8 Ketorolac Interactions You Should Know About
Key takeaways:
Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain. You shouldn’t take it for more than 5 days. But interactions can still happen during this time.
There are many ketorolac interactions. Common examples include other NSAIDs, blood thinners, and some antidepressants. Lithium (Lithobid), methotrexate (Trexall), and alcohol also interact with ketorolac.
The main risks with most ketorolac interactions are stomach bleeding or kidney damage. Sharing an updated medication list with your prescriber and pharmacist can help them discover and manage interactions.
Table of contents
On the mend from a recent medical procedure? If so, maybe you left the hospital with a medication called ketorolac.
Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that treats pain and swelling. But it’s a bit different from other NSAIDs. Ketorolac is only used short-term for moderate to severe pain, like after surgery. The first dose is given at a healthcare professional’s office or hospital as an injection. After that, you might continue taking it as an oral tablet for up to 5 days.
Even though ketorolac is only taken for a few days, there are still some drug interactions to know about.
More about ketorolac: Pharmacists answer some of the most common questions about ketorolac.
Other side effects: Stomach bleeding and kidney damage are two of ketorolac’s most serious side effects.
How to take it: Learn about recommended ketorolac dosages, including what to do if you miss a dose.
Ketorolac interaction overview
Sometimes, having all the information in one place can be helpful. Below is a helpful ketorolac interaction chart that provides a summary of what this article covers.
| Medication | Risks |
|---|---|
| Other NSAIDs (e.g., aspirin, ibuprofen) |
|
| Blood thinners (e.g., warfarin, rivaroxaban) |
|
| Antiplatelet medications (e.g., clopidogrel, ticagrelor) |
|
| Probenecid |
|
| Blood pressure medications (e.g., lisinopril, losartan, furosemide) |
|
| Some antidepressants (e.g., escitalopram, sertraline) |
|
| Lithium (Lithobid) |
|
| Methotrexate (Trexall) |
|
| Alcohol |
|
Keep in mind this isn’t a full list of all possible interactions. Be sure to share an updated medication list with your prescriber and pharmacist. This can help them pinpoint and manage interactions.
Let’s dive into more detail about these eight ketorolac interactions.
1. Other NSAIDs
You shouldn’t take ketorolac with other NSAIDs. These include common over-the-counter (OTC) medications, such as aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin).
Most NSAIDs work similarly and share side effects. Combining ketorolac with other NSAIDs can raise your risk for serious side effects. These can include kidney damage and gastrointestinal (GI) bleeding.
But it’s not just OTC pain relievers that you need to be careful about. NSAIDs are also sometimes found in cold medicines, menstrual cramp pills, and antacids. Always check the label on OTC products to see what medications are included. Your pharmacist is also a great resource to recommend safe products to take with ketorolac.
2. Antithrombotics (blood thinners)
Antithrombotics are a group of medications that can treat or prevent blood clots. They include anticoagulants (blood thinners) and antiplatelet medications. Though these medications have similar goals, they work a little differently:
Anticoagulants slow down how fast your blood makes clots. Examples include warfarin (Coumadin, Jantoven) and rivaroxaban (Xarelto).
Antiplatelet medications make it harder for blood platelets to clump together. They include medications like clopidogrel (Plavix) and ticagrelor (Brilinta).
Taken alone, ketorolac can raise your risk of GI bleeding. Taking it with antithrombotics makes this risk even higher, especially if you’ve recently had a heart attack. You could have serious bleeding or heart-related complications even if you only take a few doses together.
Let your healthcare team know if you’re taking an antithrombotic medication. There are special precautions that need to be considered before, during, and after medical procedures. This includes selecting safe pain medications to take while you’re recovering. Ketorolac and other NSAIDs are generally avoided if you take antithrombotics.
3. Probenecid
Probenecid is a medication used to treat chronic gout. You shouldn’t combine it with ketorolac. Probenecid greatly increases the amount of ketorolac in your body. And this means a higher risk of serious ketorolac side effects. These include GI bleeding and kidney damage.
Let your healthcare team know if you’re taking probenecid. They’ll likely choose an alternative pain medication.
4. Blood pressure medications
There are a few reasons to be cautious about combining ketorolac with blood pressure medications. Ketorolac can raise your blood pressure, making it harder for these other medications to work well. Your prescriber may ask you to check your blood pressure more often while taking ketorolac.
Combining ketorolac with some blood pressure medications can also put extra stress on your kidneys. NSAIDs temporarily decrease blood flow to the kidneys. And ketorolac is harder on your kidneys than other NSAIDs. Some blood pressure medications can also affect kidney function. Kidney damage is more likely to happen when they’re combined with ketorolac.
Blood pressure medications that may affect the kidneys include:
Angiotensin-converting enzyme (ACE) inhibitors like lisinopril (Zestril)
Angiotensin II receptor blockers (ARBs) like losartan (Cozaar)
Diuretics (“water pills”) like furosemide (Lasix) and hydrochlorothiazide (Microzide)
If you’re taking one of these blood pressure medications and your prescriber decides ketorolac is the best pain medication for you, they may closely monitor your kidney function. But they may also prescribe a different pain reliever that isn’t as hard on the kidneys.
5. Certain antidepressants
Not all antidepressants cause ketorolac interactions. But there are some you should be aware of. Selective serotonin reuptake inhibitors (SSRIs) are a commonly taken class of antidepressants. Examples of SSRIs include escitalopram (Lexapro) and sertraline (Zoloft).
