Toradol (Ketorolac) and Breastfeeding
Ketorolac is safe and compatible with breastfeeding, as it passes into breast milk in very low concentrations without demonstrable adverse effects in the neonate. 1
Evidence for Safety
The Association of Anaesthetists 2020 guidelines explicitly state that ketorolac is compatible with breastfeeding, with low levels detected in breast milk and no adverse neonatal effects. 1, 2
Pharmacokinetic Data Supporting Safety
- After a single 10 mg oral dose, the maximum milk concentration was only 7.3 ng/mL, with a milk-to-plasma ratio of 0.037 3, 4
- After repeated dosing (10 mg every 6 hours for one day), the maximum milk concentration remained low at 7.9 ng/mL, with a milk-to-plasma ratio of 0.025 3, 4
- In four out of ten breastfeeding women studied, ketorolac levels in milk were undetectable (less than 5 ng/mL) 3, 4
- The calculated maximum daily infant exposure is only 0.00263 mg/kg/day, which represents just 0.4% of the maternal weight-adjusted dose 3
Clinical Recommendations
Breastfeeding can continue immediately after ketorolac administration without any waiting period. 1, 2
- Ketorolac is recommended as a preferred analgesic option over opioids for breastfeeding women due to its favorable safety profile 2
- It should be used as part of multimodal analgesia at the lowest effective dose for the shortest duration 2
- No special monitoring of the infant is required, though mothers should contact their infant's healthcare provider if any adverse events are noted 3
Important Caveats
Special consideration should be given to infants less than 6 weeks of age (corrected for gestation) due to their immature hepatic and renal function. 2
- While ketorolac is generally safe, exercise caution when administering to nursing women, particularly with very young or premature infants 3
- The minimal transfer into breast milk makes it substantially safer than many opioid alternatives that carry risks of infant sedation and respiratory depression 1, 2
Comparison to Alternative Analgesics
Ketorolac stands alongside other NSAIDs (ibuprofen, diclofenac) and acetaminophen as first-line safe options for pain management during breastfeeding 2. This contrasts sharply with opioids like codeine (contraindicated due to unpredictable metabolism) and oxycodone (risk of infant sedation at doses >30 mg/day) 1, 5.