This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Ketorolac trometamol parenteral


Injections containing ketorolac

Drugs List

  • ketorolac 30mg/1ml injection
  • TORADOL 30mg/1ml injection
  • Therapeutic Indications


    Treatment of post-operative pain


    Dose should be adjusted according to the severity of pain and patient response.

    Undesirable effects may be minimised by using the lowest effective dose for the shortest possible duration. Duration of treatment should not exceed 2 days.


    Initial dose: 10mg.
    Maintenance dose: 10mg to 30mg every 4 to 6 hours as required. Ketorolac trometamol may be given every 2 hours in the initial post-operative period if necessary.
    Maximum dose in patients weighing 50kg and over: 90mg daily.
    Maximum dose in patients weighing less than 50kg: 60mg daily.


    Initial dose: 10mg.
    Maintenance dose: 10mg to 30mg every 4 to 6 hours as required. Ketorolac trometamol may be given every 2 hours in the initial post-operative period if necessary.
    Maximum dose: 60mg daily.


    Children aged 16 to 18 years
    (See Dosage; Adult)

    Children aged 6 months to 16 years (unlicensed)
    Initial dose: 500micrograms/kg to 1mg/kg (maximum 15mg per dose) by intravenous injection over at least 15 seconds
    Maintenance dose: 500micrograms/kg (maximum 15mg per dose) every 6 hours as required.
    Maximum dose: 60mg daily.
    Maximum duration: Two days.

    Patients with Renal Impairment

    In mild renal impairment the maximum recommended daily dose is 60mg.

    The Renal Drug Handbook suggests a maximum daily dose of 60mg where the glomerular filtration rate (GFR) is 20 to 50ml/minute. In patients with a GFR of less than 20ml/minute avoid if possible. Use small doses and monitor closely.

    Additional Dosage Information

    Following intravenous and intramuscular injection, the onset of analgesia takes approximately 30 minutes. Maximum analgesia occurs within 1 to 2 hours after injection. Analgesia normally lasts 4 to 6 hours.


    Administer by intramuscular or bolus intravenous injection only.

    Bolus intravenous doses should be administered over a minimum of 15 seconds.


    Children under 6 months
    Haemorrhagic diathesis
    Surgery with a risk of incomplete haemostasis
    Surgical procedure with high risk of haemorrhage
    Suspected cerebrovascular haemorrhage
    Acute renal failure
    Cerebrovascular haemorrhage
    Gastrointestinal perforation
    History of asthma
    History of gastrointestinal haemorrhage
    History of peptic ulcer
    Nasal polyps, angioedema, and bronchospastic reactivity to NSAIDs
    Peptic ulcer
    Renal impairment - serum creatinine above 160 micromol/l
    Severe cardiac failure
    Severe hepatic impairment

    Precautions and Warnings

    Children aged 6 months to 16 years
    Females attempting to conceive
    Patients over 65 years
    Predisposition to hypovolaemia
    Risk factors for cardiovascular disorder
    Weight below 50kg
    Cardiac impairment
    Cerebrovascular disorder
    Congestive cardiac failure
    Connective tissue disorder
    Crohn's disease
    Decompensated cardiac failure
    Hepatic impairment
    History of bronchospasm
    Ischaemic heart disease
    Peripheral arterial circulatory disorder
    Renal impairment
    Systemic lupus erythematosus
    Ulcerative colitis

    Do not use for prophylactic analgesia prior to surgery
    Treatment should be initiated in hospital
    Correct volume depletion and monitor patients until normovolaemic
    Discontinue if signs of gastro-intestinal bleeding occur
    May inhibit platelet aggregation - observe for signs of bleeding
    Monitor closely patient with a history of congestive cardiac failure
    Monitor patients with pre-existing hypertension
    Monitor renal function in patients with renal impairment
    Advise patients to report signs or symptoms of gastro-intestinal ulcer
    Discontinue if signs of gastro-intestinal ulceration occur
    High dose/long term use may increase risk of arterial thrombotic events
    May prolong bleeding time
    NSAIDs may provoke bronchospasm/urticaria in susceptible patients
    NSAIDs may rarely cause interstitial nephritis or glomerulonephritis
    NSAIDs may rarely cause renal medullary necrosis or nephrotic syndrome
    Risk of gastro-intestinal bleeding increased in the elderly
    Discontinue if drug-related rash or other hypersensitivity reactions occur
    Discontinue if symptoms of hepatic disease occur
    Reduce dose and/or alter dose interval in elderly patients
    Parenteral use for maximum 2 days
    May cause impaired fertility

    Ketorolac should not be used for prophylactic analgesia before surgery or for intraoperative analgesia due to the risk of increased bleeding.

