Ketorolac IV Administration: Dilution and Dosing
Ketorolac IV bolus must be administered over no less than 15 seconds without dilution in a small-volume syringe, as mixing with other medications causes precipitation. 1
Standard IV Dosing Regimens
Single-Dose Treatment
- Patients <65 years: 30 mg IV as one-time dose 1
- Patients ≥65 years, renally impaired, or <50 kg: 15 mg IV as one-time dose 1
Multiple-Dose Treatment (Every 6 Hours)
- Patients <65 years: 30 mg IV every 6 hours (maximum 120 mg/day) 1
- Patients ≥65 years, renally impaired, or <50 kg: 15 mg IV every 6 hours (maximum 60 mg/day) 1
- Maximum treatment duration: 5 days total 1
Critical Dilution Considerations
Do NOT mix ketorolac in small volumes (syringes) with morphine sulfate, meperidine, promethazine, or hydroxyzine—this causes drug precipitation. 1
The FDA label explicitly states that ketorolac should not be diluted in small-volume syringes with other medications. 1 While general IV bolus guidelines recommend administering most medications over 1-2 minutes after dilution 2, ketorolac's specific requirement is administration over ≥15 seconds as supplied, without small-volume dilution that would risk precipitation. 1
Pediatric Dosing (Ages 1+ Years)
Recommended IV dose: 0.5 mg/kg loading dose, followed by either:
- Bolus injections of 1.0 mg/kg every 6 hours, OR
- Continuous infusion at 0.17 mg/kg/hour 3
Maximum daily dose: 90 mg 3
Maximum duration: 48 hours in children 3
Not recommended: Infants <1 year old 3
The higher weight-based dosing in children reflects increased volume of distribution (2-fold higher than adults) and higher plasma clearance, though elimination half-life remains similar. 3
Administration Technique
- Inspect solution for particulate matter and discoloration before administration 1
- Administer IV bolus over minimum 15 seconds (not as rapid push) 1
- Correct hypovolemia prior to ketorolac administration to minimize renal risk 1
- Onset of analgesia: ~30 minutes, with maximum effect at 1-2 hours 1
- Duration of effect: 4-6 hours 1
Dose-Response Evidence
Recent evidence suggests an analgesic ceiling effect exists above certain doses. In elderly patients (≥65 years), lower doses (15 mg IV) demonstrated equivalent analgesic efficacy to higher doses (30 mg IV), with no significant difference in rescue analgesia requirements (6.5% vs 13.5%, p=0.094) or pain score reduction (2.8 vs 2.9 points). 4 This supports the FDA's lower dosing recommendations for this population. 1
For adjunctive use with opioid PCA, doses of 30 mg loading followed by 15 mg every 6 hours provided significant pain reduction and improved satisfaction compared to placebo, with no clinically significant side effects. 5
High-Risk Populations Requiring Avoidance
Absolute contraindications: 6
- Aspirin/NSAID-induced asthma
- Pregnancy
- Cerebrovascular hemorrhage
- Active peptic ulcer disease
Relative contraindications requiring dose reduction or avoidance: 6
- Age ≥60 years with cardiovascular disease risk
- Concurrent anticoagulant use
- Compromised fluid status
- Renal impairment
Opioid-Sparing Strategy
For breakthrough pain, do not increase ketorolac dose or frequency—instead, supplement with low-dose opioids unless contraindicated. 1 Ketorolac exhibits marked opioid-sparing effects when combined with morphine or other opioids, improving pain relief quality while reducing opioid-related adverse effects (respiratory depression, nausea, ileus). 3