Major
Ketorolac × meloxicam
Non-steroidal anti-inflammatory drugs (NSAIDs)×NSAID, COX-2 preferential, oxicam derivative
Mechanism
Dual NSAID therapy – additive GI bleeding and nephrotoxicity risk. Despite meloxicam's preferential COX-2 selectivity, GI toxicity adds up when combined with ketorolac.
Symptoms
Black or tarry stools, vomiting blood, epigastric pain. Risk multiplies in older patients and with prior peptic ulcer disease.
Management
The combination is not prescribed. One NSAID at a time. Ketorolac courses no more than 5 days. For enhanced analgesia: paracetamol or a short opioid.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.