Ketorolac Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Pain

In adults, the use of oral ketorolac is only indicated as continuation therapy to IV or IM dosing of ketorolac. The manufacturer recommends that the oral formulation should not be given as an initial dose.

Parenteral:
Single dose administration:
IM: Patients less than 65 years of age: one dose of 60 mg. Patients who are renally impaired, and/or less than 50 kg (110 pounds): one dose of 30 mg.
IV: Patients less than 65 years of age: one dose of 30 mg. Patients who are renally impaired, and/or less than 50 kg (110 pounds): One dose of 15 mg.

Multiple dose administration:
Patients less than 65 years of age: 30 mg IM or IV every 6 hours as needed. The maximum daily dose should not exceed 120 mg.
Patients who are renally impaired, and/or less than 50 kg (110 pounds): 15 mg IM or IV every 6 hours as needed. The maximum dose should not exceed 60 mg.

Oral:
10 mg orally 4 times a day as needed. The maximum daily dose should not exceed 40 mg.
Patients less than 50 kg: The maximum daily dose should not exceed 40 mg.

Nasal Spray:
For adult patients less than 65 years of age: 31.5 mg (one 15.75 mg spray in each nostril) every 6 to 8
hours.
Maximum daily dose: 126 mg

Usual Geriatric Dose for Pain

In adults, the use of oral ketorolac is only indicated as continuation therapy to IV or IM dosing of ketorolac. The manufacturer recommends that the oral formulation should not be given as an initial dose.

Parenteral:
Single dose administration:
IM: Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): one dose of 30 mg.
IV: Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): One dose of 15 mg.

Multiple dose administration:
Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): 15 mg IM or IV every 6 hours as needed. The maximum dose should not exceed 60 mg.

Oral:
10 mg orally 4 times a day as needed. The maximum daily dose should not exceed 40 mg.
Patients less than 50 kg: The maximum daily dose should not exceed 40 mg.

Nasal Spray:
65 years of age or greater, renally impaired patients, and patients less than 50 kg (110 lbs): 15.75 mg (one 15.75 mg spray in only one nostril) every 6 to 8 hours.
Maximum daily dose: 63 mg

Usual Pediatric Dose for Pain

Greater than or equal to 1 month and less than 2 years:
Multiple dose treatment: IV:
0.5 mg/kg every 6 to 8 hours. Do not exceed 48 to 72 hours of treatment.
Children 2 to 16 years and Children greater than 16 years who are less than 50 kg: Do not exceed adult doses
Single-dose treatment:
Manufacturer's recommendations:
IM: 1 mg/kg as a single dose
Maximum dose: 30 mg
IV: 0.5 mg/kg as a single dose
Maximum dose: 15 mg

Multiple-dose treatment:
IM or IV: 0.5 mg/kg every 6 hours. Do not exceed 5 days of treatment.
Oral: No pediatric studies exist.

Children greater than 16 years and greater than 50 kg:
Single-dose treatment:
IM: 60 mg as a single dose
IV: 30 mg as a single dose
Multiple-dose treatment:
IM or IV: 30 mg every 6 hours
Maximum dose: 120 mg/day
Oral:
Initial dose: 20 mg
Maintenance dose: 10 mg every 4 to 6 hours
Maximum dose: 40 mg/day

Renal Dose Adjustments

In patients with moderately elevated serum creatinine, the dosage of ketorolac injection should not exceed 60 mg per day.

Nasal Spray:
65 years of age or greater, renally impaired patients, and patients less than 50 kg (110 lbs): 15.75 mg (one 15.75 mg spray in only one nostril) every 6 to 8 hours.
Maximum daily dose: 63 mg

Liver Dose Adjustments

No adjustments recommended. The drug should be discontinued if abnormal liver tests have occurred as a result of ketorolac therapy.

Dose Adjustments

Do not exceed doses of 60 mg IV/IM per day in patients 65 years or older, in patients weighing 50 kg (110 lbs.) or less, and in patients with moderately elevated serum creatinine.

Precautions

In adults, the use of oral ketorolac is only indicated as continuation therapy to IV or IM dosing of ketorolac. The manufacturer recommends that the oral formulation should not be given as an initial dose.

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

Dosage should be adjusted for patients 65 years or older, for patients under 50 kg (110 pounds), and for patients with moderately elevated serum creatinine.

Because a large number of older adults have asymptomatic GI pathologic conditions, ketorolac meets the Beers criteria as a medication that should be avoided in older adults for immediate and long-term use.

The minimum effective dose for the individual patient should be used.

The patient should be switched to alternative analgesics as soon as possible, but ketorolac therapy should not exceed 5 days.

Safety and effectiveness of ketorolac in oral dosage form have not been established in pediatric patients under the age of 17.

Dialysis

Dialysis does not significantly clear ketorolac from the blood stream.

Other Comments

In adults, the combined duration of use of IV or IM dosing of ketorolac and oral ketorolac should not exceed 5 days.

Ketorolac injection should not be mixed in a small volume (e.g., in a syringe) with morphine sulfate, meperidine hydrochloride, promethazine hydrochloride, or hydroxyzine hydrochloride: this will result in precipitation of ketorolac from solution.

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