Drug General Information (ID: DDIIOF9V1N)
Drug Name			Ketorolac		Drug Info		Lithium carbonate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Analgesics				Antimanic Agents
Structure

Mechanism of Ketorolac-Lithium carbonate Interaction (Severity Level: Major)
Decreased renal excretion (Unspecific) Click to Show/Hide Mechanism Graph
Drug Name		Ketorolac				Lithium carbonate
Mechanism		Decreases renal blood flow and lithium excretion				Lithium salt
Key Mechanism Factor 1
		Factor Name		Pharmacokinetics
		Factor Description		Alters the excretion of the drug, resulting in changes in the plasma concentration of the drug and affecting the pharmacological effects.
Mechanism Description		Decreased renal excretion of Lithium carbonate caused by Ketorolac

Recommended Action
Management		Caution is advised when lithium is used concurrently with NSAIDs. Patients should have serum lithium levels checked every 4 to 5 days after starting an NSAID until the extent of any potential interaction can be evaluated. A reduction in lithium dosage may be needed in some cases. Patients should be advised to seek medical attention if they experience potential signs and symptoms of lithium toxicity such as drowsiness, dizziness, confusion, weakness, ataxia, tremor, tinnitus, blurred vision, vomiting, diarrhea, thirst, and increased urination.

References
1	Chen L, Pym H "Rapid onset of neurological symptoms and lithium toxicity on starting meloxicam." Aust N Z J Psychiatry 44 (2010): 95.[PMID: 20073572]
2	Nadarajah J, Stein GS "Piroxicam induced lithium toxicity." Ann Rheum Dis 44 (1985): 502.[PMID: 4026412]
3	Harrison TM, Davies DW, Norris CM "Lithium carbonate and piroxicam." Br J Psychiatry 149 (1986): 124-5.[PMID: 3096415]