Drug interactions
Enalapril + Ketorolac intranasal
Severity: Major
Enalapril and Ketorolac intranasal: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Ketorolac is a potent NSAID that is systemically absorbed from the nasal route and can reduce the antihypertensive effect of enalapril. Together they raise the risk of acute kidney injury and hyperkalemia, particularly with volume depletion or renal impairment.
What this interaction means in plain words
Enalapril and Ketorolac intranasal can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Inhibition of renal prostaglandin synthesis reduces afferent arteriolar dilation while ACE inhibition reduces efferent tone, lowering glomerular filtration.
What to do
Avoid in patients with renal impairment or volume depletion; otherwise keep ketorolac to the shortest course. Monitor blood pressure, serum creatinine and potassium.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Enalapril
- Aliskiren + Enalapril Contraindicated
- Enalapril + Protein a column Contraindicated
- Enalapril + Sacubitril / valsartan Contraindicated
- Enalapril + Sacubitril-valsartan Contraindicated
- Amifostine + Enalapril Major
- Amiloride + Enalapril Major
Frequently asked questions
Can I take Enalapril with Ketorolac intranasal?
MediHelp rates the interaction as major. Enalapril and Ketorolac intranasal can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Ketorolac is a potent NSAID that is systemically absorbed from the nasal route and can reduce the antihypertensive effect of enalapril. Together they raise the risk of acute kidney injury and hyperkalemia, particularly with volume depletion or renal impairment.
How serious is the interaction between Enalapril and Ketorolac intranasal?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid in patients with renal impairment or volume depletion; otherwise keep ketorolac to the shortest course. Monitor blood pressure, serum creatinine and potassium.
What other medicines interact with Enalapril?
MediHelp also lists interactions of Enalapril with, for example, Aliskiren, Protein a column, Sacubitril / valsartan. The full list is on the Enalapril page.
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