Ketorolac

1. Class
   1. NSAID in the Acetic acid class (Pyrrolo-pyrrole)
2. Precautions
   1. Do not use longer than 5 days
3. Indications
   1. Analgesia for moderate to severe acute pain
   2. Alternative to Narcotic Analgesic
4. Contraindications
   1. Peptic Ulcer Disease
   2. Renal insufficiency
   3. Acute or chronic bleeding risk
   4. Hypersensitivity to Aspirin or other NSAID
5. Dosing: Indications for using lower dose
   1. Age over 65 years
   2. Renal Impairment
   3. Weight under 50 kg (110 pounds)
6. Dosing: Intramuscular dose
   1. Regular dose
      1. Single dose: 60 mg IM
      2. Repeated dose: 30 mg IM every 6 hours prn (<5 days)
      3. Maximum: 120 mg per day
   2. Low dose
      1. Single dose: 30 mg IM
      2. Repeated dose: 15 mg IM every 6 hours prn (<5 days)
      3. Maximum: 60 mg per day
7. Dosing: Intravenous dose
   1. Regular dose: 30 mg IV every 6 hours prn (<5 days)
   2. Low dose: 15 mg IV every 6 hours prn <(5 days)
8. Dosing: Oral dose (continuation of parenteral dosing)
   1. Maximum: 40 mg per day
   2. Regular dose
      1. First dose: 20 mg PO (two 10 mg tablets)
      2. Subsequent dosing: 10 mg PO q4-6 hours prn
   3. Low dose
      1. Dose: 10 mg PO q4-6 hours prn
9. Adverse Effects
   1. Gastrointestinal Bleeding (Peptic Ulcer Disease)
      1. See NSAID Gastrointestinal Adverse Effects
   2. Exacerbation of renal insufficiency
      1. See NSAID Renal Adverse Effects
   3. Bleeding risk
10. Efficacy
    1. Equivalents to Toradol 60 mg IM
       1. Morphine 12 mg IM
       2. Ibuprofen 800 mg PO (See Turturro 1995)
    2. Advantages over Morphine in ER with blunt limb trauma
       1. Toradol has longer duration
       2. Toradol less adverse effects
       3. Toradol IV more effective than Morphine IV
    3. References
       1. Rainer (2000) BMJ 321:1247-51
11. References
    1. Turturro (1995) Ann Emerg Med 26:117-20
    2. (2000) Med Lett Drugs Ther 42(1085): 73-78