- 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
GUIDELINES FOR USE
- 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
- 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.)
| SC | NO |
| 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.)
Pediatric:
- 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
DOSAGE ADJUSTMENT IN RENAL IMPAIRMENT:
- CrCl 10-50 mL/minute: Administer 50% of normal dose
- CrCl <10 mL/minute: Administer 25-50% of normal dose
- 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