Can you take naproxen and receive a Toradol (ketorolac) injection on the same day?

Naproxen and Toradol (Ketorolac) Should Not Be Taken on the Same Day

Taking naproxen and receiving a Toradol (ketorolac) injection on the same day is contraindicated due to the increased risk of serious adverse effects, particularly gastrointestinal bleeding, renal toxicity, and cardiovascular complications. 1, 2

Why These Medications Cannot Be Combined

Shared Mechanism and Cumulative Risk

• Both naproxen and ketorolac are nonsteroidal anti-inflammatory drugs (NSAIDs) that work through the same mechanism of inhibiting prostaglandin synthesis 1
• Combining these medications provides no additional analgesic benefit but significantly increases the risk of adverse effects 2
• The FDA specifically contraindicates ketorolac in patients currently receiving other NSAIDs (including naproxen) because of the cumulative risk of inducing serious NSAID-related side effects 2

Specific Risks of Combination Therapy

Gastrointestinal Complications

• Both medications individually increase the risk of peptic ulcers, gastrointestinal bleeding, and perforation 1, 2
• Ketorolac carries a boxed warning about gastrointestinal risks, which are amplified when combined with another NSAID 2
• Studies have shown that elderly patients may develop gastroduodenal ulcers even after short-term use of ketorolac or naproxen 3

Renal Toxicity

• Both medications can cause renal impairment, especially in patients with compromised fluid status or pre-existing renal insufficiency 1, 2
• The risk of acute renal failure increases significantly when NSAIDs are used concurrently 1, 4

Cardiovascular Risks

• NSAIDs can increase blood pressure, worsen congestive heart failure, and are associated with adverse cardiovascular events 1
• The FDA warns that NSAID use may increase the risk of heart attack or stroke, with risk increasing at higher doses 1

Safe Alternatives

If Pain Management Is Needed

• Use only one NSAID at a time - either naproxen OR ketorolac, but never both simultaneously 2
• If ketorolac injection is necessary, discontinue naproxen at least 24 hours before administration 2, 4
• Ketorolac should only be used for short-term management (up to 5 days) of moderately severe acute pain 2, 5
• Consider acetaminophen as an alternative or adjunct that can be safely used with either NSAID (but not both) 1

For Patients Already Taking Naproxen Who Need Acute Pain Management

• Temporarily discontinue naproxen if ketorolac is required for acute pain management 2
• Consider opioid analgesics as a safe alternative to adding a second NSAID 1, 5
• For migraine or acute pain, consider non-NSAID options such as triptans, antiemetics, or other adjunctive therapies 1

Special Considerations

High-Risk Populations

• Elderly patients (≥60 years) are at particularly elevated risk for adverse effects from NSAID combinations 1, 6
• Patients with a history of peptic ulcer disease, cardiovascular disease, or renal impairment should avoid NSAID combinations entirely 1
• Patients on anticoagulants face significantly increased bleeding risk with any NSAID, especially combinations 1

Duration of Separation

• If transitioning between these medications is necessary, allow at least 24 hours between discontinuing one NSAID and starting another 2, 4
• The risk of adverse effects increases markedly when high dosages of NSAIDs are used for more than 5 days 1, 4

Remember that while each medication individually may be appropriate for pain management in certain situations, their combination provides no additional benefit but substantially increases risks of serious and potentially life-threatening complications.