From the Guidelines
Taking prednisone and ketorolac IM while on Eliquis (apixaban) is not recommended due to the increased risk of bleeding, and this combination should be avoided unless absolutely necessary and under close medical supervision. The use of ketorolac, a non-steroidal anti-inflammatory drug (NSAID), can independently increase the risk of bleeding, and when combined with prednisone, this risk may be further compounded, especially with prolonged use 1. Eliquis, an anticoagulant, prevents blood clotting, and the addition of ketorolac and prednisone may lead to an increased risk of hemorrhagic events.
Considerations for Management
- If pain management is necessary while on Eliquis, acetaminophen (Tylenol) is typically a safer alternative to ketorolac.
- For inflammation control, the doctor might consider adjusting the Eliquis dosage temporarily if prednisone is absolutely necessary, taking into account the potential interactions with CYP3A4 and P-gp inhibitors or inducers, as seen with apixaban metabolism 1.
- It is crucial to inform all healthcare providers about all medications being taken, including over-the-counter drugs and supplements, to minimize the risk of adverse interactions.
- Patients should be aware of the signs of dangerous internal bleeding, such as unusual bleeding, bruising, or dark stools, and seek immediate medical attention if these symptoms occur.
Evidence-Based Recommendations
The most recent and highest quality study on drug interactions affecting oral anticoagulant use, including apixaban, suggests avoiding the combination of apixaban with strong CYP3A4 and P-gp inhibitors due to the increased risk of bleeding 1. While the provided evidence does not directly address the interaction between prednisone, ketorolac, and apixaban, the principles of minimizing bleeding risk and carefully managing anticoagulation therapy are paramount. Therefore, any decision to use these medications together should be made with caution and under the guidance of a healthcare provider, prioritizing the patient's safety and minimizing the risk of adverse outcomes.
From the Research
Interaction between Prednisone, Ketoralac, and Elequis
- There is no direct evidence in the provided studies regarding the interaction between prednisone, ketoralac, and Elequis (apixaban) [ 2, 3, 4, 5, 6 ].
- However, it is known that ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), can affect platelet function [ 6 ].
- The use of NSAIDs, such as ketorolac, with anticoagulants like apixaban may increase the risk of bleeding [ 2, 5 ].
- A study found that ketorolac does not significantly increase perioperative bleeding when used alone [ 4 ].
- The management of patients on anticoagulants, such as apixaban, requires careful consideration of potential drug interactions and bleeding risks [ 2, 3, 5 ].
- It is essential to monitor patients for signs of bleeding and to adjust treatment as necessary when using ketorolac and apixaban together [ 2, 5 ].