Drug interactions
Ketorolac intranasal + Lithium
Severity: Major
Ketorolac intranasal and Lithium: 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
NSAIDs including ketorolac can reduce renal lithium clearance and raise serum lithium levels, leading to toxicity. Intranasal ketorolac gives meaningful systemic exposure, and lithium toxicity can cause tremor, vomiting, confusion and arrhythmias.
What this interaction means in plain words
Ketorolac intranasal and Lithium 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 renal blood flow and lithium excretion.
What to do
Avoid the combination where possible and use an alternative analgesic such as paracetamol. If it cannot be avoided, measure lithium levels at baseline and within days, and watch for toxicity.
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 Lithium
- Lithium + Thioridazine Contraindicated
- Lithium + Vandetanib Contraindicated
- Aceclofenac + Lithium Major
- Acemetacin + Lithium Major
- Amisulpride + Lithium Major
- Amlodipine-benazepril + Lithium Major
Frequently asked questions
Can I take Ketorolac intranasal with Lithium?
MediHelp rates the interaction as major. Ketorolac intranasal and Lithium 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. NSAIDs including ketorolac can reduce renal lithium clearance and raise serum lithium levels, leading to toxicity. Intranasal ketorolac gives meaningful systemic exposure, and lithium toxicity can cause tremor, vomiting, confusion and arrhythmias.
How serious is the interaction between Ketorolac intranasal and Lithium?
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 an alternative analgesic such as paracetamol. If it cannot be avoided, measure lithium levels at baseline and within days, and watch for toxicity.
What other medicines interact with Lithium?
MediHelp also lists interactions of Lithium with, for example, Thioridazine, Vandetanib, Aceclofenac. The full list is on the Lithium page.
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