From the Guidelines
The maximum dose of intramuscular ketorolac is 60 mg, with a maximal dosage of 120 mg per day, and treatment should not exceed five days. This recommendation is based on the evidence provided by the American Family Physician 1, which outlines the dosage and usage guidelines for ketorolac in the management of acute pain.
Key Considerations
- The dosage of ketorolac is crucial due to its potential for adverse effects, including gastrointestinal upset, drowsiness, dizziness, and increased diaphoresis 1.
- Ketorolac is contraindicated in patients with aspirin/NSAID-induced asthma, pregnancy, and cerebrovascular hemorrhage 1.
- The medication's efficacy as an NSAID for pain management is rated as 3 on a scale of 1 to 4, with 4 being the most effective 1.
Administration and Monitoring
- Intramuscular ketorolac should be administered every 15 to 30 minutes as needed, with careful monitoring for signs of adverse effects.
- Given its potential risks, ketorolac should be used at the lowest effective dose for the shortest duration possible to minimize the risk of serious adverse effects.
- Patients should be informed about the potential risks and benefits of ketorolac treatment and monitored closely during the treatment period.
From the FDA Drug Label
The maximum daily dose for patients <65 years of age should not exceed 120 mg The maximum daily dose for patients ≥65 years of age, renally impaired patients, and patients less than 50 kg (110 lbs) should not exceed 60 mg
Multiple-Dose Treatment (Intravenous or Intramuscular) Patients <65 years of age: The recommended dose is 30 mg ketorolac tromethamine injection every 6 hours. For patients ≥65 years of age, renally impaired patients, and patients less than 50 kg (110 lbs): The recommended dose is 15 mg ketorolac tromethamine injection every 6 hours.
The maximum dose of intramuscular ketorolac is 120 mg per day for patients less than 65 years of age, and 60 mg per day for patients 65 years of age or older, renally impaired, or less than 50 kg. The maximum single dose of intramuscular ketorolac is 60 mg for patients less than 65 years of age and 30 mg for patients 65 years of age or older, renally impaired, or less than 50 kg 2.
From the Research
Maximum Dose of Intramuscular Ketorolac
- The maximum dose of intramuscular ketorolac is not explicitly stated in the provided studies, but the doses used in the studies can be referenced.
- A study published in 2021 3 compared two doses of intramuscular ketorolac, 15 mg and 60 mg, for the treatment of acute musculoskeletal pain in a military emergency department.
- The study found that a 15 mg dose of IM ketorolac was non-inferior to a 60 mg dose for acute MSK pain in adults presenting to the ED.
- Another study published in 2010 4 used a dose of 10 mg of ketorolac qid for 24 hours in polytrauma patients.
- It is essential to note that the dosage guidelines for ketorolac have been revised, and the risk of adverse events increases with high dosages, especially when used for more than 5 days, especially in the elderly 5.
Dosage Considerations
- The choice of dose should be based on the individual patient's needs and medical history.
- Ketorolac has a strong analgesic effect, but its use should be carefully considered due to the potential risks of gastrointestinal or operative site bleeding, acute renal failure, and allergic or hypersensitivity reactions 5.
- The use of ketorolac should be in accordance with current dosage guidelines to minimize the risk of adverse events.
Comparison with Other Analgesics
- Ketorolac has been compared to other analgesics, such as acetaminophen and opioids, in various studies 4, 6.
- The studies suggest that ketorolac can be an effective alternative to opioids for acute pain management, but its use should be carefully considered due to the potential risks associated with its use.