Knowing about possible Toradol drug interactions

Drug interactions can change how a medication works for you and knowing about these drug interactions can help you identify the side effects caused due to these drug interactions. This article will help you know about some drugs that can interact with Toradol.


When aspirin and Toradol are used together, the protein binding is decreased, though the clearance of this medication (Toradol) doesn’t change. Using these two medications is not recommended because of the harmful effects associated with this combination.


Using the combination of Toradol and Probencid resulted in reduced volume and clearance of distribution of ketorolac and remarkable increase in plasma levels of ketorolac.


According to clinical studies Toradol is capable of reducing the natriuretic effect of thiazides and furosemide in some cases. This combination resulted in obstruction of renal prostaglandin synthesis. During this therapy the patients should be closely monitored for the symptoms of renal failure.


Using lithium and Toradol and lithium can lead to lithium toxicity, which should be closely monitored in patients using the combination of these two medications.

Antiepileptic drugs

Cases of seizures have been reported with combined use of antiepileptic drugs (carbamazepine and phenytoin) and Toradol


Using Toradol with methotrexate can increase the toxicity of methotrexate

Psychoactive drugs

When Toradol is taken by patients already using psychoactive drugs like fluoxetine, alprazolam, thiothixene hallucinations can occur in such patients.

Muscle Relaxants- Nondepolarizing

Using Toradol and nondepolarizing muscle relaxants leads to an interaction between ketorolac tromethamine those results in apnea.


Patients using Toradol and SSRIs can experience gastrointestinal bleeding so extra caution should be taken when you use SSRIs with Toradol.


The combination of Pentoxifylline and Toradol results in bleeding.

There are many other drugs that can interact with Toradol and here are some of them listed below

  • aliskiren
  • acetylsalicylic acid
  • apixaban
  • multivitamins
  • mesalamine
  • pemetrexed
  • prasugrel
  • bimatoprost
  • cholestyramine
  • sulfasalazine
  • tenofovir
  • tacrolimus
  • deferasirox
  • digoxin
  • vancomycin
  • heparin
  • vitamin E
  • venlafaxine
  • heparin
  • hydralazine
  • eplerenone
  • warfarin

If you are using any of the above medicines, discuss with your doctor/pharmacist. Depending on your medical condition your doctor might advise

  • you to stop using either of the medications
  • change either of the medication to some other medication
  • change the dose and frequency of either or both of the medications
  • or ask you to continue with the current schedule

A drug interaction doesn’t always mean that you need to stop using any one of the medications. You can discuss with your doctor about how the drug interactions and be or should be managed. Let your doctor know if you are using any prescription/non prescription, herbal medications.  Also let your doctor know if you are using any other supplements. Do not hesitate to share with your doctor if you are taking street drugs, smoking nicotine through cigarettes, drinking alcohol as these drugs and other things can affect the medication you have been prescribed.

Unwanted side effects of Protriptyline that need immediate medical help

Protriptyline is useful in treating depression. In order to get maximum benefits from the medication, you should take the medication in right doses as recommended by your doctor. While using Protriptyline your main objective is to get desired effects and you tend to forget about the associated side effects. You can discuss with your doctor to help you learn about the unwanted side effects of Protriptyline.

Major side effects – Protriptyline

Contact your doctor immediately if you experience below listed side effects

  • blurred vision
  • cold sweats
  • irritability or agitation
  • stomach or abdominal pain
  • convulsions
  • pale or cool skin
  • chest discomfort or pain
  • drooling
  • double vision
  • false beliefs
  • faintness, light-headedness, dizziness while getting up from sitting or lying position
  • irregular, fast or pounding pulse or heartbeat
  • seeing, hearing, feeling things that doesn’t exist
  • fever with/without chills
  • hearing loss
  • feeling that others are staring you and controlling your actions
  • hyperventilation
  • hostility
  • inability to move arms, legs or facial muscles
  • side pain or lower back pain
  • mental or mood changes
  • muscle spasms
  • muscle twitching or trembling
  • panic
  • nightmares
  • slurred speech
  • stupor
  • ulcers, white spots or sores on the mouth or lips
  • stiffness of your limbs
  • swollen glands
  • sweating
  • acting, feeling or talking with excitement
  • weight gain or weigh loss
  • yellow skin or eyes
  • weakness in feet, legs or arms
  • sore throat
  • discomfort or pain in back, neck or jaw
  • redness of neck, face and arms
  • unsteady or shakiness while walking
  • speech  problems
  • numbness, crawling, burning or tingling or itching feelings

Symptoms of overdose that need immediate medical help

  • muscle weakness
  • disorientation
  • clumsiness
  • enlarged pupils
  • muscle tightness or aches
  • low body temperature
  • shivering
  • feeble or weak pulse
  • severe sleepiness
  • disturbed concentration
  • drowsiness that leads to coma

Minor side effects

Some minor side effects of Protriptyline do not need medical attention. These side effects disappear with time as your body gets used to the medication. Your doctor can help you know how to prevent these side effects or reduce the effects. If still these side effects continue to exist for a long period, get in touch with your health care provider immediately.

