It is inappropriate to use ketorolac if any of the following conditions exist.

1. Patient has history of or active peptic ulcer disease, GI bleed or perforation.

2. Patient has advanced renal impairment or is at risk for renal failure due to volume depletion.

3. Patient has suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis and is at high risk of bleeding.

4. Patient is receiving aspirin or other non-steroidal antiinflammatory drug.

5. During immediate pre-operative or intraoperative period.

6. In obstetric patients before delivery and nursing mothers.

Dose:

Ketorolac may be given IM, IV or PO - It should only be administered for 5 days by any combination of routes.

Dosage should be reduced by 50% in patients over 65 years old or who weigh less than 50 kilograms or who have a slightly elevated serum creatinine.

Injection:

1. 60 mg may only be given IM- recommended only for single dose treatments as in emergency department or outpatient surgery.

2. 15 - 30 mg IM or IV push every 4-6 hours as needed with maximum of 120 mg daily.

Oral:

1. 10mg po q 6 hours as needed with maximum of 40 mg daily.

2. Oral should only be used as a continuation of IV/IM therapy

Monitor:

1. Renal function

2. Adverse events - GI pain, dyspepsia, nausea, GI ulceration, bleeding, headache, somnolence, drowsiness, ecchymoses, rash hematomas, renal events.

Outcome:

1. Clinical improvement with relief of pain documented.