Select a medication above to begin.
ketorolac
generic
Black Box Warnings .
Appropriate Use
for short term (up to 5 days in adults) tx of moderately severe acute pain requiring opioid-level analgesia and only as continuation of parenteral tx, if necessary; total combined duration should not exceed 5 days; not indicated for minor or chronic pain; oral tx not indicated in peds; max recommended total daily dose 40 mg PO and 120 mg IV/IM; doses above label recommendations incr. serious adverse event risk w/o improved efficacy
GI Risk
incr. serious GI adverse event risk, incl. bleeding, ulcer, and stomach or intestine perforation, which can be fatal; may occur at any time during use and w/o warning sx; elderly pts at greater risk for serious GI events; contraindicated in active PUD, recent GI bleeding or perforation, and PUD or GI bleeding hx
Cardiovascular Risk
NSAIDs incr. risk of serious and potentially fatal cardiovascular thrombotic events, incl. MI and stroke; risk may occur early in tx and may incr. w/ duration of use; contraindicated in CABG periop setting
Renal Risk
contraindicated if adv. renal impairment or if renal failure risk due to volume depletion
Bleeding Risk
contraindicated if suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or high bleeding risk because inhibits platelet fxn; contraindicated as prophylactic analgesic before major surgery
Labor/Delivery Risk
contraindicated in labor/delivery because may adversely affect fetal circulation and inhibit uterine contractions
Concomitant NSAID Use
contraindicated in combo w/ ASA or NSAIDs due to cumulative risk of serious NSAID-related side effects
Intrathecal/Epidural Use
contraindicated due to alcohol content
Hypersensitivity Rxn
hypersensitivity rxns range from bronchospasm to anaphylactic shock, have appropriate tx available; contraindicated if previous ketorolac, ASA, or other NSAID hypersensitivity rxn
Special Populations
max total daily dose 60 mg IV/IM in pts 65 yo and older, if wt <50 kg, or moderately elevated Cr; max single dose 30 mg IM and 15 mg IV in peds pts
Adult Dosing .
Dosage forms: TAB: 10 mg; INJ (pre-filled syringe, IM): 60 mg per 2 mL; INJ (pre-filled syringe, IM/IV): 15 mg per mL, 30 mg per mL; INJ (vial): 15 mg per mL, 30 mg per mL
pain, mod. severe
- [parenteral route, single dose tx]
- Dose: 60 mg IM x1; Alt: 30 mg IV x1; Info: give 30 mg IM x1 or 15 mg IV x1 in pts 65 yo and older or if wt <50 kg; use lowest effective dose
- [parenteral route, multiple dose tx]
- Dose: 30 mg IM/IV q6h; Max: 120 mg/day; Info: give 15 mg IM/IV q6h up to 60 mg/day in pts 65 yo and older or if wt <50 kg; combined duration of PO/IM/IV not to exceed 5 days; use lowest effective dose, shortest effective tx duration
- [PO route]
- Dose: 10 mg PO q4-6h; Start: 20 mg PO x1; Max: 40 mg/day; Info: only for pts who received parenteral tx; start 10 mg PO x1 in pts 65 yo and older or if wt <50 kg; duration of combined PO/IM/IV tx not to exceed 5 days; use lowest effective dose, shortest effective tx duration; give w/ food if GI upset occurs
pain, migraine-associated (off-label)
- [30 mg IV x1]
- Alt: 60 mg IM x1
renal dosing
- [single dose tx]
- mild-moderate impairment: 30 mg IM x1 or 15 mg IV x1; advanced impairment: contraindicated
- HD/PD: contraindicated
- [multiple dose tx]
- mild-moderate impairment: 15 mg IM/IV q6h, max 60 mg/day or may switch to 10 mg PO q4-6h, max 40 mg/day; advanced impairment: contraindicated
- HD/PD: contraindicated
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: INJ (pre-filled syringe, IM): 60 mg per 2 mL; INJ (pre-filled syringe, IM/IV): 15 mg per mL, 30 mg per mL; INJ (vial): 15 mg per mL, 30 mg per mL
pain, mod. severe (off-label)
- [6 mo and older]
- Dose: 0.5 mg/kg/dose IM/IV q6h up to 72h; Alt: 1 mg/kg/dose IM/IV q6h up to 24-48h; Max: 30 mg/dose IM; 15 mg/dose IV; Info: use lowest effective dose, shortest effective tx duration
pain, migraine-associated (off-label)
- [2 yo and older]
- Dose: 0.5 mg/kg/dose IV x1; Max: 15 mg/dose
renal dosing
- [see below]
- mild-moderate renal impairment: decr. usual dose by 50%; advanced impairment: contraindicated
- HD/PD: contraindicated
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised