Bedside Snapshot

Use It For: Moderately severe acute pain (musculoskeletal, postoperative); renal colic; acute migraine in the ED; opioid-sparing multimodal analgesia
Adult Dose: 15 mg IV or 30 mg IM. Differs from FDA label: 30 mg IV or 60 mg IM
Hospital: 15–30 mg q6 hr (max 120/day)
65+: avoid (AGS Beers 2023). If none, 15 mg IV or 30 mg IM once. <50 kg or renal impairment: 15 mg q6 hr, max 60/day
Pediatric Dose: Age 2–16 yr (off-label): 0.5 mg/kg IV or IM (max 15 mg by either route), single dose. Not for use under 2 yr. Age ≥17 yr: adult dosing. Differs from FDA label: label says ketorolac is not indicated in pediatric patients
Onset / Duration: IV/IM: about 30 min / 4–6 hr (peak analgesia about 1–3 hr); IN and PO: peak level about 45 min
Do Not Give / Hold If: Hypovolemia, SBP <90 mmHg; advanced renal impairment; GI bleed or ulcer history; bleeding risk or intracranial bleed; NSAID/aspirin allergy; labor, ≥30 wk pregnancy; age 65 or over (AGS Beers); CABG; other NSAIDs
Watch For: GI bleeding (melena, falling hemoglobin); AKI (urine output, creatinine, K⁺); surgical or wound bleeding; anaphylaxis or bronchospasm after the first dose
Reversal / Rescue: No antidote: stop the drug; supportive care. GI bleed: resuscitate, IV proton-pump inhibitor; anaphylaxis: IM epinephrine; AKI: restore volume
Must Remember: Analgesic ceiling: 15–20 mg IV works about as well as 30 mg or more in adult ED patients. Above-label doses add toxicity, not relief; GI bleeding rises with total daily dose. Never exceed 5 days across all routes.

Indications

Emergency & Prehospital

Moderately severe acute pain: short-term analgesia at the opioid level for adults (FDA-labeled), alone or to spare the opioid. The 2023 prehospital pain guideline conditionally recommends either IV NSAIDs or IV opioids for moderate to severe pain, and IV NSAIDs over IV acetaminophen.
Renal colic: the first analgesic to reach for when renal function is adequate. It works as well as opioids, with less vomiting and less rescue analgesia.

ED / ICU / Transport

Acute migraine in the ED: IV ketorolac is off-label here, but should be offered when appropriate (AHS 2025, level B: should offer). IV prochlorperazine and greater occipital nerve block carry level A (must offer).
Multimodal postoperative analgesia: it cuts how much opioid the patient needs. Start it only once hemostasis is secure.
Oral continuation: tablets exist to carry on therapy you started IV or IM. Keep the whole course inside the 5-day total.

Other Uses

Acute pain in children 2–16 yr: one weight-based IV or IM dose (see Pediatric Dosing). Off-label: current US labels leave out children under 17 yr.

Minor pain and chronic pain are off the table.

Dosing & Administration

Doses vary by protocol; follow local protocols and medical direction. The doses below are the E3 house doses. Check the Differs from FDA label notes before you copy one.

Available Forms

Injection, IV or IM: 15 mg/mL in 1 mL (15 mg) vial; 30 mg/mL in 1 mL (30 mg) vial. EMS and EDs stock these two.
Injection, IM only: 60 mg/2 mL (30 mg/mL) vial. Never give it IV.
Excipient: injections carry 10% alcohol. That is why neuraxial use is contraindicated.
Tablets: 10 mg, for continuation after IV/IM dosing only.
Nasal spray (Sprix): 15.75 mg per 100 microliter spray; 8 sprays (126 mg) per single-day bottle.
Ophthalmic solution (Acular and generics): eye use only.

