# Ketorolac (Toradol)

Non-opioid analgesia with strict age, renal, bleeding, and pregnancy exclusions.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/ketorolac/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Do not give above age 65, for suspected cardiac pain, NSAID hypersensitivity, renal disease/transplant, pregnancy/suspected pregnancy, or breastfeeding.
- Exclude active ulcer disease, GI bleeding/perforation within 3 months, trauma-center designation, active/high-risk hemorrhage or coagulopathy, recent major surgery within 6 weeks or planned major surgery, and concurrent NSAID/anticoagulant use. PR-075 makes an exception for low-dose aspirin.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [PR-075 — Ketorolac for Patient Analgesia](https://www.ochealthinfo.com/sites/healthcare/files/2025-05/PR-75%20ketorolac%205-2025.pdf)

## Use in OCEMS

- For moderate–severe pain (4–10), as an alternative or adjunct to an opioid when PR-075 criteria are met.
- Examples include opioid intolerance/refusal, moderate pain where opioids may not be appropriate, inability to obtain IV access, or additional analgesia after fentanyl.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Eligible adults | 15 mg IV/IO/IM once. IV is preferred when a line is present. |

## Pediatric

- For eligible children age 2 and older: 0.25 mg/kg IV/IO/IM once, maximum 15 mg.
- Age below 2 is a contraindication. Use measured weight in kilograms and record it.

## Pediatric weight table — Pain — age 2 and older only

- Source: PR-075. Dose rule: 0.25 mg/kg; route: IV/IO/IM once.
- Age 2 and older: 0.25 mg/kg IV/IO/IM once; maximum 15 mg. Children younger than 2 are excluded regardless of weight.
- Check all PR-075 exclusions, including renal disease, bleeding risk, designated trauma, recent GI bleeding, NSAID allergy/use, pregnancy, and breastfeeding. Weight alone does not establish eligibility.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO/IM once | Volume at 15 mg/mL |
| --- | --- | --- |
| 3 kg | 0.75 mg | 0.05 mL |
| 4 kg | 1 mg | 0.067 mL |
| 5 kg | 1.25 mg | 0.083 mL |
| 6 kg | 1.5 mg | 0.1 mL |
| 8 kg | 2 mg | 0.133 mL |
| 10 kg | 2.5 mg | 0.167 mL |
| 12 kg | 3 mg | 0.2 mL |
| 15 kg | 3.75 mg | 0.25 mL |
| 20 kg | 5 mg | 0.333 mL |
| 25 kg | 6.25 mg | 0.417 mL |
| 30 kg | 7.5 mg | 0.5 mL |
| 35 kg | 8.75 mg | 0.583 mL |
| 40 kg | 10 mg | 0.667 mL |
| 45 kg | 11.25 mg | 0.75 mL |
| 50 kg | 12.5 mg | 0.833 mL |
| 60 kg | 15 mg | 1 mL |

## Preparation & reassessment

- The inventory concentration is 15 mg/mL. Verify the ordered milligrams and volume; the dose is not 15 mg/kg.
- Document indication, exclusion screening, baseline pain, pediatric weight, response, and any adverse reaction.