Ketorolac Tromethamine interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

  What to do: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

  1 source

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):

Conditions

Conditions in which Ketorolac Tromethamine needs care, as documented in this source.

• Asthma

  Major

  Nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated in patients with history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs; severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients. A subpopulation of patients with asthma may have aspirin-sensitive asthma which may include chronic rhinosinusitis complicated by nasal polyps, severe potentially fatal bronchospasm, and/or intolerance to aspirin and other NSAIDs. Since cross-reactivity between aspirin and other NSAIDs has been reported in such aspirin-sensitive patients, therapy with any NSAID should be avoided in patients with this form of aspirin sensitivity. NSAIDs should be used with caution in patients with preexisting asthma (without known aspirin sensitivity), and these patients should be monitored for changes in the signs and symptoms of asthma.

  15 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):

  Show all 15 sourcesShow fewer sources

  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle (2001):
  14. "Product Information. Celebrex (celecoxib)." Searle (2001):
  15. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

• Blood Platelet Disorders

  Major

  The use of ketorolac is considered by the manufacturer to be contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or a high risk of bleeding. Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID). NSAIDs reversibly inhibit platelet adhesion and aggregation and may prolong bleeding time in healthy individuals. With the exception of aspirin, the platelet effects seen with most NSAIDs at usual recommended dosages are generally slight and of relatively short duration but may be more pronounced in patients with underlying hemostatic abnormalities. Thrombocytopenia has also been reported rarely during NSAID use. Therapy with NSAIDs, including ketorolac, should be administered cautiously in patients with significant active bleeding.

  5 sources

  1. Litvak KM, McEvoy GK "Ketorolac, an injectable nonnarcotic analgesic." Clin Pharm 9 (1990): 921-35
  2. "Product Information. Toradol (ketorolac)." Roche Laboratories (2002):
  3. Concannon MJ, Meng L, Welsh CF, Puckett CL "Inhibition of perioperative platelet aggregation using toradol (ketorolac)." Ann Plast Surg 30 (1993): 264-6
  4. Strom BL, Berlin JA, Kinman JL "Parenteral ketorolac and risk of gastrointestinal and operative site bleeding: a postmarketing surveillance study." JAMA 275 (1996): 376-82
  5. Thwaites BK, Nigus DB, Bouska GW, Mongan PD, Ayala EF, Merrill GA "Intravenous ketorolac tromethamine worsens platelet function during knee arthroscopy under spinal anesthesia." Anesth Analg 82 (1996): 1176-81

• Exanthema

  Major

  Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause serious skin adverse reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis, and exfoliative dermatitis), which can be fatal. These serious events may occur without warning. Patients should be advised to discontinue the NSAID and seek medical attention promptly at the first sign of skin rash or any other sign of hypersensitivity. NSAIDs are contraindicated in patients with previous serious skin reactions to these drugs.

  16 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle (2001):
  14. "Product Information. Celebrex (celecoxib)." Searle (2001):
  15. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
  16. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):

• Kidney Diseases

  Major

  The use of ketorolac is contraindicated in patients with advanced renal impairment or increased risk for renal failure due to volume depletion. Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID). The use of NSAIDs may be associated with renal toxicities, including elevations in serum creatinine and BUN, tubular necrosis, glomerulitis, renal papillary necrosis, acute interstitial nephritis, nephrotic syndrome, and renal failure. In patients with prerenal conditions whose renal perfusion may be dependent on the function of renal prostaglandins, NSAIDs may precipitate overt renal decompensation via a dose-related inhibition of prostaglandin synthesis. Patients at greatest risk for this reaction include geriatric patients and those with impaired renal function, heart failure, liver dysfunction, or substantial volume and/or sodium depletion (e.g., due to diuretics). Therapy with ketorolac should be administered cautiously in such patients, and hypovolemia and hyponatremia should be corrected prior to initiating treatment. Clinical monitoring of renal function is recommended during therapy. If renal function declines or renal failure occurs, prompt discontinuation of ketorolac therapy will usually lead to recovery to the pretreatment state. Since ketorolac and its metabolites are eliminated by the kidney, a reduction to half the normal dosage with a maximum of 60 mg/day is recommended in patients with moderately impaired renal function to avoid drug accumulation.