Adult Dosing

Indication	Dose & Route	Repeat / Max	Notes
Acute pain, single dose (age 17–64, ≥50 kg, normal renal function)	15 mg IV or 30 mg IM	Field: one dose, no repeat (NASEMSO excludes NSAIDs from repeats). Hospital/label: 15–30 mg q6 hr, max 120 mg/day (60 mg/day if ≥65 yr, <50 kg or renal impairment); 5 days all routes	Analgesic ceiling (adult ED trials): 15–20 mg parenteral relieves pain about as well as 30 mg or more (moderate certainty; 10 mg, low certainty); low doses may need more rescue analgesia. Give IV over at least 15 seconds. Differs from FDA label: label single dose is 30 mg IV or 60 mg IM.
Acute pain, repeated doses (age 17–64)	15–30 mg IV or IM every 6 hr	Hospital/label only: max 120 mg/day; total of all routes 5 days	Hospital/label regimen; not repeated in the field (NASEMSO). Label regimen is 30 mg every 6 hr. For breakthrough pain do not raise the dose or shorten the interval; add a low-dose opioid if not contraindicated.
Reduced-dose group, single dose (age ≥65, weight <50 kg, or moderately elevated creatinine)	15 mg IV or 30 mg IM, one dose	Single administration only; total of all routes 5 days	AGS Beers 2023: avoid ketorolac in older adults (strong). Differs from FDA label, which gives a reduced-dose regimen. Do not follow a 30 mg IM single dose with scheduled 15 mg doses that would take the 24-hr total over 60 mg.
Reduced-dose group, repeated doses	15 mg IV or IM every 6 hr	Max 60 mg/day; total of all routes 5 days	Not for patients 65 or over (AGS Beers 2023: avoid). Contraindicated in advanced renal impairment. For breakthrough pain do not raise the dose or shorten the interval.
Oral continuation after IV/IM	Age 17–64: 20 mg PO once, then 10 mg PO every 4–6 hr. Reduced-dose group: 10 mg PO once, then 10 mg every 4–6 hr	Max 40 mg/day PO; total of all routes 5 days	Tablet-label regimen. Never as the first dose. Do not shorten the 4–6 hr interval.
Intranasal (Sprix)	Age <65: 31.5 mg IN (one spray in each nostril) every 6–8 hr. Reduced-dose group: 15.75 mg IN (one spray, one nostril) every 6–8 hr	Max 126 mg/day (reduced-dose group 63 mg/day); total of all routes 5 days	Not inhaled. Discard the bottle 24 hr after the first dose. Do not combine with other ketorolac forms or NSAIDs.

Pediatric Dosing

Indication	Dose (per kg) & Route	Max Single / Max Total	Notes
Acute pain, age 2–16 yr (off-label)	0.5 mg/kg IV or IM, single dose	Max 15 mg per dose by any route; one dose	Differs from FDA label: label says ketorolac is not indicated in pediatric patients. NASEMSO model EMS pain guideline dose. Use actual body weight. Repeat dosing only under a pediatric specialist or institutional protocol.
Acute pain, age ≥17 yr	Adult dosing	Adult maximums; use the reduced-dose regimen if weight <50 kg	Same contraindications as adults.
Age <2 yr	Not for use under 2 yr (Sprix label); not established under 17 yr	Do not use	Use acetaminophen or an opioid.

Pediatric labeling: US injection labels say ketorolac is not indicated in children. Safety and effectiveness under 17 yr are not established. Pediatric doses come from AHA/AAP 2025 if it gives a dose, then the NASEMSO National Model EMS Clinical Guidelines v3.0 (2022), then the US label. If no source gives a dose, none is shown. A pediatric maximum never goes above the adult maximum (NASEMSO Universal Care Guideline, p. 13). Every pediatric dose is off-label unless marked labeled. For weights, see pediatric weight-based dosing.

Preparation & Administration

Before the dose: Correct hypovolemia first. Ask about recent aspirin or NSAID use (including over-the-counter ibuprofen), anticoagulants, kidney disease, GI bleeding and pregnancy.
IV push: Give undiluted over no less than 15 seconds.
IM: Inject slowly and deeply into a large muscle. The 60 mg/2 mL vial is IM only.
Syringe mixing: Do not mix it in a syringe with morphine, meperidine, promethazine or hydroxyzine. It precipitates.
First dose: Have anaphylaxis treatment ready. Bronchospasm and anaphylactic shock have happened.
Inspect: Solution is clear and slightly yellow; discard if particulate or discolored.

Dosing Notes:

The 5-day limit counts IV, IM, IN and PO together.
Renal and age-based reductions are covered under Special Populations.

