From the Guidelines
Using ketorolac injection together with oral prednisone significantly increases the risk of gastrointestinal side effects, particularly stomach ulcers and bleeding, and this combination should be avoided when possible or used with extreme caution and for the shortest duration necessary. This is based on the evidence from 1, which highlights the gastrointestinal risks associated with nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, and the increased risk when combined with corticosteroids like prednisone. The study found that the concomitant use of corticosteroids with NSAIDs increases the risk of gastrointestinal complications, with an estimated two-fold increase in gastrointestinal events compared to those not taking these medications. Key factors that increase the risk of gastrointestinal complications include a history of previous peptic ulcer, advanced age, and concomitant use of anticoagulants or high-dose NSAIDs. Given the potential risks, if both medications are deemed necessary, a gastroprotective agent such as a proton pump inhibitor (like omeprazole 20-40mg daily) should be prescribed concurrently to mitigate the risk of gastrointestinal side effects. It is also crucial to use the lowest effective dose of prednisone and limit the duration of ketorolac use to no more than 5 days when this combination cannot be avoided, as recommended by 1. Additionally, patients with a history of peptic ulcer disease, advanced age, or those on anticoagulants face even higher risks and require careful monitoring and management. The evidence from 1 further supports the importance of considering the risk factors for gastrointestinal complications when using NSAIDs and the benefits of using gastroprotective agents in high-risk patients. Overall, the combination of ketorolac injection and oral prednisone should be used judiciously, with careful consideration of the potential risks and benefits, and with appropriate measures to minimize the risk of gastrointestinal complications.
From the Research
Risk of Ketorolac Injection with Oral Prednisone Use
- The risk of gastrointestinal bleeding and other adverse events associated with ketorolac therapy is slightly higher than with opioids, especially with high doses, prolonged therapy, or in vulnerable patients 2.
- Corticosteroids, such as prednisone, may increase the risk of gastrointestinal bleeding in critically ill adults, although the exact risk is unknown and requires further study 3.
- Ketorolac and acetaminophen provide similar post-operative analgesia, but ketorolac may be associated with less dependence on opioids and a quicker return of bowel function 4.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are associated with an increased risk of upper gastrointestinal tract bleeding, especially in patients with certain clinical characteristics such as age, comorbidity, and smoking 5.
- NSAIDs, including ketorolac, can cause organ damage, including gastrointestinal, cardiovascular, hepatic, renal, cerebral, and pulmonary complications, and their use should be carefully evaluated to minimize risks 6.