  22 sources

  1. Aitken HA, Burns JW, McArdle CS, Kenny GNC "Effects of ketorolac trometamol on renal function." Br J Anaesth 68 (1992): 481-5
  2. Boras-Uber LA, Brackett NC Jr "Ketorolac-induced acute renal failure." Am J Med 92 (1992): 450-2
  3. Brocks DR, Jamali F "Clinical pharmacokinetics of ketorolac tromethamine." Clin Pharmacokinet 23 (1992): 415-27
  4. Mroszczak EJ, Lee FW, Combs D, Sarnquist FH, Huang BL, Wu AT, Tokes LG, Maddox ML, Cho DK "Ketorolac tromethamine absorption, distribution, metabolism, excretion, and pharmacokinetics in animals and humans." Drug Metab Dispos 15 (1987): 618-26
  5. Jung D, Mroszczak E, Bynum L "Pharmacokinetics of ketorolac tromethamine in humans after intravenous, intramuscular and oral administration." Eur J Clin Pharmacol 35 (1988): 423-5
  6. Jallad NS, Garg DC, Martinez JJ, Mroszczak EJ, Weidler DJ "Pharmacokinetics of single-dose oral and intramuscular ketorolac tromethamine in the young and elderly." J Clin Pharmacol 30 (1990): 76-81
  7. Jung D, Mroszczak EJ, Wu A, Ling TL, Sevelius H, Bynum L "Pharmacokinetics of ketorolac and p-hydroxyketorolac following oral and intramuscular administration of ketorolac tromethamine." Pharm Res 6 (1989): 62-5
  8. Litvak KM, McEvoy GK "Ketorolac, an injectable nonnarcotic analgesic." Clin Pharm 9 (1990): 921-35

  Show all 22 sourcesShow fewer sources

  9. Martinez JJ, Garg DC, Pages LJ, et al. "Single dose pharmacokinetics of ketorolac in healthy young and renal impaired subjects." J Clin Pharmacol 27 (1987): 722
  10. "Product Information. Toradol (ketorolac)." Roche Laboratories (2002):
  11. Pearce CJ, Gonzalez FM, Wallin JD "Renal failure and hyperkalemia associated with ketorolac tromethamine." Arch Intern Med 153 (1993): 1000-2
  12. Fong J, Gora ML "Reversible renal insufficiency following ketorolac therapy." Ann Pharmacother 27 (1993): 510-2
  13. Quan DJ, Kayser SR "Ketorolac induced acute renal failure following a single dose." J Toxicol Clin Toxicol 32 (1994): 305-9
  14. Singh G, Ramey DR, Morfeld D, Fries JF "Comparative toxicity of non-steroidal anti-inflammatory agents." Pharmacol Ther 62 (1994): 175-91
  15. Haragsim L, Dalal R, Bagga H, Bastani B "Ketorolac-induced acute renal failure and hyperkalemia: report of three cases." Am J Kidney Dis 24 (1994): 578-80
  16. Perneger TV, Whelton PK, Klag MJ "Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs." N Engl J Med 331 (1994): 1675-9
  17. Kelley M, Bastani B "Ketorolac-induced acute renal failure and hyperkalemia." Clin Nephrol 44 (1995): 276-7
  18. Buck ML, Norwood VF "Ketorolac-induced acute renal failure in a previously healthy adolescent." Pediatrics 98 (1996): 294-6
  19. Feldman HI, Kinman JL, Berlin JA, et al. "Parenteral ketorolac: the risk for acute renal failure." Ann Intern Med 126 (1997): 193-9
  20. Buller GK, Perazella MA "Acute renal failure and ketorolac." Ann Intern Med 127 (1997): 493
  21. Feldman HI, Kinman JL, Strom BL "Acute renal failure and ketorolac." Ann Intern Med 127 (1997): 493-4
  22. Myles PS, Power I "Does ketorolac cause postoperative renal failure: how do we assess the evidence?" Br J Anaesth 80 (1998): 420-1

• Peptic Ulcer

  Major

  The use of ketorolac is contraindicated in patients with active peptic ulcers, recent gastrointestinal bleeding or perforation, or a history of peptic ulcer disease or gastrointestinal bleeding. Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID). NSAIDs can cause gastrointestinal mucosal damage, the risk of which appears to be related to both dosage and duration of therapy. Serious GI toxicity such as bleeding, ulceration and perforation can occur at any time, with or without warning symptoms, in patients treated with ketorolac. Therapy with ketorolac should be considered and administered cautiously in patients with a history of GI inflammation or alcoholism, particularly if they are elderly and/or debilitated, since such patients may be more susceptible to the GI toxicity of NSAIDs and seem to tolerate ulceration and bleeding less well than other individuals. Close monitoring for toxicity is recommended during ketorolac therapy, which should be limited to 5 days regardless of the route of administration.