Contraindications & Precautions

Contraindications

Active peptic ulcer disease, recent GI bleeding or perforation, or any history of peptic ulcer disease or GI bleeding
Advanced renal impairment, or risk of renal failure from volume depletion (hypovolemia, hypotension, dehydration)
Suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis or high bleeding risk
Prophylactic analgesia before any major surgery; the setting of coronary artery bypass graft (CABG) surgery
Hypersensitivity to ketorolac; asthma, urticaria or allergic-type reaction after aspirin or another NSAID (including aspirin-exacerbated respiratory disease); prior serious skin reaction to an NSAID
Labor and delivery
Current aspirin or other NSAID therapy; concurrent probenecid or pentoxifylline
Epidural or intrathecal administration (alcohol content)

Precautions

Age 65 or over: avoid (AGS Beers 2023, strong recommendation); see Special Populations.
Heart failure, cirrhosis, diuretics, ACE inhibitors or ARBs: high risk of acute kidney injury (AKI).
Recent myocardial infarction (MI), severe heart failure: avoid unless benefit clearly outweighs risk.
Anticoagulant or antiplatelet therapy: Extreme caution only, and watch for bleeding closely. An established coagulopathy or bleeding diathesis is a contraindication (see above).
Surgery or trauma where hemostasis is critical: wound hematomas have been reported. Avoid it perioperatively.
Pregnancy ≥20 weeks, asthma, inflammatory bowel disease, hepatic impairment: use caution; see Special Populations.

Hold / Reassess If

SBP <90 mmHg or signs of hypovolemia: do not give until volume is restored
Urine output <0.5 mL/kg/hr for 6 hr or creatinine rise ≥0.3 mg/dL: stop
Melena, hematemesis, new wound bleeding or a falling hemoglobin: stop
Daily maximum for the route reached (IV/IM 120 mg, or 60 mg in the reduced-dose group; PO 40 mg; IN 126 mg, or 63 mg in the reduced-dose group) or day 5 reached across all routes: stop

FDA Boxed Warning: Up to 5 days total across all routes, and only for moderately severe acute pain. Not for minor or chronic pain, and not for children. The box names fatal GI bleeding and perforation, MI and stroke, renal failure, and bleeding. Most of the contraindications above also appear in the box. Probenecid, pentoxifylline and a prior serious skin reaction come from the label's Contraindications and Warnings sections instead. Doses above the label add risk. They add no relief.

Adverse Effects & Toxicity

Common

Each one showed up in about 1–10% of patients in ketorolac and NSAID trials. Nausea and headache were more common, at more than 10%:

GI: dyspepsia, nausea, abdominal pain, heartburn, diarrhea or constipation
CNS: headache, dizziness, drowsiness, tinnitus
Cardiovascular and renal: edema, hypertension, abnormal renal function
Hematologic: prolonged bleeding time, purpura, anemia
Local: injection-site pain; with nasal spray, nasal discomfort (15%) and nasal pain (13%)

Serious / Life-Threatening

Effect	Recognition	Management
GI bleeding, ulcer, perforation	Melena, hematemesis, falling hemoglobin; often silent	Stop; resuscitate; IV pantoprazole, endoscopy per protocol
Acute kidney injury, hyperkalemia	Low urine output, rising creatinine and K⁺	Stop; restore volume; treat hyperkalemia per protocol
Bleeding	Wound hematoma, oozing, postoperative hemorrhage	Stop; local hemostasis; notify the surgical team
Anaphylaxis, bronchospasm, angioedema	Wheeze, hypotension, urticaria; can occur on first exposure	Stop; IM epinephrine and anaphylaxis protocol
MI, stroke	Chest pain, ST change, focal deficit	Stop; treat per ACS or stroke pathway
Severe skin reactions (SJS/TEN, fixed drug eruption, which can be bullous), DRESS	Rash with fever, blistering, facial swelling, eosinophilia	Stop at the first rash; never rechallenge
Hepatotoxicity	Jaundice, right upper quadrant pain, ALT/AST ≥3 times normal	Stop; evaluate liver function

Dose and age drive GI bleeding: A postmarketing study of about 10,000 patients given up to 5 days of injection tracked serious GI bleeding. With no prior ulcer or GI bleed, it occurred in 0.4% of patients under 65 at ≤60 mg/day, and in 4.6% above 120 mg/day. In patients 65 or over, the rates were 1.2% and 7.7%. With a prior ulcer or bleed, the rates ran 2.1% to 15.4% under 65 and up to 25% at ≥65.

Overdose & Toxicity Management

Signs: lethargy, drowsiness, nausea, vomiting, epigastric pain, hyperventilation; GI bleeding; rarely hypertension, AKI, respiratory depression and coma.
Management: supportive care; monitor renal function and for GI bleeding. No antidote.
Extracorporeal removal: Hemodialysis, hemoperfusion, forced diuresis and urine alkalinization are unlikely to help. It is 99% protein bound.

