Can You Take Ubrelvy and Toradol Together?
Yes, you can take Ubrelvy (ubrogepant) and Toradol (ketorolac) together for acute migraine treatment, as there are no known contraindications or significant drug interactions between these medications.
Evidence for Combination Use
No Drug Interactions Identified
- Ubrogepant is a calcitonin gene-related peptide (CGRP) receptor antagonist that does not have clinically significant interactions with NSAIDs like ketorolac 1
- Studies evaluating ubrogepant pharmacokinetics have not identified concerns with NSAID co-administration 1, 2
- Ketorolac, as an NSAID, does not affect the CGRP receptor pathway that ubrogepant targets 3, 4
Clinical Context for Combined Use
- Current migraine treatment guidelines support using NSAIDs (including ketorolac) as first-line therapy for moderate to severe migraine 3
- CGRP antagonists like ubrogepant are recommended for patients who do not tolerate or have inadequate response to NSAIDs or triptans 3
- In clinical practice, ketorolac is often used in emergency or urgent care settings for severe migraine, while ubrogepant is typically used in outpatient settings 4
Practical Considerations
When This Combination Might Occur
- A patient may take ubrogepant at home for a migraine attack, then present to an emergency department where ketorolac IV is administered for persistent severe pain 4
- A patient might use ketorolac first (especially IV in acute care settings) and then take ubrogepant if pain persists after 2 hours 3, 4
Safety Monitoring
- Monitor for NSAID-related adverse effects including gastrointestinal upset, renal toxicity, and bleeding risk when using ketorolac 3
- Limit ketorolac treatment duration to no more than 5 days 3, 4
- Common ubrogepant side effects include nausea, somnolence, and dry mouth, which occur in 2-4% of patients 2
Important Caveats
- Avoid ketorolac in patients with aspirin/NSAID-induced asthma, pregnancy, active peptic ulcer disease, or significant renal impairment 3, 4
- Ubrogepant should be avoided in pregnancy and end-stage renal disease 5
- Be aware of medication overuse headache risk with frequent use of acute migraine treatments (≥15 days/month for NSAIDs, though ubrogepant's threshold is less well-defined) 3
Treatment Algorithm Guidance
For sequential use:
- If ketorolac is given first (especially IV in acute settings) and pain persists at 2 hours, ubrogepant can be added 3, 4
- If ubrogepant is taken first and provides inadequate relief within 2-4 hours, ketorolac can be considered as rescue therapy 3, 2
The combination is safe from a pharmacological standpoint, though typically these medications would be used sequentially rather than simultaneously, given their different clinical contexts and routes of administration 3, 4, 1.