Ketorolac

General

• Type: NSAID
• Dosage Forms: 15mg/mL, 30mg/mL injection
• Common Trade Names: Toradol

Although standard packaging provides 30mg doses current research demonstrates that the analgesic ceiling for ketorolac appears to be 10 mg if given intravenously

Adult Dosing

• Acute pain:
  • IM: 15mg x 1 or 15mg q6h
  • IV: 15mg x 1, then 15mg q6h
  • Black box warning against treatment for > 5 days

Pediatric Dosing

• N/A

Special Populations

• Pregnancy Rating: C
• Lactation: Enters breast milk, use caution
• Elderly (> 65 yo): Decrease dose by 50%
• Renal Dosing
  • Mild-Moderate impairment: Decrease dose by 50%
  • Severe impairment or HD: Contraindicated
• Hepatic Dosing: No dose change, but may increase LFTs

Contraindications

• Allergy to class/drug
• Active or prior PUD, recent GI bleed
• Severe renal disease or HD
• Bleeding diathesis

Adverse Reactions

Serious

• Bleeding, MI, CVA, GI bleed/perforation, Hyperkalemia

Common

• Dyspepsia, nausea, headache

Pharmacology

• Onset: 20-30 minutes
• Peak: 2-3 hours
• Duration: 4-6 hours
• Half-life: 2-6 hours, up to 19 hours in renal disease
• Metabolism: Hepatic
• Excretion: Renal
• Mechanism of Action: NSAID, Reversible COX-1/2 inhibitor

See Also

• NSAID toxicity