Occurrence not known

  • black tongue
  • stomach or abdominal cramps
  • enlarged, dilated or bigger pupils
  • heartburn
  • welts or hives
  • peculiar taste
  • increased eye sensitivity to light
  • increased skin sensitivity to sunlight
  • small purple or red spots on the skin
  • swollen testicles
  • hair thinning or hair loss
  • inflammation or swelling of mouth
  • increased sexual drive, performance, ability or desire
  • severe sunburn
  • painful, tender or swollen lymph glands( on neck or face)
  • unexpected flow of milk from breasts

You should contact your doctor in any of the side effects that bother you for a long time.

Tramadol Drug interactions that can affect the efficiency of the drug

Drug interactions change how the medications work or can result in severe side effects too. This article will help you discover some Tramadol drug interactions. Firstly, make a list of other medications that you are using currently apart from Tramadol. You can show this list to your doctor to know about various drug interactions. Your doctor can help you know about possible Tramadol interactions with the medications you are using currently.

Drugs that affect seizure threshold

Parallel use of Tramadol enhances the risk of seizures in patients taking SNRI/SSRI antidepressants or TCA antidepressants, anorectics and other tricyclic compounds, other opioids, neuroleptics or any other medications that reduce the seizure threshold.

CYP3A4 and/or CYP2D6 inhibitors

Tramadol is processed by CYP2D6 to build active metabolite- O-desmethyl tramadol (M1). The studies indicate that using CYP2D6 inhibitors like Amitriptyline, fluoxetine and paroxetine can lead to some obstruction in Tramadol metabolism process.

Tramadol is also processed by CYP3A4 and using CYP3A4 inhibitors like erythromycin, ketoconazole with Tramadol hydrochloride (extended release) can influence the process of tramadol metabolism resulting in changed tramadol exposure.


Based on mechanism of Tramadol and prospective of serotonin syndrome, extra caution should be taken when using Tramadol hydrochloride (extended release) with Triptans. The patient should be carefully monitored especially during the initial stages of treatment or dose increase.

Serotonergic drugs

The studies indicate the risk of serotonin syndrome in case of combined use of tramadol and SNRIs/SSRIs or a2-adrenergic blockers and MAOIs. Extra caution needs to be taken when tramadol hydrochloride (extended release) is taken with other drugs that can impact the serotonergic neurotransmitter system like MAOIs, triptans, SSRIs, lithium, linezolid, or St. John’s Wort. During the treatment when patient is treated with tramadol hydrochloride (extended release) and other medications that influence serotonergic neurotransmitter system, extra caution should be taken during initial stages of treatment and increment of dose.

CNS depressants

Tramadol hydrochloride (extended release) needs to be taken with extra caution and in low doses when given to the patients using CNS depressants like narcotics, anesthetic agents, opioids, sedative hypnotics, tranquilizers or phenothiazines. Tramadol hydrochloride (extended release) enhances the risk of respiratory and CNS depression in patients.

Warfarins and Digoxin

Some reports have indicated adjustment of warafin and digoxin toxicity effect including increase in prothrombin times.


Quinidine is a powerful inhibitor of CYP2D6. As per studies related to drug interactions, Tramadol doesn’t have any effect on metabolism of quinidine.

CYP3A4 Inducers

Patients using carbamazepine (CYP3A4 inducer) with Tramadol can have less analgesic effect of Tramadol as carbamazepine enhances metabolism of Tramadol and due to risk of seizures linked to tramadol, parallel use of tramadol hydrochloride(extended release)   and carbamazepine is not advised.

Do not take alcohol with tramadol and also let your doctor know if you are taking other medicines for allergy, cold, cough, anxiety, sleep, muscle relaxants, pain relievers (narcotic) psychiatric medicines etc., your doctor can help you know about the drug interactions and how to avoid them. He can recommend a dose change or other alternative medicines that can help you avoid risks associated with drug interactions.

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