Intravenous NSAID Therapy

Primary Considerations

The American Geriatrics Society recommends that NSAIDs should be used "rarely and with extreme caution" in highly selected older adults only after safer therapies have failed, and require gastroprotection with proton pump inhibitor or misoprostol 3
The Critical Care Medicine guidelines suggest using IV ketorolac (30 mg) as an alternative to opioids for discrete and infrequent procedures in critically ill adults, with a single 30 mg dose providing pain relief equivalent to 4 mg IV morphine for procedural pain 1, 2

In pregnancy, early exposure to NSAIDs shows no evidence of increased miscarriage or teratogenicity, with most reassuring data for ibuprofen, but NSAIDs should be discontinued after gestational week 28 4
The American Geriatrics Society guidelines state that older adults (>60 years) should not take NSAIDs without careful consideration due to higher risk for serious gastrointestinal events, and should be monitored for gastrointestinal toxicity, renal function deterioration, hypertension development or worsening, heart failure exacerbation, and drug-drug and drug-disease interactions 3

The Journal of the American Geriatrics Society recommends that all patients taking NSAIDs should be routinely assessed for gastrointestinal toxicity, renal function deterioration, hypertension development or worsening, heart failure exacerbation, and drug-drug and drug-disease interactions 3
Patients should not combine NSAIDs or take more than one NSAID or COX-2 inhibitor simultaneously, and should account for total NSAID dose from all sources, including combination opioid-NSAID products 3