Drug interactions
Ketorolac + Milnacipran
Severity: Major
Ketorolac and Milnacipran: 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
Serotonin-norepinephrine reuptake inhibitors impair platelet serotonin uptake and, with NSAIDs, substantially increase the risk of bleeding, especially upper gastrointestinal bleeding. Ketorolac itself carries a high bleeding risk.
What this interaction means in plain words
Ketorolac and Milnacipran 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 belongs to Musculoskeletal; Milnacipran belongs to Central Nervous System.
Why it happens
Additive platelet dysfunction (reduced platelet serotonin and COX-1 inhibition) plus NSAID gastric mucosal injury.
What to do
Avoid the combination where possible and use a non-NSAID analgesic. If needed, keep the course short, consider gastroprotection, and monitor for bleeding.
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 Ketorolac
- Aceclofenac + Ketorolac Contraindicated
- Acemetacin + Ketorolac Contraindicated
- Acetylsalicylic acid + Ketorolac Contraindicated
- Apixaban + Ketorolac Contraindicated
- Argatroban + Ketorolac Contraindicated
- Aspirin / citric acid / sodium bicarbonate + Ketorolac Contraindicated
Other interactions of Milnacipran
- Isocarboxazid + Milnacipran Contraindicated
- Methylene blue + Milnacipran Contraindicated
- Milnacipran + Phenelzine Contraindicated
- Milnacipran + Procarbazine Contraindicated
- Milnacipran + Rasagiline Contraindicated
- Milnacipran + Safinamide Contraindicated
Frequently asked questions
Can I take Ketorolac with Milnacipran?
MediHelp rates the interaction as major. Ketorolac and Milnacipran 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. Serotonin-norepinephrine reuptake inhibitors impair platelet serotonin uptake and, with NSAIDs, substantially increase the risk of bleeding, especially upper gastrointestinal bleeding. Ketorolac itself carries a high bleeding risk.
How serious is the interaction between Ketorolac and Milnacipran?
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 the combination where possible and use a non-NSAID analgesic. If needed, keep the course short, consider gastroprotection, and monitor for bleeding.
What other medicines interact with Ketorolac?
MediHelp also lists interactions of Ketorolac with, for example, Aceclofenac, Acemetacin, Acetylsalicylic acid. The full list is on the Ketorolac page.
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