  13 sources

  1. Buckley MM, Brogden RN "Ketorolac. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential." Drugs 39 (1990): 86-109
  2. Litvak KM, McEvoy GK "Ketorolac, an injectable nonnarcotic analgesic." Clin Pharm 9 (1990): 921-35
  3. "Product Information. Toradol (ketorolac)." Roche Laboratories (2002):
  4. Fuller DK, Kalekas PJ "Ketorolac and gastrointestinal ulceration." Ann Pharmacother 27 (1993): 978-9
  5. Estes LL, Fuhs DW, Heaton AH, Butwinick CS "Gastric ulcer perforation associated with the use of injectable ketorolac." Ann Pharmacother 27 (1993): 42-3
  6. Wolfe PA, Polhamus CD, Kubik C, Robinson AB, Clement DJ "Giant duodenal ulcers associated with the postoperative use of ketorolac: report of three cases." Am J Gastroenterol 89 (1994): 1110-1
  7. Singh G, Ramey DR, Morfeld D, Fries JF "Comparative toxicity of non-steroidal anti-inflammatory agents." Pharmacol Ther 62 (1994): 175-91
  8. Wiedrick JE, Friesen EG, Garton AM, Otten NH "Upper gastrointestinal bleeding associated with oral ketorolac therapy." Ann Pharmacother 28 (1994): 1109

  Show all 13 sourcesShow fewer sources

  9. Quigley EMM, Donovan JP, Livingston WC "Ketorolac-related giant gastric ulcers." Am J Gastroenterol 89 (1994): 631-2
  10. Maliekal J, Elboim CM "Gastrointestinal complications associated with intramuscular ketorolac tromethamine therapy in the elderly." Ann Pharmacother 29 (1995): 698-701
  11. Strom BL, Berlin JA, Kinman JL "Parenteral ketorolac and risk of gastrointestinal and operative site bleeding: a postmarketing surveillance study." JAMA 275 (1996): 376-82
  12. Sacanella E, Munoz F, Cardellach F, Estruch R, Miro O, Urbanomarquez A "Massive haemorrhage due to colitis secondary to nonsteroidal anti-inflammatory drugs." Postgrad Med J 72 (1996): 57-8
  13. Buchman AL, Schwartz MR "Colonic ulceration associated with the systemic use of nonsteroidal antiinflammatory medication." J Clin Gastroenterol 22 (1996): 224-6

• Thrombosis

  Major

  Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use. Clinical trials of several cyclooxygenase-2 (COX-2) selective and nonselective NSAIDs of up to 3 years duration have supported this increased risk. It is unclear from available data if the risk for cardiovascular thrombotic events is similar for all NSAIDs. Therapy with NSAIDs should be administered cautiously in patients with a history of cardiovascular or cerebrovascular disease. Patients should be treated with the lowest effective dosage for the shortest duration necessary. Appropriate antiplatelet therapy should be administered to patients requiring cardioprotection; however, there is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious cardiovascular thrombotic events associated with NSAID use, while the risk of serious gastrointestinal events is increased. Physicians and patients should remain alert for the development of adverse cardiovascular events throughout the entire duration of therapy, even without prior cardiovascular symptoms. Patients should be advised to promptly seek medical attention if they experience symptoms of cardiovascular thrombotic events (including chest pain, shortness of breath, weakness, or slurring of speech).NSAIDs are contraindicated in the setting of coronary artery bypass graft (CABG) surgery. Two large clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10 to 14 days following CABG surgery found an increased incidence of myocardial infarction and stroke.The use of NSAIDs should be avoided in patients with a recent myocardial infarction unless the benefits are expected to outweigh the risk of recurrent cardiovascular thrombotic events. If an NSAID is used in patients with a recent myocardial infarction, they should be monitored for signs of cardiac ischemia.

  8 sources

  1. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  5. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Celebrex (celecoxib)." Searle (2001):
  7. "Product Information. Ponstel (mefenamic acid)." Pfizer U.S. Pharmaceuticals Group (2006):
  8. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):

• Water-Electrolyte Imbalance

  Major

  Fluid retention and edema have been reported in association with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Therapy with NSAIDs should be administered cautiously in patients with preexisting fluid retention, hypertension, or a history of heart failure. Blood pressure and cardiovascular status should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.

  14 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Anaprox (naproxen)." Roche Laboratories (2006):
  7. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):

  Show all 14 sourcesShow fewer sources

  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle (2001):
  14. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

• Anemia

  Moderate

  Anemia has been reported in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). This may be due to fluid retention, occult/gross blood loss, or an incompletely described effect on erythropoiesis. Hemoglobin or hematocrit should be monitored in patients with any signs/symptoms of anemia or blood loss, especially during long-term therapy. NSAIDs may increase risk of bleeding events; comorbid conditions (e.g., coagulation disorders; concomitant use of warfarin/other anticoagulants, antiplatelet agents, serotonin/serotonin norepinephrine reuptake inhibitors) may increase this risk, and patients with these conditions should be monitored for signs of bleeding. Therapy with NSAIDs should be administered cautiously in patients with or predisposed to anemia. Clinical monitoring of hematopoietic function may be appropriate, particularly during chronic therapy.

