Major
celecoxib × Ketorolac
Selective COX-2 inhibitor (coxib)×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
Dual NSAID therapy – additive GI bleeding, nephrotoxicity, and cardiovascular event risks. Ketorolac itself is limited to 5 days of use.
Symptoms
Black or tarry stools (melena), vomiting blood or coffee-ground material, epigastric pain. Risk multiplies in older patients and with prior peptic ulcer disease.
Management
The combination is not prescribed. One NSAID at a time. For enhanced analgesia, add paracetamol or a short opioid course, not a second NSAID.