SSRIs and ketorolac both have risks for GI side effects like nausea. They can also both raise your risk of bleeding. If taken together, the risk of stomach bleeding is higher than with either medication alone. The combination may also cause stomach ulcers in some cases.
Tell your prescriber about any history of stomach problems with antidepressants. If they decide you should take both ketorolac and an SSRI, they may suggest a stomach-protectant medication. This could include a medication like lansoprazole (Prevacid) or famotidine (Pepcid AC).
6. Lithium
Lithium (Lithobid) is a medication commonly prescribed to treat bipolar disorder. It interacts with many medications, including ketorolac.
The kidneys clear lithium from the body. But as mentioned earlier, ketorolac can affect kidney function. Combining ketorolac and lithium can cause blood lithium levels to go too high. This can be dangerous. High lithium levels can lead to complications, like confusion and tremors.
If a healthcare professional prescribes ketorolac, make sure they know if you take lithium. They may want to check your lithium levels more closely. They may also choose to prescribe a different pain medication.
7. Methotrexate
Methotrexate (Trexall) is a medication that can treat autoimmune disorders, such as rheumatoid arthritis. It interacts with many medications, including ketorolac. This interaction is because of ketorolac’s kidney effects.
The kidneys remove methotrexate from the body. Ketorolac can cause methotrexate to build up in your bloodstream. This may increase methotrexate levels. High levels of methotrexate can lead to serious side effects, including a low number of blood platelets. This effect on platelets may be more severe if you take ketorolac on the same day as methotrexate.
Make sure your prescriber knows if you take methotrexate, including what day(s) of the week you take it. Since ketorolac is only taken for a few days, they may be able to separate the two medications. This can help limit potential complications from this ketorolac interaction.
8. Alcohol
Ketorolac also interacts with alcohol. Both substances can irritate the GI tract. And they both carry risks for ulcers and GI bleeding on their own. Combining the two can raise your risk of experiencing these complications. Even consuming small amounts of alcohol (1 to 2 drinks) while taking ketorolac is risky.
It’s best to wait at least 1 to 2 days after you’ve finished taking ketorolac to have a drink. But depending on your kidney health, you may need to wait longer. Check with your prescriber to see when it might be OK to consume alcohol again.
Frequently asked questions
No, ketorolac can actually raise blood pressure. Usually, these increases are small. And your blood pressure should return to its usual levels after you finish taking ketorolac. But if you have high blood pressure or other heart problems, your prescriber may avoid giving you ketorolac to be on the safe side.
Because ketorolac commonly causes GI side effects, such as indigestion and nausea, it’s not a good idea to lie down after taking it. Staying upright for about 15 to 30 minutes after taking it can help limit these side effects.
There are several people who shouldn’t take ketorolac. These include those who:
Have a history of GI ulcers or bleeding
Are allergic to aspirin or other NSAIDs
Have a history of breathing and sinus problems after taking aspirin or other NSAIDs
Recently had heart bypass surgery
Have advanced kidney disease
Are giving birth
Have a high risk of serious bleeding, such as those with a history of brain bleeds
The bottom line
Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that’s only taken for a few days. But it can still interact with other medications during this time. Most ketorolac interactions happen with other medications that affect your kidneys, gastrointestinal tract, or platelets.
Examples of medications that interact with ketorolac include other NSAIDs, blood thinners, and some antidepressants. Lithium (Lithobid), methotrexate (Trexall), and alcohol also interact.
Sometimes certain health conditions can make ketorolac interactions more serious. Be sure to tell your healthcare team about other medications you take. This can help them spot interactions before they happen.
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References
Alam, S. M., et al. (2022). Selective serotonin reuptake inhibitors increase risk of upper gastrointestinal bleeding when used with NSAIDs: A systemic review and meta-analysis. Scientific Reports.
Cascorbi, I. (2012). Drug interactions—principles, examples and clinical consequences. Deutsches Ärzteblatt International.
Colebatch, A. N., et al. (2011). Non-steroidal anti-inflammatory drugs, including aspirin and paracetamol (acetaminophen) in people taking methotrexate for inflammatory arthritis. Cochrane Database of Systematic Reviews.
Dixit, M., et al. (2010). Significant acute kidney injury due to non-steroidal anti-inflammatory drugs: Inpatient setting. Pharmaceuticals.
Dreischulte, T., et al. (2015). Combined use of nonsteroidal anti-inflammatory drugs with diuretics and/or renin-angiotensin system inhibitors in the community increases the risk of acute kidney injury. Kidney International.
Ingrasciotta, Y., et al. (2015). Association of individual non-steroidal anti-inflammatory drugs and chronic kidney disease: A population-based case control study. PLOS One.
Kang, D. O., et al. (2020). Concomitant NSAID treatment after MI. American College of Cardiology.
Mahmoodi, A. N., et al. (2024). Ketorolac. StatPearls.
Prescribers’ Digital Reference. (n.d.). Probenecid.
Teva Pharmaceuticals USA, Inc. (2024). Ketorolac tromethamine tablet, film coated [package insert]. DailyMed.
U.S. Food and Drug Administration. (2018). FDA Drug Safety Communication: FDA warns about serious bleeding risk with over-the-counter antacid products containing aspirin.
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