  17 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Toradol (ketorolac)." Roche Laboratories (2002):
  6. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  7. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):

  Show all 17 sourcesShow fewer sources

  9. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  10. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  11. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  12. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  13. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  14. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Daypro (oxaprozin)." Searle (2001):
  16. "Product Information. Celebrex (celecoxib)." Searle (2001):
  17. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

• Heart Failure

  Moderate

  Fluid retention and edema have been observed in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs), including some topical formulations. These drugs should be avoided in patients with severe heart failure unless the benefits are expected to outweigh the risk of worsening heart failure. If an NSAID is used in patients with severe heart failure, they should be monitored for signs of worsening heart failure.

  12 sources

  1. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  5. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  6. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  7. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  8. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):

  Show all 12 sourcesShow fewer sources

  9. "Product Information. Daypro (oxaprozin)." Searle (2001):
  10. "Product Information. Celebrex (celecoxib)." Searle (2001):
  11. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):
  12. "Product Information. Flector Patch (diclofenac topical)." Actavis U.S. (Alpharma USPD) (2016):

• Hyperkalemia

  Moderate

  Increases in serum potassium concentration (including hyperkalemia) have been reported with use of nonsteroidal anti-inflammatory drugs (NSAIDs), even in some patients without renal impairment. In patients with normal renal function, these effects have been attributed to a hyporeninemic-hypoaldosteronism state. Caution is advised in patients with hyperkalemia.

  3 sources

  1. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  2. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  3. "Product Information. Celebrex (celecoxib)." Searle (2001):

• Hypertension

  Moderate

  Nonsteroidal anti-inflammatory drugs (NSAIDs), including topicals, can lead to new onset of hypertension or worsening of preexisting hypertension, either of which can contribute to the increased incidence of cardiovascular events. NSAIDs should be used with caution in patients with hypertension. Blood pressure should be monitored closely during the initiation of NSAID therapy and throughout the course of therapy.

  12 sources

  1. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  5. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  6. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  7. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  8. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):

  Show all 12 sourcesShow fewer sources

  9. "Product Information. Daypro (oxaprozin)." Searle (2001):
  10. "Product Information. Celebrex (celecoxib)." Searle (2001):
  11. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):
  12. "Product Information. Flector Patch (diclofenac topical)." Actavis U.S. (Alpharma USPD) (2016):

• Liver Diseases

  Moderate

  Borderline elevations of 1 or more liver tests may occur in up to 15% of patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). These laboratory abnormalities may progress, remain unchanged, or regress with continuing therapy. Elevations of ALT or AST (at least 3 times the upper limit of normal) have been reported in about 1% of patients in clinical trials. In addition, rare (sometimes fatal) cases of severe hepatotoxicity, including liver necrosis, hepatic failure, jaundice, and fulminant hepatitis have been reported. Therapy with NSAIDs should be administered cautiously in patients with preexisting liver disease. Periodic monitoring of liver function is recommended during prolonged therapy. NSAIDs are also highly protein-bound and some are extensively metabolized by the liver. Metabolic activity and/or plasma protein binding may be altered in patients with hepatic impairment. A dosage reduction may be required in some cases.

  17 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Toradol (ketorolac)." Roche Laboratories (2002):
  6. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  7. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):

  Show all 17 sourcesShow fewer sources

  9. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  10. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  11. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  12. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  13. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  14. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Daypro (oxaprozin)." Searle (2001):
  16. "Product Information. Celebrex (celecoxib)." Searle (2001):
  17. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

Therapeutic duplication

Drug classes that overlap with Ketorolac Tromethamine, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Consensi

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Famotidine/ibuprofen

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Synalgos-dc

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Diphenhydramine/naproxen

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Esomeprazole/naproxen

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Treximet

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Phosphasal

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Acetaminophen/caffeine/magnesium salicylate

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Chlorpheniramine/ibuprofen/pseudoephedrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Trilisate

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Orphengesic forte

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Combunox

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Diclofenac/misoprostol

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Acetaminophen/magnesium salicylate/pamabrom

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/citric acid/sodium bicarbonate

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Ibuprofen/pseudoephedrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Soma compound with codeine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Stanback

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Methenamine/sodium salicylate

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/methocarbamol

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Diphenhydramine/ibuprofen

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/butalbital/caffeine/codeine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/carisoprodol

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Micrainin

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Acetaminophen/ibuprofen

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/chlorpheniramine/dextromethorphan/phenylpropanolamine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Ibuprofen/phenylephrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Zynrelef

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Seglentis

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Percodan

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Doans pm

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/omeprazole

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/dipyridamole

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Migraine relief

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/chlorpheniramine/phenylephrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Prosed ds

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/hydrocodone

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Chlorpheniramine/ibuprofen/phenylephrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Laniroif

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Naproxen/pseudoephedrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Reprexain