Can you take Ketorolac and Oxycodone together

What does Ketorolac do

Ketorolac is a Generic name for a non-steroidal anti-inflammatory drug (NSAID) with pyrrolizine structure containing salt ketorolac tromethamine as an active ingredient, that is used as an anti-inflammatory agent with analgesic and antipyretic properties for the management of osteoarthritis and moderately severe acute pain that needs analgesia at the opioid level, usually in a postoperative patients.

It is a peripherally acting analgesic. Ketorolac is available in a form of solution and injection for intramuscular route in doses of 15 mg/ml and 30 mg/ml, as an ophthalmic solution in doses of 4, 4.5 and 5 mg/ml, as and intravenous solution in doses of 15, 30 and 60 mg/ml and as a film coated tablet in the dose of 10 mg.

Ketorolac tromethamine in tablet and intramuscular dosage forms is a racemic mixture of both (S)-(−)-ketorolac, the active isomer with analgesic properties, and (R)-(+)-ketorolac.

An ophthalmic solution is used to treat eye pain and to relieve the burning and itchiness caused by seasonal allergies. It is usually taken every 4 to 6 hours on a schedule or as needed for pain.

Common Brand names on the market containing ketorolac tromethamine as an active ingredient are: Bedoral, Dolten, Emodol, Etorac, Ketora, Ketonic, Syndol, Lixidol, Toradol and Tarasyn.

What does Ketorolac do

What does Oxycodone do

Oxycodone is a Generic name for an opioid narcotic drug containing same name active ingredient that is used for moderate to severe pain relief. As a narcotic analgesic, oxycodone is more potent and addicting than its related compound codeine.

Oxycodone is available in the form of tablet (extended or immediate release), capsule and solution in following strengths: 5, 10, 15, 20, 30, 40 and 80 mg. The extended-release form of this drug is for around-the-clock therapy of pain.

This form of oxycodone is not for use on an as-needed basis for pain. Oxycodone dose should be adjusted individually, according to the pain severity and the patient response. The dose can be exceeded in patients who have more severe pain or in those who become tolerant to the opioids analgesic effects.

Other products on the market containing oxycodone are: OxyCONTIN, Oxecta, Oxyfast, OxyIR, M-Oxy, Roxicodone, ETH-Oxydose, Percolone, Endocodone, Dazidox, Roxicodone Intensol, Oxaydo.


How does Ketorolac and Oxycodone work in the body

Ketorolac tromethamine is a racemic mixture of [+]R- and [-]S- enantiomers, with the S-form containing analgesic activity. This drug works by inhibiting both cyclooxygenase enzyme, COX-1 and COX-2, leading to the inhibition of prostaglandin synthesis, decreased formation of precursors of prostaglandins and thromboxanes.

Analgesic effects are probably produced through peripheral action in which impulse signaling blockage results from decreased prostaglandin activity.

However, analgesic effects may be also contributed through the inhibition of actions or synthesis of other body substances that can sensitize receptors responsible for pain due to mechanical or chemical stimulation. After ocular administration, ketorolac reduces prostaglandin E2 levels in aqueous humor, secondary to inhibition of prostaglandin biosynthesis.

Oxycodone is a weak agonist of μ – mu, κ – kappa, and δ – delta opioid receptors within the CNS. Oxycodone predominantly affects μ opioid receptors, which are binded with G-protein receptors complex and acts as modulators, both negative and positive, of synaptic transmission through G-proteins that trigger effector proteins.

Oxycodone decrease intracellular levels of cAMP by inhibiting enzyme called adenylate cyclase and release of nociceptive neurotransmitters such as GABA, dopamine, substance P, acetylcholine, and noradrenaline.

Oxycodone can also inhibit hormone release of somatostatin, insulin, vasopressin, and glucagon. As κ -receptor agonist oxycodone closes N-type voltage-operated calcium channels, while as μ and δ receptor agonist, oxycodone opens calcium-dependent potassium channels. The results are hyperpolarization and reduced neuronal excitability.

Can patients take Ketorolac and Oxycodone together

Ketorolac and Oxycodone can be used together for the treatment of conditions characterized by acute severe pain and inflammation but only short-term administration.

Oxycodone is an opiate analgesic, while ketorolac is a strong anti-inflammatory drug with pain killing equivaliancy of Morphine, but with no addictive properties.

