Acular (ketorolac ophthalmic) Disease Interactions
There are 2 disease interactions with Acular (ketorolac ophthalmic):
Nsaids (Includes Acular) ↔ Asthma
Severe Potential Hazard, High plausibility
Applies to: Asthma
Approximately 10% of patients with asthma may have aspirin-sensitive asthma, characterized by nasal polyposis, pansinusitis, eosinophilia, and precipitation of asthma and rhinitis attacks after ingestion of aspirin. The use of aspirin in these patients has been associated with severe bronchospasm and fatal anaphylactoid reactions. Since cross-sensitivity has been noted between aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), therapy with any NSAID should be avoided in asthmatic patients with a history of aspirin or other NSAID sensitivity, and administered cautiously in all patients with preexisting asthma. Prior to initiating therapy with NSAIDs, patients should be questioned about previous allergic-type reactions to these agents. Salicylate salts, salsalate, salicylamide, and acetaminophen may be appropriate alternatives in patients with a history of NSAID-induced bronchospasm, since cross-sensitivity to these agents appears to be low. However, cross-sensitivity has been demonstrated occasionally with high dosages of these agents (e.g., acetaminophen >= 1000 mg), thus it may be appropriate to initiate therapy with low dosages and increase gradually. There is some evidence suggesting that COX-2 inhibitors may be safely used in patients with aspirin-sensitive asthma, although the labeling for these products contraindicate such use. If necessary, aspirin desensitization may also be attempted in some patients under medical surveillance.
- "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
- "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
- Stevenson DD, Hougham AJ, Schrank PJ, Goldlust MB, Wilson RR "Salsalate cross-sensitivity in aspirin-sensitive patients with asthma." J Allergy Clin Immunol 86 (1990): 749-58
- "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
- "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
- Stevenson DD, Simon RA "Lack of cross-reactivity between rofecoxib and aspirin in aspirin-sensitive patients with asthma." J Allerg Clin Immunol 108 (2001): 47-51
- Lewis RV "Severe asthma after naproxen." Lancet 05/30/87 (1987): 1270
- Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
- Settipane RA, Stevenson DD "Cross sensitivity with acetaminophen in aspirin-sensitive subjects with asthma." J Allergy Clin Immunol 84 (1989): 26-33
- "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
- "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
- Carmona MJ, Blanca M, Garcia A, Fernandez S, Burgos F, Miranda A, Vega JM, Garcia J "Intolerance to piroxicam in patients with adverse reactions to nonsteroidal antiinflammatory drugs." J Allergy Clin Immunol 90 (1992): 873-9
- Israel E, Fischer AR, Rosenberg MA, Lilly CM, Callery JC, Shapiro J, Cohn J, Rubin P, Drazen JM "The pivotal role of 5-lipoxygenase products in the reaction of aspirin-sensitive asthmatics to aspirin." Am Rev Respir Dis 148 (1993): 1447-51
- Haddow GR, Riley E, Isaacs R, McSharry R "Ketorolac, nasal polyposis, and bronchial asthma: a cause for concern." Anesth Analg 76 (1993): 420-2
- Cohen RD, Bateman ED, Potgieter PD "Near-fatal bronchospasm in an asthmatic patient following ingestion of flurbiprofen. A case report." S Afr Med J 61 (1982): 803
- Shapiro N "Acute angioedema after ketorolac ingestion - report of case." J Oral Maxillofac Surg 52 (1994): 626-7
- Ayres JG, Fleming DM, Whittington RM "Asthma death due to ibuprofen." Lancet 05/09/87 (1987): 1082
- "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
- "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
- "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
- "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
- "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
- Szczeklik A, Stevenson DD "Aspirin-induced asthma: Advances in pathogenesis and management." J Allerg Clin Immunol 104 (1999): 5-13
- "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
- Woessner KM, Simon RA, Stevenson DD "The safety of celecoxib in patients with aspirin-sensitive asthma." Arthritis Rheum 46 (2002): 2201-6
- Zikowski D, Hord AH, Haddox JD, Glascock J "Ketorolac-induced bronchospasm." Anesth Analg 76 (1993): 417-9
- "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
- Dahlen B, Szczeklik A, Murray HH "Celecoxib in patients with asthma and aspirin intolerance." N Engl J Med 344 (2000): 142
- "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
- Schreuder G "Ketoprofen: possible idiosyncratic acute bronchospasm." Med J Aust 152 (1990): 332-3
- Nasser SMS, Lee TH "Aspirin-induced early and late asthmatic responses." Clin Exp Allergy 25 (1995): 1-3
- "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
- Chan TY "Severe asthma attacks precipitated by NSAIDs." Ann Pharmacother 29 (1995): 199
- Lee TH "Mechanism of bronchospasm in aspirin-sensitive asthma." Am Rev Respir Dis 148 (1993): 1442-3
- "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
- "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
- Salberg DJ, Simon MR "Severe asthma induced by naproxen: a case report and review of the literature." Ann Allergy 45 (1980): 372-5
- Lee TH "Mechanism of aspirin sensitivity." Am Rev Respir Dis 145 (1992): s34-6
Ophthalmic Nsaids (Includes Acular) ↔ Platelet Inhibition
Moderate Potential Hazard, Low plausibility
Applies to: Coagulation Defect, Thrombocytopathy, Thrombocytopenia, Bleeding, Vitamin K Deficiency
Topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) are systemically absorbed, with the potential for producing rare but clinically significant systemic effects. NSAIDs have been shown to reversibly inhibit platelet adhesion and aggregation and may slightly prolong bleeding time in healthy individuals. These effects may be more pronounced in patients with underlying hemostatic abnormalities. Thrombocytopenia has also been reported rarely during NSAID use. Therapy with ocular NSAIDs should be administered cautiously in patients with significant active bleeding or a hemorrhagic diathesis, including hemostatic and/or coagulation defects associated with hemophilia, vitamin K deficiency, hypoprothrombinemia, thrombocytopenia, thrombocytopathy, or severe hepatic impairment.
