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[1]

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

  • Dispepsia, 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

References

  1. Motov S et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med 2016. PMID: 27993418