Intranasal or oral ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is FDA-approved for short-term (no more than 5 days) management of acute moderate to severe pain, usually in the postoperative setting, that requires pain management at the opioid level.

Oral ketorolac is only approved for use after therapy initiation with intravenous or intramuscular ketorolac. Therefore, a prescription for a parenteral form of ketorolac should precede treatment with oral ketorolac to satisfy manufacturer and FDA recommendations.

The maximum recommended dosage for oral ketorolac is 40 mg/24 hours given in divided doses every 4 to 6 hours. Dosages exceeding this recommendation will be reviewed.

Intranasal ketorolac is dosed as one spray (15.75 mg) in each nostril every 6 to 8 hours for a maximum total of 8 sprays (126 mg) in a 24-hour period for patients less than 65 years of age. In patients with renal impairment, age greater than or equal to 65 years, or those weighing less than 50 kg, intranasal ketorolac should be dosed as one spray (15.75 mg) in one nostril every 6 to 8 hours for a total of 4 doses (63 mg) per 24-hour period.   Discard the intranasal ketorolac bottle after 24 hours, even if liquid is still present in the bottle, as the delivery system is not designed to deliver the intended dose after 24 hours.

Ketorolac is not FDA-approved for pediatric patients younger than 17 years of age as safety and efficacy in this age group have not been established. In adolescents 17 years of age and older, the maximum oral daily ketorolac dose is 40 mg in divided doses as continuation from parenteral ketorolac therapy. The maximum intranasal dose in pediatric patients 17 years of age and older is 126 mg per 24 hours in divided doses [one spray (15.75 mg) in each nostril (31.5 mg total) every 6 to 8 hours]. Discard the intranasal ketorolac bottle after 24 hours, even if liquid is still present in the bottle, as the delivery system is not designed to deliver the intended dose after 24 hours.