Is Toradol (ketorolac) safe to use while breastfeeding a 7-month-old infant?

Ketorolac (Toradol) Use During Breastfeeding for a 7-Month-Old Infant

Ketorolac is compatible with breastfeeding a 7-month-old infant, as it transfers into breast milk in very low amounts with no demonstrable adverse effects in the infant. 1

Safety Profile of Ketorolac During Breastfeeding

Evidence on Ketorolac Transfer into Breast Milk

• Research has shown that ketorolac transfers into breast milk in minimal amounts:
  • In a study of 10 breastfeeding women, milk concentrations were either undetectable or very low (5.2-7.9 ng/mL) 2
  • The milk-to-plasma ratio ranged from only 0.015 to 0.037 2
  • The maximum potential infant exposure is estimated at 0.16% to 0.40% of the maternal weight-adjusted dose 3, 2

Age Considerations

• At 7 months of age, an infant has more mature hepatic and renal function compared to neonates, making them less vulnerable to potential medication effects
• The Association of Anaesthetists guideline specifically notes that infants less than 6 weeks of age require extra caution with medications, but your 7-month-old is well beyond this threshold 1

Clinical Recommendations

Administration Guidelines

• Use the lowest effective dose for the shortest duration possible
• No need to "pump and dump" or interrupt breastfeeding when using ketorolac 1
• For postoperative pain, ketorolac can be used as part of a multimodal pain management approach 1, 4

Monitoring

• Although adverse effects are unlikely, observe the infant for any unusual symptoms
• If you notice any changes in the infant's behavior, feeding patterns, or alertness, contact a healthcare provider

Alternative Pain Management Options

If you have concerns about using ketorolac, other NSAIDs that are also considered safe during breastfeeding include:

• Ibuprofen: Has been used extensively during lactation and is considered safe 1
• Diclofenac: Small amounts detected in breast milk; considered safe during breastfeeding 1
• Naproxen: Although it has a longer half-life than diclofenac, it is widely used and considered safe 1

Important Considerations

• The benefits of adequate pain control for the breastfeeding mother often outweigh the minimal risks to the infant
• Untreated pain can interfere with successful breastfeeding by affecting milk letdown reflex and comfortable positioning 4
• For surgical pain, using non-opioid analgesics like ketorolac can help minimize the need for opioids, which may have more significant effects on the infant 1, 4

In conclusion, current evidence supports that ketorolac is a safe option for a breastfeeding mother with a 7-month-old infant, with minimal transfer into breast milk and no reported adverse effects in nursing infants.