MajorNon-steroidal anti-inflammatory drugs (NSAIDs)×Antimetabolites, folic acid analogues
Updated · Methodology
Mechanism
Ketorolac reduces renal methotrexate clearance and suppresses tubular secretion. At high oncologic methotrexate doses: risk of severe toxicity (pancytopenia, nephrotoxicity, mucositis).
Symptoms
Mouth ulcers (mucositis), nausea, diarrhoea, hair loss. Blood counts fall: leukocytes, platelets, erythrocytes. Severe cases: fatal pancytopenia, nephrotoxicity.
Management
At oncologic methotrexate doses, the combination is not prescribed. At low rheumatologic doses, avoid ketorolac; use paracetamol or a short opioid course for analgesia. Ketorolac courses never exceed 5 days.
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Sources
- FDA: Ketorolac tromethamine tablet (Amerisyn LLC) – Prescribing Information (2013)– ; DailyMed setid 5734e81e-2471-1314-e063-6294a90ac9fe
- AEMPS: Ficha técnica de Metotrexato Accord 100 mg/ml concentrado para solución para perfusión (2025)– AEMPS CIMA, nregistro 79440, secciones 4.4, 4.5
- EMA: Ficha técnica (SmPC EMA) de Nordimet 15 mg solución inyectable en pluma precargada (2026)– EMA SmPC vía AEMPS CIMA, nregistro 1161124004 (EU/1/16/1124), secciones 4.4, 4.5
- FDA: Methotrexate injection (Fresenius Kabi) prescribing information (2021)– FDA label, DailyMed setid b585f621-f6c9-4735-ab61-bd1b401f3df0, WARNINGS; PRECAUTIONS, Drug Interactions
- AEMPS: Ficha técnica de Toradol 30 mg/1 ml solución inyectable (ketorolaco) (2024)– AEMPS CIMA, nregistro 58976, secciones 4.4, 4.5