- Thwaites BK, Nigus DB, Bouska GW, Mongan PD, Ayala EF, Merrill GA "Intravenous ketorolac tromethamine worsens platelet function during knee arthroscopy under spinal anesthesia." Anesth Analg 82 (1996): 1176-81
- "Product Information. Voltaren (diclofenac)." Ciba Vision Ophthalmics, Duluth, GA.
- Camba L, Joyner MV "Acute thrombocytopenia following ingestion of indomethacin." Acta Haematol 71 (1984): 350-2
- Katz ME, Wang P "Fenoprofen-associated thrombocytopenia." Ann Intern Med 92 (1980): 262
- "Product Information. Acular (ketorolac)." Allergan Inc, Irvine, CA.
- Stambaugh JE Jr, Gordon RL, Geller R "Leukopenia and thrombocytopenia secondary to clinoril therapy." Lancet 2 (1980): 594
- Schafer AI "Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis." J Clin Pharmacol 35 (1995): 209-19
- Price AJ, Obeid D "Spontaneous non-gastrointestinal bleeding associated with diclofenac ." Lancet 2 (1989): 1520
- Bondeson J, Berglund S "Diclofenac-induced thrombocytopenic purpura with renal and hepatic involvement." J Intern Med 230 (1991): 543-7
- Poldre PA "Naproxen thrombocytopenia." Am J Hematol 31 (1989): 74
- Shojania AM, Rusen SD "Thrombocytopenia secondary to sulindac therapy." Can Med Assoc J 125 (1981): 1313
- Bjornstad H, Vik O "Thrombocytopenic purpura associated with piroxicam." Br J Clin Pract 40 (1986): 42
- Bobrove AM "Diflunisal-associated thrombocytopenia in a patient with rheumatoid arthritis ." Arthritis Rheum 31 (1988): 148-9
- Khazan U, Toth M, Mutgi A "Diclofenac sodium and bruising ." Ann Intern Med 112 (1990): 472-3
- Hirsh J, Dalen JE, Fuster V, Harker LB, Patrono C, Roth G "Aspirin and other platelet-active drugs: the relationship among dose, effectiveness, and side effects." Chest 108 Suppl (1995): s247-57
- "Product Information. Profenal (suprofen topical)." Alcon Laboratories Inc, Fort Worth, TX.
- Sanz MA, Martinez JA, Gomis F, Garcia-Borras JJ "Sulindac-induced bone marrow toxicity." Lancet 2 (1980): 802-3
- "Product Information. Ocufen Liquifilm (flurbiprofen)." Allergan Inc, Irvine, CA.
- Kramer MR, Levene C, Hershko C "Severe reversible autoimmune haemolytic anaemia and thrombocytopenia associated with diclofenac therapy." Scand J Haematol 36 (1986): 118-20
- Gandini R, Cunietti E, Pappalepore V, et al "Effects of intravenous high doses of ketoprofen on blood clotting, bleeding time and platelet aggregation in man." J Int Med Res 11 (1983): 243
- Concannon MJ, Meng L, Welsh CF, Puckett CL "Inhibition of perioperative platelet aggregation using toradol (ketorolac)." Ann Plast Surg 30 (1993): 264-6
- Green D, Davies RO, Holmes GI et al "Effects of diflunisal on platelet function and fecal blood loss." Pharmacotherapy 3 (1983): s65-9
- Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects 5th" Boston, MA: Butterworth-Heinemann (2001):
- Buchanan GR, Martin V, Levine PH, et al "The effects of "anti-platelet" drugs on bleeding time and platelet aggregation in normal human subjects." Am J Clin Pathol 68 (1977): 355-9
- Kim HL, Kovacs MJ "Diclofenac-associated thrombocytopenia and neutropenia." Ann Pharmacother 29 (1995): 713-5
- Epstein M, Vickars L, Stein H "Diclofenac induced immune thrombocytopenia." J Rheumatol 17 (1990): 1403-4
- Rosenbaum JT, O'Connor M "Thrombocytopenia associated with sulindac." Arthritis Rheum 24 (1981): 753-4
- Karachalios GN, Parigorakis JG "Thrombocytopenia and sulindac." Ann Intern Med 104 (1986): 128
Acular (ketorolac ophthalmic) drug Interactions
There are 117 drug interactions with Acular (ketorolac ophthalmic)
Drug Interaction Classification
|Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.|
|No information available.|
Do not stop taking any medications without consulting your healthcare provider.
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