Date Published
March 28, 2019
Updated For
ALS PCS Version ALS PCS Version 5.2
Question:
If I want a faster onset of pain relief can I go straight to Ketorolac IV?
Answer:
Due to the risks/benefits of IV initiation and administration, oral agents are preferred, whenever possible. The Condition for ketorolac under the ALS-PCS v4.5 for the Analgesia Medical Directive include, Restricted to those who are unable to tolerate oral medications. Per the OBHG Companion Document, The only advantage of parenteral ketorolac over oral ibuprofen is the ability to administer an NSAID despite vomiting. The overall clinical effect of these drugs is almost identical.
From this years Mandatory CME Pre-course, the timing of onset, peak plasma concentration and duration of ibuprofen and ketorolac are:
| Drug | Route | Onset | Peak | Duration |
|---|---|---|---|---|
| Ibuprofen | PO | 30min | 2-4h | 6-8h |
| Ketorolac | IM | 10min | 1-2h | 4-6h |
| Ketorolac | IV | 10min | 1-2h | 4-6h |
Other references including the Canadian Pharmacists Association Compendium of Pharmaceuticals and Specialties (CPS) reference manual and MedReference (accessed from the SWORBHP MEDLink resource) list even more comparable onset and peak times than the above. Therefore, there is only minimal benefit in timing of onset, when taking into consideration the time required to start the IV.
This concept is a common theme on Ask MAC. Please see: -Ask MAC Sept 29, 2016 -Ask MAC Dec 17, 2015
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