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Acuvail Disease Interactions

There are 2 disease interactions with Acuvail (ketorolac ophthalmic).

Major

NSAIDs (applies to Acuvail) asthma

Major Potential Hazard, High plausibility.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated in patients with history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs; severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients. A subpopulation of patients with asthma may have aspirin-sensitive asthma which may include chronic rhinosinusitis complicated by nasal polyps, severe potentially fatal bronchospasm, and/or intolerance to aspirin and other NSAIDs. Since cross-reactivity between aspirin and other NSAIDs has been reported in such aspirin-sensitive patients, therapy with any NSAID should be avoided in patients with this form of aspirin sensitivity. NSAIDs should be used with caution in patients with preexisting asthma (without known aspirin sensitivity), and these patients should be monitored for changes in the signs and symptoms of asthma.

References

  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
  2. (2002) "Product Information. Nalfon (fenoprofen)." Xspire Pharma
  3. (2002) "Product Information. Indocin (indomethacin)." Merck & Co., Inc
  4. (2002) "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories
  5. (2002) "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc
  6. (2001) "Product Information. Clinoril (sulindac)." Merck & Co., Inc
  7. (2001) "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical
  8. (2001) "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals
  9. (2001) "Product Information. Relafen (nabumetone)." SmithKline Beecham
  10. (2001) "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals
  11. (2001) "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn
  12. (2001) "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories
  13. (2001) "Product Information. Daypro (oxaprozin)." Searle
  14. (2001) "Product Information. Celebrex (celecoxib)." Searle
  15. (2001) "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim
View all 15 references
Moderate

Ophthalmic NSAIDs (applies to Acuvail) platelet inhibition

Moderate Potential Hazard, Low plausibility. Applicable conditions: 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.

References

  1. Katz ME, Wang P (1980) "Fenoprofen-associated thrombocytopenia." Ann Intern Med, 92, p. 262
  2. Camba L, Joyner MV (1984) "Acute thrombocytopenia following ingestion of indomethacin." Acta Haematol, 71, p. 350-2
  3. Gandini R, Cunietti E, Pappalepore V, et al. (1983) "Effects of intravenous high doses of ketoprofen on blood clotting, bleeding time and platelet aggregation in man." J Int Med Res, 11, p. 243
  4. Poldre PA (1989) "Naproxen thrombocytopenia." Am J Hematol, 31, p. 74
  5. Stambaugh JE Jr, Gordon RL, Geller R (1980) "Leukopenia and thrombocytopenia secondary to clinoril therapy." Lancet, 2, p. 594
  6. Sanz MA, Martinez JA, Gomis F, Garcia-Borras JJ (1980) "Sulindac-induced bone marrow toxicity." Lancet, 2, p. 802-3
  7. Rosenbaum JT, O'Connor M (1981) "Thrombocytopenia associated with sulindac." Arthritis Rheum, 24, p. 753-4
  8. Shojania AM, Rusen SD (1981) "Thrombocytopenia secondary to sulindac therapy." Can Med Assoc J, 125, p. 1313
  9. Karachalios GN, Parigorakis JG (1986) "Thrombocytopenia and sulindac." Ann Intern Med, 104, p. 128
  10. Buchanan GR, Martin V, Levine PH, et al. (1977) "The effects of "anti-platelet" drugs on bleeding time and platelet aggregation in normal human subjects." Am J Clin Pathol, 68, p. 355-9
  11. Bobrove AM (1988) "Diflunisal-associated thrombocytopenia in a patient with rheumatoid arthritis ." Arthritis Rheum, 31, p. 148-9
  12. Green D, Holmes GI, et al. (1983) "Effects of diflunisal on platelet function and fecal blood loss." Pharmacotherapy, 3, s65-9
  13. Khazan U, Toth M, Mutgi A (1990) "Diclofenac sodium and bruising ." Ann Intern Med, 112, p. 472-3
  14. Bondeson J, Berglund S (1991) "Diclofenac-induced thrombocytopenic purpura with renal and hepatic involvement." J Intern Med, 230, p. 543-7
  15. Price AJ, Obeid D (1989) "Spontaneous non-gastrointestinal bleeding associated with diclofenac ." Lancet, 2, p. 1520
  16. Epstein M, Vickars L, Stein H (1990) "Diclofenac induced immune thrombocytopenia." J Rheumatol, 17, p. 1403-4
  17. Kramer MR, Levene C, Hershko C (1986) "Severe reversible autoimmune haemolytic anaemia and thrombocytopenia associated with diclofenac therapy." Scand J Haematol, 36, p. 118-20
  18. Concannon MJ, Meng L, Welsh CF, Puckett CL (1993) "Inhibition of perioperative platelet aggregation using toradol (ketorolac)." Ann Plast Surg, 30, p. 264-6
  19. Bjornstad H, Vik O (1986) "Thrombocytopenic purpura associated with piroxicam." Br J Clin Pract, 40, p. 42
  20. (2001) "Product Information. Acular (ketorolac)." Allergan Inc
  21. (2001) "Product Information. Voltaren (diclofenac)." Ciba Vision Ophthalmics
  22. (2022) "Product Information. Ocufen (flurbiprofen ophthalmic)." Allergan Inc
  23. (2022) "Product Information. Profenal (suprofen ophthalmic)." Alcon Laboratories Inc
  24. Kim HL, Kovacs MJ (1995) "Diclofenac-associated thrombocytopenia and neutropenia." Ann Pharmacother, 29, p. 713-5
  25. Schafer AI (1995) "Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis." J Clin Pharmacol, 35, p. 209-19
  26. Hirsh J, Dalen JE, Fuster V, Harker LB, Patrono C, Roth G (1995) "Aspirin and other platelet-active drugs: the relationship among dose, effectiveness, and side effects." Chest, 108 Suppl, s247-57
  27. Thwaites BK, Nigus DB, Bouska GW, Mongan PD, Ayala EF, Merrill GA (1996) "Intravenous ketorolac tromethamine worsens platelet function during knee arthroscopy under spinal anesthesia." Anesth Analg, 82, p. 1176-81
  28. Fraunfelder FT, Fraunfelder FW; Randall JA (2001) "Drug-Induced Ocular Side Effects" Boston, MA: Butterworth-Heinemann
View all 28 references

Acuvail drug interactions

There are 74 drug interactions with Acuvail (ketorolac ophthalmic).

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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