From the FDA Drug Label
Ketorolac tromethamine is contraindicated in patients currently receiving aspirin or NSAIDs because of the cumulative risks of inducing serious NSAID-related adverse events.
Administration of ketorolac after ibuprofen is contraindicated due to the cumulative risks of inducing serious NSAID-related adverse events 1.
From the Research
It is not recommended to administer ketorolac after a patient has taken ibuprofen without an appropriate time interval between doses, as this can increase the risk of adverse effects. The primary concern with combining these two nonsteroidal anti-inflammatory drugs (NSAIDs) is the potential for increased risk of gastrointestinal bleeding, ulceration, kidney injury, and cardiovascular events, as both medications work by inhibiting cyclooxygenase enzymes that produce inflammatory prostaglandins 2. If a patient has taken ibuprofen, it's recommended to wait until the ibuprofen has cleared from their system before administering ketorolac, which typically means waiting at least 4-6 hours after a standard ibuprofen dose. Some key points to consider when deciding on the administration of ketorolac after ibuprofen include:
- The risk of adverse drug reactions (ADRs) and healthcare resource utilization (HCRU) associated with parenteral ibuprofen and ketorolac, with studies suggesting that IV-ibuprofen may be a safer alternative to ketorolac 2.
- The efficacy of IV ibuprofen and IV ketorolac in managing acute postoperative pain, with some studies indicating comparable efficacy but significant clinical and statistical heterogeneity 3.
- The potential benefits and harms of different nonsteroidal anti-inflammatory drugs (NSAIDs) for the management of pain in adults with acute renal colic, with ketorolac being compared to other NSAIDs such as ibuprofen, diclofenac, and parecoxib 4. Overall, the decision to administer ketorolac after a patient has taken ibuprofen should be made with caution and careful consideration of the potential risks and benefits, prioritizing the patient's morbidity, mortality, and quality of life outcomes.