From the Guidelines
Ketorolac (Toradol) should not be given during pregnancy, except in the immediate postdelivery period for pain management, as its use during pregnancy is not well-established and may pose risks to the fetus.
Evidence for Use in Postdelivery Period
- According to a 2019 study published in the American Journal of Obstetrics and Gynecology 1, ketorolac can be used in the immediate postdelivery period for pain management after cesarean delivery, with a recommended dose of 30 mg intravenously every 6 hours standing for 24 hours.
- This study suggests that ketorolac can be used as part of a multimodal pain management approach, including neuraxial morphine, acetaminophen, and ibuprofen.
Safety during Breastfeeding
- A 2020 guideline published in Anaesthesia 1 states that ketorolac is compatible with breastfeeding, with low levels detected in breast milk and no demonstrable adverse effects in the neonate.
- This guideline suggests that ketorolac can be used during breastfeeding, but it is essential to weigh the benefits and risks of its use during pregnancy.
Key Considerations
- The use of ketorolac during pregnancy is not well-established, and its safety profile is not fully understood.
- Ketorolac should only be used during pregnancy if the benefits outweigh the risks, and under close medical supervision.
- In general, the use of ketorolac during pregnancy should be avoided, except in specific situations where its benefits outweigh the risks, such as in the immediate postdelivery period for pain management.
From the FDA Drug Label
Pregnancy Teratogenic Effects Pregnancy Category C Reproduction studies have been performed during organogenesis using daily oral doses of ketorolac tromethamine at 3.6 mg/kg (0. 37 times the human AUC) in rabbits and at 10 mg/kg (1 times the human AUC) in rats. Results of these studies did not reveal evidence of teratogenicity to the fetus. However, animal reproduction studies are not always predictive of human response Nonteratogenic Effects Because of the known effects of non-steroidal anti-inflammatory drugs on the fetal cardiovascular system (closure of ductus arteriosus), use during pregnancy (particularly late pregnancy) should be avoided.
Pregnancy In late pregnancy, as with other NSAIDs, ketorolac tromethamine should be avoided because it may cause premature closure of the ductus arteriosus.
Ketorolac tromethamine should not be used during pregnancy, especially in late pregnancy, due to the potential risk of premature closure of the ductus arteriosus and other effects on the fetal cardiovascular system 2 2. Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus.
From the Research
Use of Toradol (Ketorolac) During Pregnancy
- The use of Toradol (Ketorolac) during pregnancy has been studied in various contexts, including its effects on fetal kidney outcomes and its efficacy as a tocolytic agent or analgesic.
- A study published in JAMA Pediatrics 3 found that gestational exposure to nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, may increase the risk of adverse fetal kidney outcomes, such as chronic kidney disease (CKD) in childhood.
- The same study found that specific NSAID exposures, including ketorolac, were associated with a higher risk of CKD in the first trimester, highlighting the need for caution when prescribing NSAIDs during pregnancy.
Efficacy and Safety of Toradol (Ketorolac) in Pregnancy
- A comparative study published in the Southern Medical Journal 4 found that ketorolac was more rapid and effective than magnesium sulfate in arresting preterm labor, with no significant difference in neonatal complications between the two groups.
- Another study published in Fertility and Sterility 5 found that the use of ketorolac immediately after oocyte retrieval had no apparent detrimental effect on in vitro fertilization (IVF) pregnancy outcomes, suggesting that it may be a safe and effective analgesic option in this context.
- However, a randomized clinical trial published in Contraception 6 found that intramuscular ketorolac did not offer superior pain control compared to oral ibuprofen for first-trimester surgical abortion, and was associated with significant arm pain.
Pain Control with Toradol (Ketorolac) in Pregnancy
- A double-blind, randomized, placebo-controlled trial published in Contraception 7 found that perioperative ketorolac had a similar effect on postoperative pain as placebo in patients undergoing first-trimester aspiration abortion, although it was associated with reduced use of postoperative acetaminophen.
- These findings suggest that the use of Toradol (Ketorolac) during pregnancy should be carefully considered, taking into account the potential benefits and risks, as well as alternative options for pain control and tocolysis.