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Ketorolac

Also indexed as: Acular®, Toradol®

Ketorolac is used orally to treat moderately severe acute pain (e.g., migraine headaches), but should not be used for more than five days. It is also used in the eye to treat itching due to seasonal allergies and to prevent inflammation following cataract surgery.

Interactions with Dietary Supplements

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.1 Since major changes in lithium blood levels can produce unwanted side effects or interfere with its efficacy, NSAIDs should be used with caution, and only under medical supervision, in people taking lithium supplements.

Potassium
A 50-year-old male developed high blood levels of potassium following eight days of ketorolac treatment.2 Additional research is needed to determine whether taking ketorolac together with supplemental potassium might enhance this side effect. individuals taking oral ketorolac should probably avoid potassium supplements and salt substitutes until more information is available.

Interactions with Herbs

White willow bark (Salix alba)
White willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of salicylates like aspirin to individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs.3 Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.

Interactions with Foods and Other Compounds

Food
Taking ketorolac with a high-fat breakfast slows the speed of drug absorption by about an hour, but it does not affect overall blood levels of the drug.4 To lessen stomach upset, ketorolac tablets should be taken with a meal or a snack.

Summary of Interactions for Ketorolac

Depletion or interference None known
Adverse interaction Lithium*
Potassium
White willow*
Side effect reduction/prevention None known
Supportive interaction None known
Reduced drug absorption/bioavailability High-fat meal

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

2. Kelley M, Bastani B. Ketorolac-induced acute renal failure and hyperkalemia. Clin Nephrol 1995;44:276–7 [letter].

3. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

4. Mroszczak EJ, Jung D, Yee J, et al. Ketorolac tromethamine pharmacokinetics and metabolism after intravenous, intramuscular, and oral administration in humans and animals. Pharmacotherapy 1990;10:33S–9S.