Is Toradol (ketorolac) and Robaxin (methocarbamol) safe for a breastfeeding mother?

Safety of Toradol (Ketorolac) and Robaxin (Methocarbamol) in Breastfeeding

Toradol (ketorolac) is safe for breastfeeding mothers and can be used without interrupting nursing, while Robaxin (methocarbamol) should be used with caution due to insufficient safety data in human lactation. 1, 2

Ketorolac (Toradol) - Safe and Compatible

The Association of Anaesthetists explicitly lists ketorolac as a safe analgesic option for breastfeeding women in their 2020 guidelines. 1 This recommendation is based on several key factors:

Pharmacokinetic Profile

• Ketorolac transfers into breast milk in very low concentrations, with levels often undetectable (less than 5 ng/mL) 3
• After a single 10 mg dose, the maximum milk concentration was only 7.3 ng/mL with a milk-to-plasma ratio of 0.037 3
• The calculated maximum daily infant exposure is 0.00263 mg/kg/day, representing only 0.4% of the maternal weight-adjusted dose 3

Clinical Use Recommendations

• Breastfeeding can continue immediately after ketorolac administration without any waiting period 1
• Ketorolac is preferred over opioids due to its favorable safety profile and avoidance of infant sedation and respiratory depression risks 1
• Use at the lowest effective dose for the shortest duration 1
• Ketorolac is considered a first-line NSAID option alongside ibuprofen and diclofenac 4, 5

Special Considerations

• Exercise additional caution in infants less than 6 weeks of age (corrected for gestation) due to immature hepatic and renal function 1
• Monitor for any adverse events in the infant, though no specific adverse events have been documented in nursing infants 3

Methocarbamol (Robaxin) - Use with Caution

Methocarbamol has insufficient human lactation data and should be used cautiously, only when clearly needed. 2

Limited Safety Data

• Methocarbamol and/or its metabolites are excreted in dog milk, but it is not known whether methocarbamol or its metabolites are excreted in human milk 2
• The FDA label explicitly states "caution should be exercised when methocarbamol is administered to a nursing woman" 2
• No human studies exist documenting safety or infant exposure levels during breastfeeding 2

Additional Concerns

• Methocarbamol possesses CNS-depressant effects that could theoretically affect a breastfed infant 2
• The drug may cause drowsiness and dizziness in adults, raising concerns about potential infant sedation 2
• Safety and effectiveness have not been established in pediatric patients below age 16 2

Clinical Decision Algorithm

For pain management in breastfeeding mothers:

1. First-line choice: Use ketorolac (Toradol) alone if NSAID analgesia is sufficient 1, 5
2. Alternative NSAIDs: Ibuprofen or diclofenac are equally safe alternatives if ketorolac is unavailable 4, 5
3. Avoid or minimize: Methocarbamol (Robaxin) unless muscle relaxation is absolutely necessary and benefits clearly outweigh unknown risks 2
4. If muscle relaxant needed: Consider non-pharmacologic approaches first or use methocarbamol for the shortest duration possible while monitoring infant closely for sedation 2

Common Pitfalls to Avoid

• Do not unnecessarily discontinue breastfeeding when ketorolac is prescribed, as this is safe and compatible 1
• Do not assume all muscle relaxants are well-studied in lactation; methocarbamol specifically lacks human data 2
• Do not use combination products containing multiple ingredients when single agents would suffice 6
• Do not forget to consider infant age when prescribing ketorolac to mothers of very young infants (under 6 weeks) 1