day limit applies to prevent serious gastrointestinal and renal complications 2

How to Take the Tablet

Food Considerations

• High-fat meals decrease peak concentration and delay absorption by approximately 1 hour 1
• While the tablet can be taken with or without food, taking it with food may reduce gastrointestinal upset 3
• Antacids do not affect the extent of absorption 1

DT (Dispersible Tablet) Formulation

• The "DT" designation typically indicates a dispersible or disintegrating tablet formulation 4
• These tablets can be swallowed whole with water or may be designed to dissolve/disperse in the mouth or water before swallowing 4

Important Safety Warnings

Absolute Contraindications

Do not take Ketorol DT if you have: 3, 1, 2

• History of aspirin or NSAID-induced asthma
• Active or history of gastrointestinal bleeding or peptic ulcer disease
• Bleeding disorders or compromised blood clotting
• Severe kidney impairment
• Pregnancy (especially third trimester) or breastfeeding
• Recent or planned surgery where bleeding is a concern

High-Risk Populations Requiring Extreme Caution

• Elderly patients (≥65 years): Use lower dose (10 mg) due to increased risk of adverse effects 1, 2
• Asthma patients: Risk of life-threatening bronchospasm; use is contraindicated if history of aspirin/NSAID-induced asthma 3, 5
• Patients with cardiovascular disease: NSAIDs increase risk of heart attack and stroke 3

Common Pitfalls to Avoid

• Never exceed 5 days total treatment (IV/IM + oral combined)—this is the most critical error to avoid 1, 2
• Never use as initial therapy—must follow injectable ketorolac 1
• Never exceed 40 mg daily regardless of pain severity 1
• Never take more frequently than every 4 hours 1
• Do not combine with other NSAIDs (ibuprofen, naproxen, aspirin) as this increases toxicity risk 3

Monitoring for Adverse Effects

Gastrointestinal Effects

• Watch for stomach pain, black/tarry stools, or vomiting blood—these indicate serious bleeding requiring immediate medical attention 2
• Nausea and mild stomach upset are common but usually self-limiting 3, 6

Renal Effects

• Monitor for decreased urination, swelling in legs/feet, or sudden weight gain 2
• Risk increases with dehydration, so maintain adequate fluid intake 3

Bleeding Risk

• Expect slightly prolonged bleeding time, though usually within normal range 7
• Report any unusual bruising or bleeding 2

Allergic Reactions

• Seek immediate help for difficulty breathing, facial swelling, or severe rash 5, 2

When to Contact Healthcare Provider

Call immediately if you experience: 3, 2

• Black, tarry stools or blood in vomit
• Severe abdominal pain
• Difficulty breathing or wheezing
• Decreased urination or swelling
• Chest pain or signs of heart attack/stroke
• Severe allergic reaction symptoms

Clinical Context

Ketorolac is comparable in potency to morphine for acute pain but without sedation, respiratory depression, or addiction potential 6, 7. However, its serious gastrointestinal and renal toxicity risks necessitate strict adherence to dosing limits and duration restrictions 2. The revised dosage guidelines (lower doses, shorter duration) have significantly reduced the incidence of serious adverse events 2.