IV Ketorolac and IV Morphine interaction

Q: Which precaution should be taken while giving IV Ketorolac in post-operative patients who are also getting IV Morphine?

Answer: Use different ports to avoid precipitation

When giving Ketorolac intravenously through the same IV catheter as morphine, the two drugs have been known to combine and form a precipitate. Line flushing can push the blockage through and may cause embolism. Different ports should be used for each drug.

Another less well-known fact is that ketorolac potentiates the effect of morphine which may cause respiratory depression in postop patients.

#pharmacology

#surgical-critical-care

References:

1. Feng-Sheng Lin,Tzu-Fu Lin,Yu-Chang Yeh,Chih-Peng Lin &Wei-Zen Sun Compatibility and stability of ketorolac tromethamine and morphine hydrochloride in 0.9% sodium chloride injection - Pages 99-103 | Published online: 19 Jul 2013 The Pain Clinic - Volume 19, 2007 - Issue 3 https://doi.org/10.1179/016911107X268701 

2. Picard P, Bazin JE, Conio N, Ruiz F, Schoeffler P. Ketorolac potentiates morphine in postoperative patient-controlled analgesia. Pain. 1997 Dec;73(3):401-406. doi: 10.1016/S0304-3959(97)00128-0. PMID: 9469531.