Is IV Toradol (ketorolac) safe for use in breastfeeding patients?

IV Toradol Safety During Breastfeeding

IV Toradol (ketorolac) is safe and compatible with breastfeeding as it transfers into breast milk in very low concentrations without demonstrable adverse effects in the neonate. 1, 2

Evidence for Safety

• Ketorolac is specifically listed as a safe analgesic option for breastfeeding women by the Association of Anaesthetists in their 2020 guidelines 3
• The American College of Anaesthesia recommends ketorolac as safe during breastfeeding due to minimal transfer into breast milk 1
• FDA data shows that after administration of ketorolac, the maximum milk concentration observed was only 7.3 ng/mL, with a maximum milk-to-plasma ratio of 0.037 4
• The calculated maximum daily infant exposure is approximately 0.00263 mg/kg/day, which is only 0.4% of the maternal weight-adjusted dose 4

Pharmacokinetic Considerations

• After a single 10 mg dose of ketorolac, breast milk levels are very low and often undetectable (less than 5 ng/mL) in some patients 4
• Even with multiple doses (10 mg every 6 hours), the maximum milk concentration remains low at 7.9 ng/mL 4
• The minimal transfer into breast milk makes it a suitable option for postoperative pain management in breastfeeding mothers 3, 1

Clinical Recommendations

• Ketorolac can be used as part of a multimodal analgesia approach for breastfeeding women 3
• NSAIDs, including ketorolac, are preferred over opioids when possible for breastfeeding women due to their favorable safety profile 3, 2
• No waiting period or "pump and dump" is required after ketorolac administration before resuming breastfeeding 1

Alternative Options

• Other NSAIDs with established safety during breastfeeding include:
  • Ibuprofen (first-line option due to extensive study) 2
  • Diclofenac 2
  • Naproxen 2
  • Celecoxib 2
• Acetaminophen (paracetamol) is another safe alternative for pain management during breastfeeding 1, 5

Monitoring Considerations

• While adverse events in nursing infants are rare with ketorolac, mothers should be instructed to contact their infant's healthcare provider if they notice any unusual symptoms 4
• Unlike opioids, ketorolac does not cause respiratory depression, sedation, or other concerning effects in breastfed infants 6

Important Caveats

• The maximum recommended duration of IV ketorolac treatment is 48 hours 6
• Ketorolac, like other NSAIDs, should be used at the lowest effective dose for the shortest period of time 3
• Special consideration should be given to infants less than 6 weeks of age (corrected for gestation) due to their immature hepatic and renal function 3