Moderate
Bisoprolol × Ketorolac
Selective beta-adrenergic blockers×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
NSAIDs weaken the antihypertensive effect of beta-blockers via prostaglandin-dependent renal regulation (natriuresis). Ketorolac is the most potent NSAID.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
Ketorolac courses are limited to 5 days. Check blood pressure in the first days. In borderline hypertension, temporarily increase bisoprolol. For chronic analgesia: paracetamol or a short opioid course.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.