Dose:  0.5 to 1.0 mg/kg/dose IV, PO

Frequency: Q 4 to 6 hours

Comments: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID). It has both analgesic and antipyretic effects. It does not depress ventilatory drive. NSAIDs act peripherally to interfere with the production and release of prostaglandins and leukotrienes from cellular stores. Since NSAIDs do not block pain receptors directly, the drugs have no effect on chemical mediators already released. It is currently used in adults for post-operative pain relief. Following oral intake, ketorolac is completely absorbed and is not effected by food intake or concurrent use of antacids.  Ketorolac is intended to be used for short-term therapy; treatment should not continue beyond 5 days.  More comments on ketorolac.

Toxicity: Urticaria and bronchospasm are the most frequent side effects.  GI bleeding has been reported in one infant.  Side effects following short-term therapy in adults that may be a concern in the newborn include decreased renal blood flow and impaired platelet function.  Other adverse reactions associated with ketorolac.

Preparation:
IV: Ketorolac (Toradol) is available in a 30 mg/ml syringe which is diluted with either SWFI or NS to a 1 mg/ml concentration. Stable for 24 hours under refrigeration.

PO: Only as continuation of parenteral therapy. Use extemporaneous IV mixture.