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.

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.	High-fat meal
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	Lithium* Potassium White willow*
Depletion or interference	None known
Side effect reduction/prevention	None known
Supportive interaction	None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

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.

References
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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.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.

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