From the Guidelines
Ketorolac can be used in patients with a history of sulfonamide allergy, as there is no significant cross-reactivity between sulfonamide non-antimicrobials and antimicrobial sulfonamides, according to the most recent evidence from 2022 1.
Key Points to Consider
- The 2022 practice parameter update on drug allergy states that there is minimal concern for cross-reactivity between sulfonamide non-antimicrobials, such as ketorolac, and antimicrobial sulfonamides 1.
- Ketorolac is not listed as a medication with cross-reactivity in patients with a history of sulfonamide antimicrobial adverse reactions, as shown in Table XIV of the study 1.
- The study highlights that sulfonamide non-antimicrobials, including COX-2 inhibitors like celecoxib, have no or weak evidence of cross-reactivity in patients with a history of sulfonamide antimicrobial adverse reactions 1.
Clinical Implications
- Patients with a history of sulfonamide allergy can be considered for treatment with ketorolac, as the risk of cross-reactivity is minimal 1.
- However, it is essential to note that ketorolac is an NSAID and can have its own set of side effects, such as gastrointestinal bleeding and kidney damage, which should be monitored closely.
- As with any medication, it is crucial to inform all healthcare providers about the patient's medication history, including any allergies or adverse reactions, to prevent potential drug interactions.
From the Research
Ketorolac and Sulfa Interactions
- There is no direct evidence of interactions between ketorolac and sulfa in the provided studies 2, 3, 4, 5, 6.
- However, it is known that ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that can cause adverse effects such as gastrointestinal bleeding, renal impairment, and allergic reactions 2, 3.
- Sulfa drugs, on the other hand, are a class of antibiotics that can also cause adverse effects such as allergic reactions and renal impairment.
- The combination of ketorolac and gentamicin (an antibiotic) has been shown to be deleterious to renal function in an animal model 5.
- It is possible that the combination of ketorolac and sulfa drugs could increase the risk of adverse effects, particularly renal impairment and allergic reactions.
- However, without direct evidence, it is difficult to determine the exact nature and extent of any potential interactions between ketorolac and sulfa drugs.
Potential Risks and Precautions
- Patients taking ketorolac and sulfa drugs should be closely monitored for signs of adverse effects, particularly renal impairment and allergic reactions 2, 3.
- The dosage and duration of ketorolac therapy should be limited to the minimum necessary to control pain, and patients should be carefully selected to minimize the risk of adverse effects 2.
- Patients with a history of gastrointestinal bleeding, renal impairment, or allergic reactions should be cautious when taking ketorolac and sulfa drugs 2, 3.