Monitoring

Parameter	When / How Often	Target / Act If
Clinical: pain score	Baseline and 30–60 min after the dose	Inadequate relief: add a different analgesic class; do not give extra ketorolac early
Clinical: BP, HR, volume status	Before the dose and with routine vitals	SBP <90 mmHg or hypovolemia: withhold; restore volume first
Clinical: allergic reaction	Observe after the first dose	Wheeze, urticaria, hypotension: stop, treat as anaphylaxis
Clinical: urine output	Hourly in ICU or high-risk patients on repeated doses	<0.5 mL/kg/hr for 6 hr: stop, assess for AKI
Clinical: bleeding and GI signs	Every assessment; wound checks after surgery or trauma	Melena, hematemesis, hematoma: stop, check hemoglobin, notify the provider
Laboratory: creatinine, BUN	Baseline in older adults, CKD, heart failure, cirrhosis or diuretic use; daily with repeated doses	Creatinine rise ≥0.3 mg/dL: stop
Laboratory: potassium	With renal labs in at-risk patients	Rising K⁺: stop, treat hyperkalemia per protocol
Laboratory: hemoglobin, platelets	If bleeding is suspected or with anticoagulants	Falling hemoglobin: stop, evaluate for GI or surgical bleeding
Dose safety: daily total and day count	Each dose, all routes	Route daily max reached (IV/IM 120 mg, reduced-dose 60 mg; PO 40 mg; IN 126 mg, reduced-dose 63 mg) or day 5 across all routes: stop

Interactions & Compatibility

Clinically Significant Interactions

Drug / Class	Effect	What To Do
Aspirin and other NSAIDs (ibuprofen, naproxen, meloxicam, other ketorolac forms)	Cumulative GI, renal and bleeding toxicity	Contraindicated
Probenecid, pentoxifylline	Probenecid: ketorolac AUC about 3 times higher, half-life doubled. Pentoxifylline: increased bleeding	Contraindicated
Anticoagulants and antiplatelets (heparin, enoxaparin, warfarin, clopidogrel)	Additive bleeding; warfarin plus an NSAID raises serious GI bleeding risk more than either alone	Avoid; if used, extreme caution and close bleeding monitoring
SSRIs, SNRIs, corticosteroids	Higher GI bleeding risk	Use caution; prefer another analgesic in high-risk patients
ACE inhibitors, ARBs, diuretics (furosemide, thiazides)	AKI risk, especially if volume-depleted; blunted antihypertensive and natriuretic effect	Avoid in volume depletion; monitor creatinine and diuretic response
Lithium, methotrexate	Reduced renal clearance; lithium trough levels about 15% higher; methotrexate toxicity	Monitor for toxicity and drug levels
Nondepolarizing neuromuscular blockers (rocuronium, vecuronium)	Postmarketing reports of apnea	Monitor ventilation in the recovering patient
Antiepileptics (phenytoin, carbamazepine); psychoactive drugs (fluoxetine, thiothixene, alprazolam)	Sporadic seizures reported with antiepileptics; hallucinations reported with psychoactive drugs	Monitor

IV Compatibility

Syringe: do not mix it in a syringe with morphine, meperidine, promethazine or hydroxyzine. It precipitates.
Line: flush the IV line before and after the push when other drugs share it.
Verify with an institutional compatibility resource.

Special Populations

Pediatrics: The FDA label does not cover anyone under 17 yr. Single weight-based doses for ages 2–16 follow NASEMSO v3.0. The Pediatric Dosing table has them.
Pregnancy: Contraindicated in labor and delivery, because of uterine hemorrhage risk. From about 20 weeks, NSAIDs can harm fetal kidney function and cause oligohydramnios. If one is needed at 20–30 weeks, use the lowest dose for the shortest time, and consider ultrasound if use runs past 48 hr. Avoid from about 30 weeks, since NSAIDs can close the fetal ductus arteriosus early. In an emergency, pick a non-NSAID analgesic.
Lactation: Milk levels run low. The estimated infant dose is about 0.4% of the maternal weight-adjusted dose, and no specific infant harms are reported. Use with caution, and ask the parent to report any infant effects. Some EMS protocols (NASEMSO v3.0 medication appendix) still list breastfeeding as a contraindication, so follow local protocol.
Older Adults: Avoid at 65 or over. AGS Beers Criteria 2023 says avoid oral and parenteral ketorolac (strong recommendation), because of GI bleeding and AKI. If no alternative exists, give a single reduced dose only (15 mg IV or 30 mg IM once), with no scheduled repeats. This differs from the FDA label, which gives a reduced-dose regimen (max 60 mg/day). The half-life stretches from about 5 to 7 hr.
Renal Impairment: Contraindicated in advanced renal impairment and in volume depletion. The label sets no creatinine clearance cutoff. AGS Beers advises avoiding all NSAIDs at CrCl <30 mL/min. With moderately elevated creatinine, use the reduced-dose regimen, max 60 mg/day. The half-life runs 6–19 hr in renal impairment and about 14 hr on dialysis. Dialysis is unlikely to remove it, since it is 99% protein bound.
Hepatic Impairment: The label gives no dose change (kinetics are similar). Use with caution. Liver-disease coagulopathy counts as a bleeding-risk contraindication. The label puts liver dysfunction among the patients at greatest risk of NSAID-induced renal decompensation. Cirrhosis, especially with ascites, carries a high AKI risk because the kidneys lose renal prostaglandins. It adds bleeding risk too. Prefer a non-NSAID analgesic.
Obesity / Dosing Weight: Adult doses are fixed. They are not weight-based. The <50 kg reduced-dose rule and the pediatric mg/kg doses both use actual body weight, with the caps stated in the tables.
Cardiovascular Disease: Avoid after a recent MI and in severe heart failure, unless the benefit clearly outweighs the risk.

