Drug interactions
Enalapril-hydrochlorothiazide + Ketorolac
Severity: Major
Enalapril-hydrochlorothiazide and Ketorolac: major interaction.
Last updated
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 can blunt the antihypertensive effect of enalapril and hydrochlorothiazide and substantially raises the risk of acute kidney injury, especially in volume-depleted or elderly patients. The triple combination of ACE inhibitor, diuretic and NSAID is particularly hazardous for the kidneys.
What this interaction means in plain words
Enalapril-hydrochlorothiazide and Ketorolac 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.
Enalapril-hydrochlorothiazide belongs to Cardiovascular; Ketorolac belongs to Musculoskeletal.
Why it happens
Ketorolac inhibits renal prostaglandin synthesis, reducing afferent arteriolar dilation and causing sodium retention, which compounds the reduced glomerular perfusion from ACE inhibition and diuresis.
What to do
Avoid where possible and choose a non-NSAID analgesic. If ketorolac must be used, keep the course very short, ensure adequate hydration and monitor creatinine, potassium and blood pressure.
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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Other interactions of Enalapril-hydrochlorothiazide
- Aliskiren + Enalapril-hydrochlorothiazide Contraindicated
- Dofetilide + Enalapril-hydrochlorothiazide Contraindicated
- Enalapril-hydrochlorothiazide + Protein a column Contraindicated
- Enalapril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Amifostine + Enalapril-hydrochlorothiazide Major
- Amiloride + Enalapril-hydrochlorothiazide Major
Other interactions of Ketorolac
- Aceclofenac + Ketorolac Contraindicated
- Acemetacin + Ketorolac Contraindicated
- Acetylsalicylic acid + Ketorolac Contraindicated
- Apixaban + Ketorolac Contraindicated
- Argatroban + Ketorolac Contraindicated
- Aspirin / citric acid / sodium bicarbonate + Ketorolac Contraindicated
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Ketorolac?
MediHelp rates the interaction as major. Enalapril-hydrochlorothiazide and Ketorolac 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 can blunt the antihypertensive effect of enalapril and hydrochlorothiazide and substantially raises the risk of acute kidney injury, especially in volume-depleted or elderly patients. The triple combination of ACE inhibitor, diuretic and NSAID is particularly hazardous for the kidneys.
How serious is the interaction between Enalapril-hydrochlorothiazide and Ketorolac?
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 where possible and choose a non-NSAID analgesic. If ketorolac must be used, keep the course very short, ensure adequate hydration and monitor creatinine, potassium and blood pressure.
What other medicines interact with Enalapril-hydrochlorothiazide?
MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Enalapril-hydrochlorothiazide page.
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