Critical
Diclofenac × Ketorolac
Non-steroidal anti-inflammatory drugs (NSAIDs)×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
Ketorolac and diclofenac are both NSAIDs. Co-administration adds up the risks: gastrointestinal bleeding, acute kidney injury, raised blood pressure. FDA Toradol Section 4.3 specifically lists other NSAIDs as contraindications.
Symptoms
Black or tarry stools (melena), vomiting blood or coffee-ground material, epigastric pain. Acute kidney injury and a rise in blood pressure are also possible. Risk of bleeding multiplies in patients over 65 and with prior peptic ulcer disease.
Management
The combination is not prescribed. For adequate analgesia, choose one NSAID as monotherapy (diclofenac or ketorolac short course with PPI cover such as pantoprazole). Alternative: paracetamol plus an opioid if pain is insufficiently controlled.