Ketorolac

Usual Dosing (Adults)

DOSAGE AND ADMINISTRATION

IN ADULTS, THE COMBINED DURATION OF USE OF KETOROLAC TROMETHAMINE INJECTION AND KETOROLAC TROMETHAMINE TABLETS IS NOT TO EXCEED FIVE (5) DAYS. IN ADULTS, THE USE OF KETOROLAC TROMETHAMINE TABLETS IS ONLY INDICATED AS CONTINUATION THERAPY TO KETOROLAC TROMETHAMINE INJECTION.

Ketorolac Tromethamine Injection
Adult Patients
Ketorolac Tromethamine Injection may be used as a single or multiple dose on a regular or “prn” schedule for the management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting. Hypovolemia should be corrected prior to the administration of ketorolac tromethamine. Patients should be switched to alternative analgesics as soon as possible, but ketorolac tromethamine therapy is not to exceed five (5) days.

When administering Ketorolac Tromethamine Injection, the IV bolus must be given over no less than 15 seconds. The IM administration should be given slowly and deeply into the muscle. The analgesic effect begins in ~30 minutes with maximum effect in 1 to 2 hours after dosing IV or IM. Duration of analgesic effect is usually 4 to 6 hours.

Single-Dose Treatment: The Following Regimen Should Be Limited to Single Administration Use Only

Adult Patients
IM Dosing
Patients < 65 years of age: One dose of 60 mg.
Patients >/= 65 years of age, renally impaired and/or less than 50 kg (110 lbs) of body weight: One dose of 30 mg.

IV Dosing
Patients < 65 years of age: One dose of 30 mg.
Patients >/= 65 years of age, renally impaired and/or less than 50 kg (110 lbs) of body weight: One dose of 15 mg.

Multiple-Dose Treatment (IV or IM) in Adults
Patients < 65 Years of Age

The recommended dose is 30 mg Ketorolac Tromethamine Injection every 6 hours. The maximum daily dose should not exceed 120 mg.

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 daily dose for these populations should not exceed 60 mg.

For breakthrough pain do not increase the dose or the frequency of ketorolac tromethamine. Consideration should be given to supplementing these regimens with low doses of opioids prn unless otherwise contraindicated.

Renal Dosing

See comments above.

Ketorolac tromethamine is CONTRAINDICATED in patients with advanced renal impairment and in patients at risk for renal failure due to volume depletion.

Ketorolac tromethamine and its metabolites are eliminated primarily by the kidneys, which, in patients with reduced creatinine clearance, will result in diminished clearance of the drug. Therefore, ketorolac tromethamine should be used with caution in patients with impaired renal function and such patients should be followed closely. With the use of ketorolac tromethamine, there have been reports of acute renal failure, nephritis and nephrotic syndrome.

Because patients with underlying renal insufficiency are at increased risk of developing acute renal failure, the risks and benefits should be assessed prior to giving ketorolac tromethamine to these patients. Hence, in patients with moderately elevated serum creatinine, it is recommended that the daily dose of Ketorolac Tromethamine Injection be reduced by half, not to exceed 60 mg/day. KETOROLAC TROMETHAMINE IS CONTRAINDICATED IN PATIENTS WITH SERUM CREATININE CONCENTRATIONS INDICATING ADVANCED RENAL IMPAIRMENT.

Hypovolemia should be corrected before treatment with ketorolac tromethamine is initiated.

Hemodialysis

Specific guidelines not available.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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