Major
Ketorolac × naproxen
Non-steroidal anti-inflammatory drugs (NSAIDs)×NSAID, propionic acid derivative
Mechanism
Dual NSAID therapy – sharp rise in GI bleeding risk (3- to 5-fold), acute kidney injury, and cardiovascular events.
Symptoms
Black or tarry stools, vomiting blood, 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: paracetamol or a short opioid course, not a second NSAID. Ketorolac courses never exceed 5 days.