What is the proper dosing and administration of ketorolac (nonsteroidal anti-inflammatory drug) for acute pain management?

How to Give Ketorolac

For adults under 65 years, administer ketorolac 30 mg IV over at least 15 seconds or 60 mg IM, then 30 mg IV/IM every 6 hours (maximum 120 mg/day) for no more than 5 days. 1

Dosing by Route and Patient Population

Intravenous Administration

• Standard adult dose (<65 years): 30 mg IV bolus given over no less than 15 seconds, followed by 30 mg every 6 hours 1
• High-risk patients (≥65 years, <50 kg, or renal impairment): 15 mg IV bolus, then 15 mg every 6 hours (maximum 60 mg/day) 1
• Single-dose treatment: 30 mg IV for standard adults; 15 mg IV for high-risk patients 1

Intramuscular Administration

• Standard adult dose (<65 years): 60 mg IM as single dose, or 30 mg every 6 hours for multiple dosing 1
• High-risk patients: 30 mg IM as single dose, or 15 mg every 6 hours (maximum 60 mg/day) 1
• Administer slowly and deeply into the muscle 1

Pediatric Dosing

• IV bolus: 0.5 mg/kg, followed by either 1.0 mg/kg every 6 hours or continuous infusion at 0.17 mg/kg/hour 2
• Maximum daily dose: 90 mg 2
• Maximum duration: 48 hours for IV use 2
• Not recommended for infants <1 year of age 2

Critical Administration Guidelines

Maximum Duration

• Never exceed 5 days of ketorolac therapy for any indication 3, 1
• Switch to alternative analgesics as soon as possible 1

Onset and Duration of Action

• Analgesic effect begins in approximately 30 minutes 1
• Maximum effect occurs 1-2 hours after dosing 1
• Duration of analgesia is typically 4-6 hours 1

Pre-Administration Requirements

Correct Hypovolemia First

• Always correct fluid status before administering ketorolac to minimize renal risk 1

Baseline Monitoring

Before initiating therapy, obtain: 3, 4

• Blood pressure
• BUN and creatinine
• Liver function tests
• Complete blood count
• Fecal occult blood test

Absolute Contraindications

Do not administer ketorolac in patients with: 3

• Aspirin or NSAID-induced asthma
• Pregnancy
• Cerebrovascular hemorrhage
• Active peptic ulcer disease or GI bleeding

High-Risk Populations Requiring Dose Reduction

Use the lower dose regimen (15 mg IV or 30 mg IM every 6 hours) in: 4, 1

• Age ≥65 years
• Body weight <50 kg (110 lbs)
• Renal impairment
• Compromised fluid status
• Concomitant nephrotoxic drug use

Clinical Applications

Postoperative Pain

• Post-cesarean delivery: 15-30 mg IV every 6 hours for maximum 5 days, administered at end of surgery if no contraindications present 3
• Effective as part of multimodal analgesia, reducing opioid requirements 3

Emergency Department Use

• Renal colic: 30 mg IV over 1 minute provides effective pain relief 5
• Acute pain management: 10 mg IV is as effective as 30 mg, representing the analgesic ceiling dose 6
• Procedural pain in ICU: Single 30 mg IV dose comparable to morphine 4 mg IV for chest tube removal 3

Drug Compatibility Warning

Do not mix ketorolac in a syringe with: 1

• Morphine sulfate
• Meperidine hydrochloride
• Promethazine hydrochloride
• Hydroxyzine hydrochloride

This combination causes precipitation of ketorolac from solution 1

Breakthrough Pain Management

• Do not increase dose or frequency beyond recommended limits 1
• Consider supplementing with low-dose opioids for breakthrough pain unless contraindicated 1
• Ketorolac demonstrates opioid-sparing effects when used in combination 2

Common Adverse Effects

Monitor for: 3

• Edema
• Drowsiness and dizziness
• Gastrointestinal upset
• Increased diaphoresis

Ongoing Monitoring for Extended Use

If therapy approaches 3-5 days, monitor: 4

• Signs of renal toxicity
• Development or worsening of hypertension
• GI upset, nausea, or signs of GI bleeding
• Bleeding time (ketorolac reversibly inhibits platelet aggregation) 2