From the Guidelines
Ketorolac dosing for pediatric patients should be carefully considered due to potential kidney function concerns, but it can be an effective opioid-sparing medication.
Key Considerations
- The use of ketorolac in pediatric patients has been shown to be effective in reducing postoperative pain and opioid requirements in various surgical procedures, including orthopedic procedures, inguinal hernia repair, and adenotonsillectomy 1.
- However, care should be taken when using ketorolac in children with marginal kidney function, as it can be associated with acute kidney injury.
Dosing Information
- Unfortunately, the provided evidence does not specify the exact dosing of ketorolac for pediatric patients.
- It is essential to consult a reliable medication guide or clinical guidelines for the recommended dosing of ketorolac in pediatric patients, taking into account the patient's kidney function and other individual factors.
Important Precautions
- Ketorolac should be used with caution in pediatric patients with kidney function concerns, such as those presenting with sickle cell vaso-occlusive pain crisis 1.
- Close monitoring of kidney function and overall patient condition is crucial when using ketorolac in pediatric patients.
From the FDA Drug Label
Limited information is available regarding the pharmacokinetics of dosing of ketorolac tromethamine in the pediatric population. Following a single intravenous bolus dose of 0.5 mg/kg in 10 children 4 to 8 years old, the half-life was 5.8 ± 1.6 hours, the average clearance was 0.042 ± 0. 01 L/hr/kg, the volume of distribution during the terminal phase (V β) was 0.34 ± 0.12 L/kg and the volume of distribution at steady state (Vss) was 0.26 ± 0. 08 L/kg.
The appropriate dosing of Toradol (ketorolac) for pediatric patients is not well established due to limited information available regarding its pharmacokinetics in this population. However, a single intravenous bolus dose of 0.5 mg/kg was used in a study of 10 children aged 4 to 8 years.
- Key points about this dosing include:
- Half-life: 5.8 ± 1.6 hours
- Average clearance: 0.042 ± 0.01 L/hr/kg
- Volume of distribution during the terminal phase (V β): 0.34 ± 0.12 L/kg
- Volume of distribution at steady state (Vss): 0.26 ± 0.08 L/kg 2
From the Research
Dosing of Toradol (Ketorolac) for Pediatric Patients
The appropriate dosing of Toradol (ketorolac) for pediatric patients varies based on age, weight, and the specific medical condition being treated.
- The recommended intravenous dosage of ketorolac in children is 0.5 mg/kg, followed either by bolus injections of 1.0 mg/kg every 6 hours or an intravenous infusion of 0.17 mg/kg/h, with a maximum daily dosage of 90mg and a maximum duration of treatment of 48 hours 3.
- For oral administration, the recommended dosage is 0.25 mg/kg to a maximum of 1.0 mg/kg/day, with a maximum duration of 7 days 3.
- In neonates and infants following cardiac surgery, a ketorolac regimen of 0.5 mg/kg/dose every 6 hours may be safe with regard to renal function and bleeding risk, and effective regarding opioid-sparing capacity 4.
- A study on pediatric patients weighing at least 60 kg treated with intravenous ketorolac for headache found that a maximum dose of 15 mg was effective for analgesia and resulted in fewer side effects compared to a dose of 30 mg 5.
- A population analysis of the pharmacokinetics of intravenous ketorolac in children aged 2 months to 16 years found that a dosing regimen of 0.5 mg/kg every 6 hours maintains a trough concentration larger than 0.37 mg/L in children 9 months to 16 years of age 6.
Special Considerations
- Ketorolac is not recommended for use in infants aged < 1 year 3.
- The safety of ketorolac in neonates and infants with single-ventricle physiology is not well studied, and its use in these populations should be approached with caution 7.
- Ketorolac can be used in specific pediatric patients after cardiac surgery with minimal risk of bleeding or renal dysfunction with appropriate dosing and duration of use 7.