Critical
Ibuprofen × Ketorolac
Non-steroidal anti-inflammatory drugs (NSAIDs)×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
Ketorolac and ibuprofen are both NSAIDs. Additive risk of gastrointestinal bleeding, acute kidney injury, and blood pressure dysregulation. 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. One NSAID at a time. Ketorolac courses are limited to 5 days. If analgesia from one NSAID is insufficient, add paracetamol or a short opioid – not a second NSAID.