What should a patient do after taking 1200 mg of ibuprofen (NSAID) and a ketorolac (Toradol) shot within 2 hours?

Management of Ibuprofen and Ketorolac Combination Exposure

A patient who has taken 1200 mg ibuprofen and received a ketorolac (Toradol) injection within 2 hours should immediately contact their healthcare provider or go to the emergency department due to the high risk of serious adverse effects from this NSAID combination.

Why This Is Dangerous

Taking two different NSAIDs (ibuprofen and ketorolac) within a short timeframe creates significant risks:

1. Additive toxicity: Both medications work through the same mechanism (COX inhibition) 1
2. Increased risk of gastrointestinal bleeding and ulceration 1, 2
3. Heightened risk of renal toxicity 1, 2
4. Potential cardiovascular complications 2

Immediate Actions to Take

1. Contact medical help immediately:

   • Call healthcare provider
   • Go to emergency department if symptoms develop
   • Do not wait for symptoms to appear as they may not correlate with severity 1

2. Do not take additional doses of either medication or any other NSAIDs

3. Monitor for concerning symptoms:

   • Abdominal pain
   • Black/tarry stools
   • Vomiting blood
   • Decreased urine output
   • Swelling of extremities
   • Shortness of breath

Risk Assessment Factors

The risk severity depends on several factors:

• Age: Patients over 60 years are at higher risk 1
• Medical history: Particularly renal impairment, GI ulcers, cardiovascular disease 1, 2
• Concurrent medications: Especially anticoagulants, corticosteroids, SSRIs 2
• Dose of ketorolac received: Standard doses range from 15-60mg 1

Clinical Considerations

Pharmacological Overlap

Both medications are NSAIDs with similar mechanisms but different potencies:

• Ketorolac is approximately 5-10 times more potent than ibuprofen 3, 4
• Taking both creates a substantial "double dose" effect 1

Monitoring Parameters

If the patient presents to medical care, the following should be monitored:

• Vital signs, particularly blood pressure
• Renal function (BUN, creatinine)
• Signs of GI bleeding
• Urine output 1

Special Populations Considerations

Patients with Pre-existing Conditions

• Cardiovascular disease: Higher risk of thrombotic events and heart failure exacerbation 2
• Renal impairment: Significantly increased risk of acute kidney injury 1
• History of GI bleeding/ulcers: Extremely high risk of recurrence 1, 2

Common Pitfalls

1. Assuming different administration routes are safe: Even though one medication was oral (ibuprofen) and one was injectable (ketorolac), they still have additive systemic effects 4

2. Waiting for symptoms: GI bleeding or renal damage may occur without initial symptoms 1

3. Taking additional pain medications: Adding other analgesics (especially NSAIDs) would further increase risk

4. Underestimating the risk: This combination presents a genuine medical concern, not just a minor drug interaction

The evidence consistently shows that combining NSAIDs significantly increases adverse effects without providing additional pain relief benefits 3, 4, 5. The risk-benefit ratio strongly favors seeking immediate medical attention.