Drug reference

Ketorolac trometamol

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1434, 1435

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Short-term management of moderate to severe acute postoperative pain only ▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION ▶Adult (body-weight up to 50 kg): Initially 10 mg, then 10–30 mg every 4–6 hours as required for maximum duration of treatment 2 days, frequency may be increased to up to every 2 hours during initial postoperative period; maximum 60 mg per day ▶Adult (body-weight 50 kg and above): Initially 10 mg, then 10–30 mg every 4–6 hours as required for maximum duration of treatment 2 days, frequency may be increased to up to every 2 hours during initial postoperative period; maximum 90 mg per day ▶Elderly: Initially 10 mg, then 10–30 mg every 4–6 hours as required for maximum duration of treatment 2 days, frequency may be increased to up to every 2 hours during initial postoperative period; maximum 60 mg per day

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Contra Indications

Active or history of gastro- intestinal bleeding. active or history of gastro-intestinal ulceration. coagulation disorders. complete or partial syndrome of nasal polyps. conﬁrmed or suspected cerebrovascular bleeding. dehydration. following operations with high risk of haemorrhage or incomplete haemostasis. haemorrhagic diatheses. history of gastro- intestinal bleeding related to previous NSAID therapy. history of gastro-intestinal perforation related to previous NSAID therapy. hypovolaemia. severe heart failure

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Cautions

Allergic disorders. cardiac impairment (NSAIDs may impair renal function). cerebrovascular disease. connective-tissue disorders. elderly (risk of serious side- effects and fatalities). heart failure. history of gastro- intestinal disorders (e.g. ulcerative colitis, Crohn’s disease) . ischaemic heart disease. peripheral arterial disease. risk factors for cardiovascular events. uncontrolled hypertension

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Allergy And Cross Sensitivity

Contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID—which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID.

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Safety

Interactions

→Appendix 1: NSAIDs

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Side Effects

Agranulocytosis. angioedema. anxiety. aplastic anaemia. appetite decreased. asthenia. asthma. azotaemia. bradycardia. burping. chest pain. concentration impaired. confusion. constipation. Crohn’s disease aggravated. depression. diarrhoea. dizziness. drowsiness. dry mouth. dyspnoea. electrolyte imbalance. embolism and thrombosis. euphoric mood. fever. ﬂank pain. ﬂuid retention. ﬂushing. gastrointestinal discomfort. gastrointestinal disorders. haemolytic anaemia. haemorrhage. hallucination. headache. hearing loss. heart failure. hepatic disorders. hyperhidrosis. hyperkinesia. hypersensitivity. hypertension. hypotension. infertility female. malaise. meningitis aseptic (patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible). musculoskeletal disorder. myalgia. myocardial infarction. nausea. nephritis tubulointerstitial . nephropathy. neutropenia. oedema. optic neuritis. oral disorders. pallor. palpitations. pancreatitis. paraesthesia . perforation. photosensitivity reaction. platelet aggregation inhibition. psychotic disorder. pulmonary oedema. renal impairment. respiratory disorders. seizure . severe cutaneous adverse reactions (SCARs). skin reactions. sleep disorders. stroke. taste altered. thinking abnormal. thirst. thrombocytopenia. tinnitus. ulcer. urinary disorders. vertigo. visual impairment. vomiting. weight increased. wound haemorrhage SIDE-EFFECTS, FURTHER INFORMATION For information about cardiovascular and gastrointestinal side-effects, and a possible exacerbation of symptoms in asthma, see Non- steroidal anti-inﬂammatory drugs. p. 1193

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Conception And Contraception

Caution—long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment.

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Pregnancy

Avoid unless the potential beneﬁt outweighs the risk. Avoid during the third trimester (risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn); onset of labour may be delayed and duration may be increased.

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Breast Feeding

Amount too small to be harmful.

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Hepatic Impairment

Manufacturer advises caution—may increase risk of renal impairment; avoid in hepatic failure.

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Renal Impairment

Avoid if possible or use with caution. Avoid if serum creatinine greater than 160 micromol/litre. Dose adjustments The lowest effective dose should be used for the shortest possible duration. Max. 60 mg daily by intramuscular injection or intravenous injection. Monitoring In renal impairment monitor renal function; sodium and water retention may occur and renal function may deteriorate, possibly leading to renal failure.

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Dose and formulations

Directions For Administration

For intravenous injection, give over at least 15 seconds.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Ketorolac trometamol (Non-proprietary) Ketorolac trometamol 30 mg per 1 ml Ketorolac 30mg/1ml solution for injection ampoules | 5 ampoule P £20.00–£30.00 DT = £5.36 (Hospital only) ▶Toradol (Atnahs Pharma UK Ltd) Ketorolac trometamol 30 mg per 1 ml Toradol 30mg/1ml solution for injection ampoules | 5 ampoule P £5.36 DT = £5.36 (Hospital only)

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Dose text by age group

Adult (body-weight up to 50 kg)

Initially 10 mg, then

First-line fragment. Read the complete Indications and Dose section above.

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Adult (body-weight 50 kg and above)

Initially 10 mg,

First-line fragment. Read the complete Indications and Dose section above.

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Elderly

Initially 10 mg, then 10–30 mg every 4–6 hours

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1434

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Ketorolac trometamol

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1434, 1435

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 1434

Contra Indications

PDF page 1434

Cautions

PDF page 1434

Allergy And Cross Sensitivity

PDF page 1434

Safety

Interactions

→Appendix 1: NSAIDs

PDF page 1434

Side Effects

PDF page 1434

Conception And Contraception

Caution—long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment.

PDF page 1434

Pregnancy

PDF page 1435

Breast Feeding

Amount too small to be harmful.

PDF page 1435

Hepatic Impairment

Manufacturer advises caution—may increase risk of renal impairment; avoid in hepatic failure.

PDF page 1435

Renal Impairment

PDF page 1435

Dose and formulations

Directions For Administration

For intravenous injection, give over at least 15 seconds.

PDF page 1435

Medicinal Forms

PDF page 1435

Dose text by age group

Adult (body-weight up to 50 kg)

Initially 10 mg, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1434

Adult (body-weight 50 kg and above)

Initially 10 mg,

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1434

Elderly

Initially 10 mg, then 10–30 mg every 4–6 hours

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1434

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.