Ketorolac (Toradol) Safety During Breastfeeding
Ketorolac is safe for use during breastfeeding as low levels are detected in breast milk without demonstrable adverse effects in the neonate. 1
Safety Profile in Breastfeeding
- Ketorolac is transferred into breast milk in very low concentrations, making it compatible with breastfeeding 1
- Limited data from one study of 10 breastfeeding women 2-6 days postpartum showed low levels of ketorolac in breast milk, with levels undetectable (less than 5 ng/mL) in 4 of the patients 2
- After a single 10 mg dose of ketorolac, the maximum milk concentration was only 7.3 ng/mL, with a maximum milk-to-plasma ratio of 0.037 2
- With multiple doses (10 mg every 6 hours for 1 day), the maximum milk concentration remained low at 7.9 ng/mL 2
- The calculated maximum daily infant exposure was only 0.00263 mg/kg/day, which is just 0.4% of the maternal weight-adjusted dose 2
Clinical Recommendations
- Ketorolac and other NSAIDs are considered preferred analgesics during lactation 3
- The FDA label notes that available information has not shown any specific adverse events in nursing infants 2
- When prescribing medications for breastfeeding mothers, it's important to select those with the lowest risk to the infant 3
- The amount of medication that enters breast milk depends on maternal serum concentration and pharmacologic properties of the medication 3
Monitoring Considerations
- While ketorolac is considered safe, mothers should be advised to contact their infant's healthcare provider if they notice any adverse events in the infant 2
- The dose received via milk is generally small and much less than known safe doses of the same drug given directly to neonates and infants 4
Alternative Options
- Other NSAIDs like ibuprofen and diclofenac are also considered safe during breastfeeding 1, 5
- Paracetamol (acetaminophen) is another safe alternative for pain management during breastfeeding 5, 3
- Non-pharmacological approaches such as physical therapy and heat/cold therapy can be considered as safe alternatives for muscle spasm and pain 5
Practical Considerations
- Most medications appear in only small amounts within breast milk 6
- The benefits of breastfeeding generally outweigh the potential risks of medication exposure through breast milk 7
- With proper medication selection and timing, mothers can usually continue breastfeeding while receiving necessary treatment 6