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deleted171991
Just another study which proves that ketorolac reaches most of its analgesic effects at 10 mg. I have been giving only 15 of ketorolac to everybody, regardless of age, for years.
https://pharmertoxguy.com/2016/12/16/the-ceiling-effect-of-iv-ketorolac/
http://www.annemergmed.com/article/S0196-0644(16)31244-6/fulltext
https://pharmertoxguy.com/2016/12/16/the-ceiling-effect-of-iv-ketorolac/
http://www.annemergmed.com/article/S0196-0644(16)31244-6/fulltext
Results
We enrolled 240 subjects (80 in each dose group). At 30 minutes, substantial pain reduction was demonstrated without any differences between the groups (95% confidence intervals 4.5 to 5.7 for the 10-mg group, 4.5 to 5.6 for the 15-mg group, and 4.2 to 5.4 for the 30-mg group). The mean numeric rating scale pain scores at baseline were 7.7, 7.5, and 7.8 and improved to 5.1, 5.0, and 4.8, respectively, at 30 minutes. Rates of rescue analgesia were similar, and there were no serious adverse events. Secondary outcomes showed similar rates of adverse effects per group, of which the most common were dizziness, nausea, and headache.
Conclusion
Ketorolac has similar analgesic efficacy at intravenous doses of 10, 15, and 30 mg, showing that intravenous ketorolac administered at the analgesic ceiling dose (10 mg) provided effective pain relief to ED patients with moderate to severe pain without increased adverse effects.
Importance
Nonsteroidal anti-inflammatory drugs may commonly be used at doses above their analgesic ceiling, although this may not offer an incremental analgesic advantage and potentially adds risk of harm. Analgesic ceiling is the dose of a drug beyond which any further dosage increase results in no additional analgesic effect.4 The ketorolac analgesic ceiling dose of 10 mg is lower than both the dosing regimen recommended in emergency medicine textbooks5 and the recommended Food and Drug Administration–approved doses: 30 mg intravenously and 60 mg intramuscularly for patients younger than 65 years.6 Ketorolac is the only analgesic whose parenteral dosing is 3 to 6 times higher than the oral regimen based on the Food and Drug Administration–recommended oral regimen of 10 mg every 6 hours for no more than 5 days.6
Like all nonsteroidal anti-inflammatory drugs, ketorolac has several potentially serious adverse effects: gastrointestinal hemorrhage, nausea, vomiting, dyspepsia, dizziness or lightheadedness, and somnolence. Of these, gastrointestinal hemorrhage is the most concerning because it also appears to be dose dependent. Of all nonsteroidal anti-inflammatory drugs, the risk of gastrointestinal hemorrhage is highest for ketorolac and increases with higher doses.7 In healthy volunteers, single doses of parenteral ketorolac have been demonstrated to interfere with platelet function by prolonging bleeding time, inhibiting platelet aggregation, and reducing platelet thromboxane production.8, 9, 10 Likewise, single doses of ketorolac at 15 and 30 mg intravenously and 60 mg intramuscularly have been shown to worsen hemorrhage in postoperative patients.11, 12
Several studies have demonstrated that ketorolac analgesic efficacy at 10 mg is similar to that at higher doses (15 to 90 mg) for treatment of postoperative and cancer pain while minimizing the adverse effects typical of higher dosages.13, 14, 15, 16 Despite this, Food and Drug Administration recommendations and the majority of studies of parenteral ketorolac in the ED advocate the use of doses that are higher than 10 mg.
Many providers/nurses ask me if I'm sure i only want to do 15mg lol
