Drug interactions
Ketorolac + Methotrexate
Severity: Contraindicated
Ketorolac and Methotrexate: contraindicated 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 can sharply increase methotrexate exposure and impair renal function, leading to severe myelosuppression, mucositis and renal injury, particularly with high-dose methotrexate.
What this interaction means in plain words
Ketorolac and Methotrexate are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Ketorolac belongs to Musculoskeletal; Methotrexate belongs to Oncology.
Why it happens
Reduced renal tubular secretion of methotrexate combined with ketorolac-induced reduction in renal perfusion.
What to do
Do not combine ketorolac with high-dose methotrexate and use a non-NSAID analgesic instead. Avoid it with low-dose methotrexate where possible, particularly in renal impairment.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Methotrexate
- Acitretin + Methotrexate Contraindicated
- Adenovirus types 4 and 7 live + Methotrexate Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Methotrexate Contraindicated
- Measles mumps and rubella vaccine live + Methotrexate Contraindicated
- Measles mumps and rubella vaccine + Methotrexate Contraindicated
- Measles mumps rubella and varicella vaccine live + Methotrexate Contraindicated
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 Ketorolac with Methotrexate?
MediHelp rates the interaction as contraindicated. Ketorolac and Methotrexate are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Ketorolac can sharply increase methotrexate exposure and impair renal function, leading to severe myelosuppression, mucositis and renal injury, particularly with high-dose methotrexate.
How serious is the interaction between Ketorolac and Methotrexate?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not combine ketorolac with high-dose methotrexate and use a non-NSAID analgesic instead. Avoid it with low-dose methotrexate where possible, particularly in renal impairment.
What other medicines interact with Methotrexate?
MediHelp also lists interactions of Methotrexate with, for example, Acitretin, Adenovirus types 4 and 7 live, Influenza virus vaccine quadrivalent intranasal. The full list is on the Methotrexate page.
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