They have different mechanisms of action and have no significant pharmacological interactions in the body. Doctor may prescribe them both at the same time, oxycodone for pain control and ketorolac for inflammation.

However, patients should not use this combination for more than 5 days, because Ketorolac can cause serious gastrointestinal side effects such as GI bleeding and ulcers and also kidney problems in predisposed patients while oxycodone may cause prolonged constipation. If these side effects occur, patients should stop using them and call their doctor immediately.

The table below shows side effects after Oxycodone and Ketoralac administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Very common side effects >10% Headache (17%), Constipation (8-11%), Somnolence (3-14%), Dyspepsia (12-13%), GI pain (12-13%), Nausea (12-13%)
Common side effects 1-10% Vomiting (3-5%), UTI (1-5%), Dry mouth (3%), Pruritus (3%), Hypertension (4%) Tremor (3%), Fatigue (1-4%), Back pain (1-4%), Dizziness (3-9%), Peripheral edema (1-3%), Pruritus (3-9%), URI infection (1-3%) and Muscle spasms (1-3%), Decreased appetite (2%), Tinnitus (2%), Insomnia (3%), Influenza (3%), Diarrhea (3-9%), Increased blood urea nitrogen (BUN) (3%), Purpura (<3%). Increased serum creatinine (2%)

Special precautions and warnings during Ketorolac and Oxycodone administration:

  • Patients should tell their doctor and pharmacist if they are allergic to ketorolac or oxycodone, or any other medicines, or any of the ingredients that are used in these products.
  • Patients should tell their doctors or pharmacists what prescription and nonprescription medicines, vitamins or nutritional supplements they are taking or plan to take while taking these drugs.
  • Patients administrating oxycodone should also tell their doctors if they are using any of the following medications: antihistamines; dronedarone (Multaq); medications for irritable bowel disease, Parkinson’s disease, ulcers, haloperidol (Haldol); azithromycin (Zithromax, Zmax); amiodarone (Cordarone, Pacerone, Nexterone); butorphanol; chlorpromazine; citalopram (Celexa); laxatives such as lactulose (Cholac, Constulose, Enulose, others); nalbuphine; or pentazocine (Talwin), levofloxacin (Levaquin).They should also tell their doctors if they are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), rasagiline (Azilect), or tranylcypromine (Parnate). Doctor may need to change the doses of medicines or monitor carefully for side effects.
  • Oxycodone shouldn’t be used if patient has blockage of stomach or intestines, or paralytic ileus.
  • Patients should tell their doctor if they have or have ever had hypotension, difficulties with urinating, seizure attacks, or any of the thyroid, liver, kidney, gall bladder or pancreas disease.
  • Patients should tell their doctor if they are breastfeeding.
  • If patients are having surgery, including dental surgery, they should tell their doctor or dentist that they are taking oxycodone or ketorolac.
  • Oxycodone may make patients drowsy. Patients taking oxycodone should not drive a car or operate machinery.
  • Oxycodone may cause dizziness, fainting and lightheadedness, if patient get up too quickly from a lying position. This is more common when initial dose of oxycodone is taken. To avoid this problem, patients should slowly get out of bed, resting their feet on the floor for a few minutes before standing up.
  • Oxycodone can cause constipation. Patients should talk with their doctor about changing diet and using other medications to treat or prevent constipation
  • Patient should not take Ketorolac if they are already using Probenecid. They should also tell their doctor or pharmacists if they are using some of the following drugs: medications for anxiety or mental illness; antidepressants; methotrexate (Rheumatrex);  medications for seizures such as carbamazepine or phenytoinsedatives; sleeping pills; and tranquilizers. Doctor may need to change the doses of medicines or monitor carefully for side effects.
  • Ketorolac shouldn’t be used for more than 5 days, because it can cause gastrointestinal side effects.
  • Patients using Ketorolac should tell their doctor if they have or have ever had: swelling of the hands, ankles, lower legs or feet.
  • Women on Ketorolac therapy should tell their doctor if they are pregnant, especially if they are in the last trimester of their pregnancy, or if they plan to become pregnant. If they become pregnant while taking ketorolac, they should call their doctor.
  • Older adults (65 or older) should not usually take ketorolac because it is not as safe as other drugs that can be used to treat the same conditions.
  • Ketorolac may make patients drowsy or dizzy. They shouldn’t drive a car or operate machinery while using this medicine
  • Alcohol can make the side effects of ketorolac worse and increase the incidence of side effects.

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