Parenteral Manual

Ketorolac tromethamine

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Non-steroidal anti-inflammatory agent
Original Date: 
August 2005
Revised Date: 
August 2016
  • Acute pain management where there is need to administer a NSAID drug parenterally
  • This drug is intended for short term use (<5 days combined for oral and parenteral) in patients unable to tolerate opioid analgesics


  • Use restricted to parenteral form of the drug - IV route recommended
  • Patients with relative or absolute contraindication to narcotics
  • Post-op in Ambulatory Care/Day Surgery where alertness is a factor in determining discharge
  • Palliative care patients unable to tolerate oral non-steroidal inflammatory agents
Reconstitution and Stability: 
  • Available as 30 mg/mL vials
  • Store vials at room temperature, protect from light
  • Diluted solutions stable 48 hours at room temperture
  • Stable for 21 days at room temperature in 0.9% NaCl or D5W when diluted to a concentration of 0.3 mg/mL and 0.6 mg/mL

- Solutions Compatible: D5W, 0.9% NaCl, D5NS, ringer's solution, ringer's lactate

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: dexmedetomidine, fentanyl, hydromorphone , KCl, morphine

- Incompatible: azithromycin, diazepam, haloperidol, hydroxyzine, nalbuphine, prochlorperazine, promethazine,  do not administer in the same syringe as narcotics



(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IM YES, slowly and deeply into muscle   
Usual dilution: 30 mg/mL
IV Direct YES
Usual dilution: 1-5 mg/mL   
Infusion time: 1-5 minutes
IV Intermittent Infusion YES
Usual dilution: 1 mg/mL
Infusion time: 15-20 minutes
IV Continuous Infusion NO

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


- greater than or equal to 1 month - less than 2 years:

  • 0.5 mg/kg IV Q6 - 8 hours

- 2 years - 16 years:

- Single-dose treatment: 

  • IM: 1 mg/kg ; Max 30 mg
  • IV:  0.5 mg/kg: Max 15 mg

- Multiple-dose treatment:

  • 0.5 mg/kg IM/IV Q 6 hours  Dose limit: 15 mg/dose

Adolescent(>16 years)/Adult:
- Single-dose treatment: 

  • IM:  60 mg
  • IV:  30 mg

- Multiple-dose treatment:

  • 30 mg IM/IV Q 6 hours
  • Maximum: 120 mg/day


  • CrCl 10-50 mL/minute: Administer 50% of normal dose
  • CrCl <10 mL/minute: Administer 25-50% of normal dose
Potential hazards of parenteral administration: 
  • Pain at injection site
  • Somnolence, headache, sweating, dizziness
  • Nausea, vomiting, abdominal pain, diarrhea, GI ulceration and bleeding
  • Edema, fluid retention, sodium retention
  • Inhibits platelet aggregation- may prolong bleeding time
  • Elevation of liver enzymes
  • May worsen renal dysfunction or affect normal renal function
  • Possibility of cross-sensititivty in patients allergic to ASA or other NSAIDs (and/or triad with asthma/nasal polyps)
  • As with other NSAIDs, should not be used in patients with peptic ulcers or active inflammatory disease of the gastrointestinal system
  • Monitor signs of pain relief, BUN, serum creatinine, liver enzymes, occult blood loss, urinalysis
  • 30 mg ketorolac provides analgesia comparable to 12 mg of morphine or 100 mg of meperidine (PDH 2005)
  • The 60 mg/2 mL product is for IM use only
  • The IV route is not approved by Health Canada; however its use is supported in the medical literature and in clinical practice.  Toradol IM has the same ingredients as Ketorolac Injection (Sandoz); therefore both can be given by the intravenous route at CHEO.    Reference:  eCPS accesssed 25Apr2012  Ketorolac tromethamine, NSAID Analgesic, CPhA Monograph,   Date of revision: October 2009

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