Ketorolac interactions to avoid

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

We have all experienced acute pain, be it from any number of causes, anything from spraining an ankle to passing a kidney stone. The agony can make us desperate for relief. When we end up at a doctor’s office, emergency room, or urgent care center looking for help, ketorolac may be offered as a pain medication. This non-steroidal anti-inflammatory drug (NSAID) can certainly take away severe pain and help with inflammation and swelling. Still, it can also play havoc with our system in other ways. Known by the brand name Acular, ketorolac has several interactions with other drugs and health conditions that should give you pause, even if you are anxious for a remedy to your pain. The consequences can include serious intestinal bleeding, kidney damage, and heart problems. We will prepare you to make a more educated decision about taking ketorolac by briefing you on the most important interactions to know.

Ketorolac drug interactions

Anticoagulants, antihypertensives, diuretics, immunosuppressants, and various other medications comprise a thorough lineup of drugs that may interact with ketorolac. We will highlight some of these to provide you with an understanding of the nature of these interactions.

Anticoagulants

Like other NSAIDs, Ketorolac impairs the function of platelets, cells that help blood clot when needed. Naturally, this action entails some risk of bleeding, but the risk becomes heightened when combined with other anticoagulants. You could experience easy bruising or bloody stools, which require immediate medical attention. If you take an anticoagulant, antiplatelet agent, or other NSAIDs, double-check with the healthcare professional recommending ketorolac to ensure your safety against interactions. Examples from these drug classes include:

• Eliquis (apixaban)
• Xarelto (rivaroxaban)
• Pradaxa (dabigatran)
• Jantoven (warfarin)
• Lovenox (enoxaparin)
• Plavix (clopidogrel)
• Brilinta (ticagrelor)
• Aspirin
• Ibuprofen
• Naprosyn (naproxen)
• Meloxicam

Aspirin, prednisone, and NSAIDs

People can be taking long-term aspirin for preventive releases or taking either NSAIDs or prednisone for chronic inflammatory conditions. If you are in any of these situations, the risk of taking ketorolac could be higher. Ketorolac can thin the protective lining of the stomach, making bleeding peptic ulcers more likely, a risk that would be magnified by aspirin, prednisone, or other NSAIDs, like ibuprofen, naproxen, or meloxicam.

Signs of an ulcer can include stomach pain, constipation, vomiting blood or material with the appearance of coffee grounds, GI bleeding, and tarry dark stools. These symptoms warrant emergency treatment. Preventing this bad outcome may require you to question the safety of ketorolac if you are taking aspirin, steroids, or NSAIDs. Acetaminophen, an alternative to NSAIDs for pain relief, tends to be gentler on the stomach.

ACE-inhibitors and ARBs 

Angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs) are two widely used classes of antihypertensives, and by effectively lowering blood pressure, they can protect our kidneys from the damaging effects of hypertension (high blood pressure). Their mechanism of action involves the kidney, and when used alongside NSAIDs, renal function can be harmed. Impaired kidney function can lead to nausea, edema or swelling, and electrolyte imbalances like hyperkalemia (high potassium levels). You may need to avoid or adjust ketorolac if you are taking an ACE inhibitor or ARB, such as the following:

• Zestril (lisinopril)
• Enalapril
• Lotensin (benazepril)
• Accupril (quinapril)
• Diovan (valsartan)
• Cozaar (losartan)
• Avapro (irbesartan)
• Benicar (olmesartan)

Diuretics

By asking our kidneys to eliminate more bodily fluid, diuretics or water pills can assist with hypertension treatment and control of edematous states like congestive heart failure and cirrhosis. However, renal function can be affected when combining a diuretic with an NSAID like ketorolac, as you may experience a decline in kidney function. If any diuretic, like the following examples, is on your med list, ask your healthcare provider about increased risks to your kidneys before taking ketorolac.

• Hydrochlorothiazide (HCTZ)
• Metolazone
• Chlorthalidone
• Lasix (furosemide)
• Bumex (bumetanide)

Methotrexate

An immunosuppressant for various autoimmune diseases and, at higher doses, a chemotherapeutic for some types of cancer, methotrexate has been around for a long time and still sees considerable use. Toxicity is a major concern, requiring regular monitoring of blood tests of kidney and liver function, as well as blood cell counts. Taking ketorolac with methotrexate can elevate the risk further, which means you need to discuss the pros and cons with your healthcare team first.