Field & Transport Considerations

Scope: Paramedic, RN and critical-care transport, where the protocol includes it. It varies by state and by agency protocol.
Patient Selection: It fits best for isolated musculoskeletal pain or renal colic in a normotensive, well-hydrated adult under 65. Avoid it with hypotension, possible ongoing hemorrhage, head injury with possible intracranial bleeding, anticoagulant use, kidney disease, age 65 or over, or pregnancy.
Storage & Stability: Keep it at 20–25°C (68–77°F), and protect it from light. Vials stay in the carton. Limit heat exposure in the vehicle. Nasal spray: refrigerate unopened bottles, and discard 24 hr after priming.
Carried Concentration: Two IV/IM strengths are carried (15 mg/mL and 30 mg/mL), so confirm the concentration and volume before you draw up. The 60 mg/2 mL vial is IM only. ISMP lists ketorolac and ketamine (Ketalar) as a confused pair, and both sit in many drug boxes.
Handoff Essentials: drug, dose (mg), route and time; any home aspirin or NSAID; creatinine if known. The receiving team counts your dose toward the daily maximum and the 5-day limit. They must not stack another NSAID on it.

Clinical Pearls

Analgesic ceiling (adult ED patients only): In adult ED patients, 15–20 mg of parenteral ketorolac relieves pain about as well as 30 mg or more (moderate certainty). The 10 mg dose has low certainty. Low doses can still need more rescue analgesia. The label warns that going above recommended doses adds toxicity, not efficacy. Bigger doses mostly stretch out how long it lasts.

Volume before NSAID: A dehydrated, septic or bleeding patient leans on renal prostaglandins to keep the kidneys perfused. Ketorolac takes that support away. One dose can be enough to cause AKI. Correct hypovolemia first, or pick another analgesic.

Breakthrough pain is not a reason for more ketorolac: Don't raise the dose, and don't shorten the interval. Add an opioid, acetaminophen or a regional block instead.

Exam discriminator: ketorolac vs opioids: Ketorolac doesn't sedate. It doesn't cause opioid-type respiratory depression, and it isn't a controlled substance. What you trade for that is GI bleeding, renal injury and platelet dysfunction. Check the kidneys, the gut, bleeding risk and pregnancy before you give it.

Ketorolac vs aspirin on platelets: Both block cyclooxygenase. Ketorolac's platelet effect is weaker, shorter and reversible. Aspirin's lasts the life of the platelet. Even so, ketorolac still causes surgical bleeding that matters clinically.

Renal colic and migraine: For renal colic, reach for an NSAID first. It brings less vomiting and needs less rescue analgesia than opioids. For ED migraine, AHS 2025 puts IV prochlorperazine at level A (must offer). IV ketorolac and IV metoclopramide sit at level B (should offer).

Pharmacology

Mechanism of Action

Nonselective, reversible COX-1 and COX-2 inhibition. Less prostaglandin gets made, so peripheral nociceptors sensitize less (analgesia, anti-inflammatory and antipyretic effects).
Platelet COX-1 inhibition means less thromboxane A₂. The platelets become reversibly dysfunctional, and bleeding time gets longer.
Lose the renal prostaglandins and the afferent arteriole constricts. GFR drops when perfusion depends on them (hypovolemia, heart failure, cirrhosis, CKD).
Lose the gastric prostaglandins and the mucosa loses its protection. Ulceration and bleeding follow.
The activity sits in the S-enantiomer. It has no sedative or anxiolytic effect.