    Ketorolac should be used with caution in patients with conditions leading to a reduction in blood volume and/or renal blood flow. Administration of NSAIDs in these patients can cause reduced renal prostaglandin formation and may lead to overt renal failure. This effect is more likely in patients who are volume depleted due to blood loss or severe dehydration, patients with renal impairment, cardiac failure and hepatic impairment, the elderly, and those taking diuretics. Patients generally return to their pre-treatment state following discontinuation of NSAIDs.

    Patients with systemic lupus erythematosus and mixed connective tissue disorders may have an increased risk of aseptic meningitis.

    Pregnancy and Lactation


    Ketorolac is contraindicated in pregnancy. Ketorolac should also be avoided during labour and delivery.

    If an NSAID is clinically indicated in the first or second trimester, ibuprofen would be the preferred agent. NSAIDs should be avoided during the third trimester. In circumstances where the clinical condition requires treatment with NSAIDs during the third trimester, the foetus should be monitored regularly for oligohydramnios and to ensure normal circulation. Schaefer concludes that use of a non-preferred agent in early pregnancy (such as ketorolac), does not require termination of pregnancy or invasive diagnostic procedures.

    Approximately 10% of the dose crosses the placenta.

    There is very limited information concerning ketorolac specifically during pregnancy, however, congenital abnormalities have been reported in association with NSAID administration in humans. However, these are infrequent and do not follow any noticeable pattern. There is an increased risk of spontaneous abortion following maternal exposure to NSAIDs during pregnancy. Ketorolac is a prostaglandin synthesis inhibitor. These inhibitors may expose the foetus to cardiopulmonary toxicity as well as renal dysfunction. The mother and neonate may be exposed to prolongation of bleeding time and/or inhibition of uterine contractions causing a delayed or prolonged labour.

    Exposure to NSAIDs after 30 weeks of pregnancy is associated with increased risk of premature closure of the ductus arteriosus and oligohydramnios. The incidence and severity of premature closure of ductus arteriosus appears to be dose related and increases with advancing gestational age beyond 30 weeks.

    There was no evidence of teratogenicity in rats or rabbits given maternally toxic doses. A prolonged gestational period and delayed parturition have been observed in rats. Ketorolac and its metabolites transfer into the animal foetus.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Ketorolac is contraindicated in breastfeeding.

    UK Drugs in Lactation Advisory Service states that there is no evidence of safety with parenteral use.

    Ketorolac and its metabolites have been detected in human milk.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abnormal liver function tests
    Abnormal thinking
    Acute renal failure
    Arterial thrombosis
    Aseptic meningitis
    Cardiac failure
    Chest pain
    CNS stimulation
    Dream abnormalities
    Dry mouth
    Exfoliative dermatitis
    Flank pain
    Fluid retention
    Functional disorders
    Gastro-intestinal disturbances
    Gastro-intestinal pain
    Gastro-intestinal ulceration
    Gastrointestinal bleeding
    Haemolytic uraemic syndrome
    Hearing disturbances
    Hepatic failure
    Impaired concentration
    Increased thirst
    Increased urinary frequency
    Laryngeal oedema
    Local pain (injection site)
    Maculopapular rash
    Mood changes e.g. depression, elation
    Nephrotic syndrome
    Peptic ulceration with perforation and haemorrhage
    Post operative wound haemorrhage
    Prolonged bleeding
    Psychotic reactions
    Pulmonary oedema
    Rectal bleeding
    Serum creatinine increased
    Serum urea increased
    Stevens-Johnson syndrome
    Taste disturbances
    Toxic epidermal necrolysis
    Ulcerative stomatitis
    Urinary retention
    Visual disturbances
    Weight gain


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: July 2016

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Ketorolac 30 mg/ml solution for injection. Beacon Pharmaceuticals. March 2011.

    Summary of Product Characteristics: Toradol 30 mg/ml Solution for Injection. Atnahs Pharma UK. Revised September 2015.

    The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

    NICE Evidence Services Available at: Last accessed: 08 September 2017

    UK Drugs in Lactation Advisory Service.
    Available at:
    Ketorolac. Last accessed: July 21, 2016

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Ketorolac. Last revised: October 22, 2013
    Last accessed: July 21, 2016

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.