From the Guidelines
NSAIDs like ibuprofen and ketorolac are generally considered safe during breastfeeding, with minimal amounts transferring into breast milk and unlikely to cause adverse effects in the nursing infant. According to the most recent guideline from the Association of Anaesthetists 1, ibuprofen has been used extensively for postpartum pain and during lactation, and is considered safe to use during breastfeeding. Similarly, ketorolac is also considered compatible with breastfeeding, with low levels detected in breast milk without demonstrable adverse effects in the neonate.
When considering the use of NSAIDs during breastfeeding, it's essential to weigh the benefits and risks. The American Academy of Pediatrics considers ibuprofen, indomethacin, and naproxen safe in breastfeeding women, with trace amounts found in breast milk 1. However, it's crucial to note that most NSAIDs displace bilirubin, making them contraindicated when breastfeeding a neonate with jaundice.
Key points to consider when using NSAIDs during breastfeeding include:
- Ibuprofen can be taken at standard doses (400-600mg every 6-8 hours as needed)
- Ketorolac should only be used short-term (typically no more than 5 days) due to its potency
- The amount of NSAIDs that transfers into breast milk is minimal and unlikely to cause adverse effects in the nursing infant
- As with any medication during breastfeeding, it's best to take the lowest effective dose for the shortest duration needed to treat symptoms.
Overall, the use of NSAIDs like ibuprofen and ketorolac during breastfeeding is considered safe, with minimal risks to the nursing infant, as long as the lowest effective dose is used for the shortest duration necessary 1.
From the FDA Drug Label
Limited data from one published study involving 10 breastfeeding women 2 to 6 days postpartum showed low levels of ketorolac in breast milk. After a single administration of 10 mg of ketorolac tromethamine tablets, the maximum milk concentration observed was 7.3 ng/mL, and the maximum milk-to-plasma ratio was 0. 037. Assuming a daily intake of 400 to 1,000 mL of human milk per day and a maternal body weight of 60 kg, the calculated maximum daily infant exposure was 0.00263 mg/kg/day, which is 0. 4% of the maternal weight-adjusted dose. Exercise caution when ketorolac is administered to a nursing woman. It is not known whether this drug (ibuprofen) is excreted in human milk Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from ibuprofen tablets, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
NSAIDs and Breastfeeding
- Ketorolac: Low levels in breast milk, exercise caution when administered to a nursing woman 2.
- Ibuprofen: Unknown if excreted in human milk, consider discontinuing nursing or the drug due to potential for serious adverse reactions in nursing infants 3. Due to the limited information and potential risks, it is recommended to exercise caution when using NSAIDs, such as ibuprofen and ketorolac, during breastfeeding.
From the Research
Safety of NSAIDs during Breastfeeding
- The safety of NSAIDs, such as Ibuprofen (IBU) and Ketorolac (Toradol), during breastfeeding is a concern for many mothers.
- According to a study published in the American Family Physician 4, acetaminophen and ibuprofen are preferred analgesics during lactation, indicating that ibuprofen is considered safe for use during breastfeeding.
- However, there is limited information available on the safety of ketorolac during breastfeeding.
- A study published in the journal Paediatric Drugs 5 discusses the use of NSAIDs in children, including ibuprofen and ketorolac, but does not provide specific information on their safety during breastfeeding.
- Another study published in the journal Current Drug Metabolism 6 discusses the use of NSAIDs during pregnancy, but does not provide information on their safety during breastfeeding.
- A study published in the journal Drugs 7 provides an evidence-based appraisal of the use of ibuprofen in children, but does not specifically address its safety during breastfeeding.
Key Considerations
- When prescribing medications for a breastfeeding patient, those with the lowest risk to the infant should be selected, and dosing should be before the infant's longest sleep interval 4.
- The amount of medication that enters breast milk varies based on the maternal serum concentration and the pharmacologic properties of the medication 4.
- It is essential to use current, accurate resources, such as LactMed, to determine the safety of medications during breastfeeding 4.