Is ketorolac (nonsteroidal anti-inflammatory drug (NSAID)) safe to use during breastfeeding?

Ketorolac Safety in Breastfeeding

Yes, ketorolac is safe to use during breastfeeding and does not require interruption of nursing or discarding breast milk. 1

Guideline-Based Recommendations

The Association of Anaesthetists explicitly lists ketorolac as a safe analgesic option for breastfeeding women in their 2020 guidelines. 1 This represents the most authoritative guidance on this question, as ketorolac is specifically recommended as part of multimodal analgesia approaches for lactating mothers. 1

Key Safety Evidence

• Ketorolac transfers into breast milk in very low concentrations without demonstrable adverse effects in the neonate. 1
• The minimal transfer into breast milk makes ketorolac substantially safer than opioid alternatives, which carry risks of infant sedation and respiratory depression. 1
• Breastfeeding can continue immediately after ketorolac administration without any waiting period. 1

FDA Drug Label Information

The FDA label provides supportive pharmacokinetic data: 2

• After a single 10 mg oral dose, the maximum milk concentration was 7.3 ng/mL with a milk-to-plasma ratio of 0.037. 2
• After repeated dosing (10 mg every 6 hours for 1 day), the maximum milk concentration was 7.9 ng/mL with a milk-to-plasma ratio of 0.025. 2
• The calculated maximum daily infant exposure was 0.00263 mg/kg/day, which represents only 0.4% of the maternal weight-adjusted dose. 2
• The FDA label states to "exercise caution" but notes that available information has not shown any specific adverse events in nursing infants. 2

Clinical Implementation

Dosing Strategy

• Use the lowest effective dose for the shortest period of time. 1
• Ketorolac should be incorporated into multimodal analgesia regimens to minimize the need for opioids. 1

Special Populations Requiring Extra Consideration

• Infants less than 6 weeks of age (corrected for gestation) warrant additional caution due to immature hepatic and renal function. 1
• However, this caution applies more significantly to opioids than to NSAIDs like ketorolac. 1

Comparison with Alternative Analgesics

The Association of Anaesthetists confirms that other NSAIDs are equally safe alternatives: 1, 3

• Ibuprofen - extensively studied with excellent safety data 3
• Diclofenac - also compatible with breastfeeding 4
• Paracetamol (acetaminophen) - safe alternative with different mechanism of action 3

Advantages of Ketorolac Over Opioids

• Ketorolac is preferred over opioids due to its favorable safety profile. 1
• Unlike opioids, ketorolac does not cause infant sedation or respiratory depression. 1
• Mothers can maintain their ability to care for their infants without sedation concerns. 4

Common Pitfalls to Avoid

• Do not advise mothers to "pump and dump" after ketorolac administration - this is completely unnecessary given the minimal milk transfer. 1
• Do not unnecessarily delay breastfeeding - immediate nursing after administration is safe. 1
• Do not default to opioids when NSAIDs like ketorolac are appropriate - this exposes infants to greater risks. 1

Supporting Evidence Quality

The 2020 Association of Anaesthetists guideline 5, 1 represents the highest quality evidence available, as it is a recent, specialty-specific guideline from a prestigious international society that directly addresses anesthesia and analgesia in breastfeeding women. This guideline explicitly names ketorolac as compatible with breastfeeding, making the recommendation straightforward and unambiguous.