Is intramuscular (IM) Toradol (ketorolac) and Norflex (orphenadrine) safe for a breastfeeding mother?

Safety of IM Toradol (Ketorolac) and Norflex (Orphenadrine) During Breastfeeding

Ketorolac (Toradol) is safe for breastfeeding mothers, with low levels detected in breast milk and no demonstrable adverse effects in the infant, but orphenadrine (Norflex) should be avoided due to lack of safety data in breastfeeding. 1, 2

Ketorolac (Toradol) Safety in Breastfeeding

Evidence on Safety

• Ketorolac is considered compatible with breastfeeding according to the Association of Anaesthetists' 2020 guidelines 1
• Only low levels are detected in breast milk without demonstrable adverse effects in the neonate 1
• FDA data shows that after a single 10mg dose, the maximum milk concentration was only 7.3 ng/mL, with a maximum milk-to-plasma ratio of 0.037 3
• The calculated maximum daily infant exposure is approximately 0.4% of the maternal weight-adjusted dose 3

Administration Recommendations

• Use the lowest effective dose for the shortest duration possible 2
• Take immediately after breastfeeding to maximize clearance time before the next feeding 2
• Standard adult dosing is appropriate with no special dosage adjustment needed for lactation 2

Precautions

• Exercise extra caution if the nursing infant is less than 6 weeks of age due to immature hepatic and renal function 2
• Monitor the infant for any unusual symptoms, although adverse events in nursing infants have not been specifically reported with ketorolac 3

Orphenadrine (Norflex) in Breastfeeding

There is a significant lack of data regarding the safety of orphenadrine during breastfeeding:

• No specific information about orphenadrine (Norflex) appears in any of the provided guidelines or research evidence
• Due to this lack of safety data, orphenadrine should be avoided during breastfeeding
• Consider alternative muscle relaxants or non-pharmacological approaches for muscle spasm

Alternative Approaches for Pain Management in Breastfeeding

First-Line Options

• Topical NSAIDs with or without menthol gel (minimal systemic absorption) 2
• Oral NSAIDs like ibuprofen or naproxen (both considered safe) 2
• Paracetamol/acetaminophen (safe during breastfeeding) 2, 4

Non-Pharmacological Approaches

• Transcutaneous electrical nerve stimulation (TENS) 2
• Specific acupressure techniques 2
• Physical therapy and appropriate rest

Important Considerations

Benefits vs. Risks

• Adequate pain control is important not only for maternal comfort but also for successful breastfeeding 2
• The benefits of using medications like ketorolac for appropriate pain management clearly outweigh the minimal risks to the nursing infant 2
• Untreated pain can interfere with successful breastfeeding by affecting milk letdown reflex and comfortable positioning 2

When to Use Caution

• If the infant shows any signs of sedation, respiratory depression, or feeding difficulties, contact healthcare provider immediately
• For stronger pain control, morphine is considered the opioid of choice when needed, with single doses not expected to cause detrimental effects to infants 1, 2

In summary, ketorolac (Toradol) can be safely used in breastfeeding mothers with minimal risk to the infant, but orphenadrine (Norflex) should be avoided due to insufficient safety data. Consider alternative muscle relaxants or non-pharmacological approaches for muscle spasm management.