ModerateNon-steroidal anti-inflammatory drugs (NSAIDs)×Analgesics and antipyretics. Pyrazolones
Updated · Methodology
Mechanism
Ketorolac carries the highest digestive risk of the group and its label contraindicates it in patients on aspirin or other NSAIDs. Metamizole does not fall into that category, so the pair is not contraindicated, yet it stacks two different risks on the same patient: gastrointestinal bleeding from ketorolac and agranulocytosis from metamizole. The added analgesia is modest against that weight.
Symptoms
From ketorolac: black stools, coffee-ground vomit, epigastric pain, reduced urine output. From metamizole: returning fever, sore throat, mouth ulcers. The combination over 65 or with a prior ulcer concentrates both scenarios.
Management
The ketorolac course is short by label and admits no other NSAID alongside; metamizole may accompany it in severe acute pain, but it is worth checking whether paracetamol fills the gap first. Keep gastric protection while ketorolac lasts and watch the blood count if metamizole continues.
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- AEMPS: Ficha técnica Metamizol Cinfa 575 mg cápsulas duras EFG (2024)– AEMPS, CIMA, nº registro 68116, sección 4.5
- AEMPS: Ficha técnica Ketorolaco Kabi 30 mg/ml solución inyectable EFG (2024)– AEMPS, CIMA, nº registro 84357, sección 4.3
- AEMPS: Metamizol y riesgo de agranulocitosis: conclusiones de la evaluación europea (2018)– AEMPS, nota informativa MUH (FV), 15/2018