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.
Ketorolac (Toradol) injection should not be given to someone taking clopidogrel (Plavix), as the label does not directly address this combination, but it does mention that ketorolac is contraindicated in patients currently receiving aspirin or NSAIDs due to cumulative risks of serious adverse events. Although clopidogrel is an antiplatelet agent and not an NSAID, its use may increase the risk of bleeding, and combining it with ketorolac, which inhibits platelet function, may further increase this risk. Therefore, as a conservative clinical decision, it is recommended to avoid this combination. 1
From the Research
Interaction between Ketorolac and Clopidogrel
- The use of ketorolac in patients taking clopidogrel may increase the risk of bleeding due to the antiplatelet effects of both medications 2, 3.
- A case report described a patient taking clopidogrel who experienced an intra-abdominal bleed after receiving a single dose of ketorolac 2.
- Another study reported a case of spinal epidural hematoma in a patient taking fluoxetine and receiving intramuscular ketorolac after a cervical interlaminar epidural steroid injection, highlighting the potential risk of bleeding with concomitant use of antiplatelet medications 3.
Mechanism of Interaction
- Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet function, which can increase the risk of bleeding when used with other antiplatelet medications like clopidogrel 4, 5, 6.
- The combination of ketorolac and clopidogrel may have additive antiplatelet effects, increasing the risk of bleeding complications 3.
Clinical Implications
- The use of ketorolac in patients taking clopidogrel should be approached with caution, and alternative pain management options should be considered to minimize the risk of bleeding complications 2, 3.
- Patients taking clopidogrel who require ketorolac for pain management should be closely monitored for signs of bleeding, and the dose and duration of ketorolac treatment should be minimized whenever possible 4.