Cyclosporine

Cyclosporine is another immunosuppressant and is used to prevent organ transplant rejection. It has significant adverse effects if not carefully dosed and monitored. Ketorolac therapy can increase cyclosporine levels, resulting in a higher risk of kidney toxicity. Get the medical advice of your healthcare providers before taking ketorolac.

Metformin

Metformin is probably the most widely used drug for Type 2 diabetes mellitus. It carries a risk of an uncommon but serious side effect, lactic acidosis. NSAIDs like ketorolac can raise that risk, so before you take the two together, you can ask your pharmacist or prescriber to assess the likelihood of harm.

Lithium

A classic mood stabilizer for treating bipolar disorder, lithium requires vigilant monitoring of drug levels to ensure its safe use. Ketorolac, as well as other NSAIDs, can increase the concentration of lithium and thereby increase the chance of adverse effects. Your medical provider may want you to avoid ketorolac or monitor lithium levels more closely.

Probenecid

Taking ketorolac when on probenecid is contraindicated and cannot be taken together because probenecid increases the level of ketorolac. As a result, the adverse effects of ketorolac could be too pronounced.

Ketorolac food interactions

Ketorolac is administered as an oral tablet or an intravenous or intramuscular injection. Taking the oral formulation with food is best to reduce stomach upset. However, you should remember that a fatty meal may delay or reduce the absorption of the drug.

Other ketorolac interactions

By now, you are likely getting the impression that ketorolac comes with some baggage in the form of adverse event potential. The Food and Drug Administration (FDA) has taken steps to call attention to this by placing several black box warnings on the drug, including for bleeding, kidney, stomach, and drug-drug interaction risks. The FDA’s warnings also highlight that the drug should only be used short-term and not for more than five days. You can benefit from understanding these warnings and risks by recognizing that ketorolac can interact with aspects of your lifestyle and other health conditions.

Ketorolac and alcohol

Alcohol can wash away the protective mucous barrier that lines the stomach and protects the organ from its acidic contents. Throwing alcohol on top of ketorolac can result in pain and gastrointestinal bleeding. Avoid consuming alcohol when ketorolac is in use.

Ketorolac and caffeine

Both ketorolac and caffeine can raise blood pressure. Coupling the two could result in an additive hypertensive effect. Monitoring blood pressure may be recommended by your medical team.

Ketorolac and kidney disease

As we have pointed out, ketorolac can harm the kidneys. This risk can be even greater if your kidney function is already impaired. Older adults must be particularly mindful of this hazard based on the greater likelihood of pre-existing renal impairment. Have the prescribing healthcare professional assess the balance of benefits and risks to determine if you should avoid ketorolac.

Ketorolac and liver disease

Patients with liver disease have a higher likelihood of kidney problems. As a result, ketorolac therapy could spell trouble by having two risk factors for kidney dysfunction. NSAIDs are usually either avoided or used with great caution in liver disease, so it is worth getting advice on this matter before using ketorolac.

Ketorolac and heart disease

NSAIDs, including ketorolac, can increase the chance of heart attack and stroke. These life-threatening thrombotic events can happen early in the course of treatment, according to the FDA warning regarding this danger. If you have a history of heart disease or stroke, your doctor may want you to avoid or limit ketorolac. The FDA points out that the drug should absolutely be avoided after coronary artery bypass graft (CABG) surgery.

Ketorolac and pregnancy and breastfeeding

Ketorolac should not be used for pain during labor and delivery due to adverse effects on fetal circulation. The drug can also be harmful at times during pregnancy and breastfeeding. An analysis of ketorolac risk in your particular circumstance is needed.

How to minimize ketorolac interactions

Knowing some of the most critical interactions between ketorolac and other drugs and medical conditions is an excellent first step to staying safe. Next, you need to get organized with your health information. Keep an accurate list of your prescription drugs, over-the-counter medications, and supplements, not to mention maintaining a listing of your health conditions. Having done all this, you can present the information to your pharmacist and healthcare providers and ask them to watch for any interactions.

When to talk to a healthcare provider about ketorolac interactions

The best time to seek the counsel of your healthcare provider regarding ketorolac interactions is before you have taken your first dose. Ketorolac is only meant to be taken for a maximum of five days, and interactions can happen quickly, as you have learned. 

With all of this in mind, you should specifically ask about interactions between ketorolac and your other meds and medical conditions before starting the NSAID. As a result, an alternative may be advised, an adjustment to the dose of ketorolac could occur, or monitoring for side effects might be recommended. It is well worth it to seek this medical advice, and if drug costs are preventing you from seeking an alternative, then the SingleCare discount card could help.