Moderate
Amlodipine × Ketorolac
Calcium channel blockers (dihydropyridines)×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
Ketorolac suppresses vasodilator prostaglandins, weakening amlodipine's antihypertensive effect. Plus additive nephrotoxicity.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
Ketorolac courses are limited to 5 days. Monitor blood pressure and creatinine in the first days. In chronic kidney disease or reduced ejection fraction, avoid ketorolac; use paracetamol or a short opioid course for analgesia.