Pharmacokinetics

Route	Onset	Peak	Duration
IV	About 30 min	About 1–3 hr (analgesia)	4–6 hr
IM	About 30 min	About 1–3 hr (analgesia)	4–6 hr
IN	—	About 45 min (plasma)	Dosed every 6–8 hr
PO	—	About 45 min (plasma)	Dosed every 4–6 hr

Peak analgesia: the label gives 1–2 hr under Dosage and Administration and 2–3 hr under Pharmacodynamics. Bigger doses mostly lengthen the effect.
Half-life: 5–6 hr for the racemate in healthy adults. The S-enantiomer runs about 2.5 hr. Older adults sit near 7 hr, and renal impairment runs 6–19 hr.
Bioavailability: PO and IM are about 100%. IN is about 60% of IM.
Metabolism: the liver hydroxylates and conjugates it into inactive products. It neither induces nor inhibits hepatic enzymes.
Elimination: about 92% leaves in urine, about 60% of it unchanged and 40% as metabolites. About 6% leaves in feces.
Protein binding / Vd: 99% bound to albumin. Low albumin raises the free drug. Vd is about 13 L.

Names & Classification

Generic Name: Ketorolac tromethamine
Brand Names: Toradol (original brand; injection and tablets are now mostly generic); Sprix (nasal spray); Acular (ophthalmic)
Pharmacologic Class: Nonselective NSAID (pyrrolo-pyrrole group), COX-1 and COX-2 inhibitor
Therapeutic Class: Non-opioid analgesic
Controlled Substance: Not controlled
ISMP High-Alert: No
Look-Alike / Sound-Alike: ketorolac / ketamine (Ketalar); ketorolac / methadone; Toradol / Foradil

References

Hospira, Inc. (2024). Ketorolac tromethamine injection, USP, for IV/IM use [prescribing information] (revised November 2024). DailyMed, National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8accbb78-fc64-45d5-69b0-35c23a1d2a2e
Mylan Pharmaceuticals Inc. (2024). Ketorolac tromethamine tablets, USP [prescribing information] (revised August 2024). DailyMed, National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2837a082-3a34-6f81-5e43-45a70295686b
Zyla Life Sciences US. (2024). SPRIX (ketorolac tromethamine) nasal spray [prescribing information] (revised November 2024). DailyMed, National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=97005a1c-167e-4676-bae7-e49b38c36f9e
Lindbeck, G., Shah, M. I., Braithwaite, S., Powell, J. R., Panchal, A. R., Browne, L. R., et al. (2023). Evidence-based guidelines for prehospital pain management: Recommendations. Prehospital Emergency Care, 27(2), 144–153. https://doi.org/10.1080/10903127.2021.2018073
National Association of State EMS Officials. (2022). National Model EMS Clinical Guidelines, version 3.0 (Pain Management guideline). NASEMSO. https://nasemso.org/wp-content/uploads/National-Model-EMS-Clinical-Guidelines_2022.pdf
Forestell, B., Sabbineni, M., Sharif, S., Chao, J., & Eltorki, M. (2023). Comparative effectiveness of ketorolac dosing strategies for emergency department patients with acute pain. Annals of Emergency Medicine, 82(5), 615–623. https://doi.org/10.1016/j.annemergmed.2023.04.011
Pathan, S. A., Mitra, B., & Cameron, P. A. (2018). A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic. European Urology, 73(4), 583–595. https://doi.org/10.1016/j.eururo.2017.11.001
Robblee, J., Minen, M., Friedman, B., Cortel-LeBlanc, M., Cortel-LeBlanc, A., & Orr, S. (2026). 2025 guideline update to acute treatment of migraine for adults in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies. Headache, 66(1), 53–76 (published online December 1, 2025). https://doi.org/10.1111/head.70016
2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372
Motov, S., Yasavolian, M., Likourezos, A., Pushkar, I., Hossain, R., Drapkin, J., Cohen, V., & Filk, N. (2017). Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Annals of Emergency Medicine, 70(2), 177–184. https://doi.org/10.1016/j.annemergmed.2016.10.014
Institute for Safe Medication Practices. (updated through June 2024). ISMP List of Confused Drug Names [PDF]. ISMP (ECRI). https://online.ecri.org/hubfs/ISMP/Resources/ISMP_ConfusedDrugNames.pdf

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