Ketorolac Safety During Breastfeeding
Ketorolac is safe and compatible with breastfeeding, including in the early postpartum period, and can be used without interrupting nursing or discarding breast milk. 1, 2, 3
Evidence-Based Safety Profile
The Association of Anaesthetists explicitly lists ketorolac as a compatible NSAID for breastfeeding mothers, with no requirement to interrupt nursing or express and discard milk. 1, 2, 3
Ketorolac transfers into breast milk in very low concentrations without demonstrable adverse effects in the neonate. 3 The FDA label confirms that 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. 4
The calculated maximum daily infant exposure is 0.00263 mg/kg/day, representing only 0.4% of the maternal weight-adjusted dose—well below the 10% safety threshold established for breastfeeding medications. 4
Levels were undetectable (less than 5 ng/mL) in 4 of 10 breastfeeding women studied 2–6 days postpartum. 4
Clinical Recommendations for Use
Breastfeeding can continue immediately after ketorolac administration without any waiting period. 3 Expressing and discarding breast milk is unnecessary and offers no safety benefit. 2
Use the lowest effective dose for the shortest duration needed, consistent with multimodal analgesia principles. 1, 2, 3
Ketorolac is recommended as a preferred option over opioids for breastfeeding women due to its favorable safety profile and lack of infant sedation or respiratory depression risk. 2, 3
Combining ketorolac with paracetamol (acetaminophen) provides effective multimodal analgesia while minimizing total NSAID exposure. 2, 5
Special Considerations for Young Infants
Extra caution is required for infants less than 6 weeks of age (corrected for gestational age) due to immature hepatic and renal function, though ketorolac remains a safe option even in this population. 3, 5
Preterm infants have the highest medication sensitivity, followed by neonates, then young infants. 2, 5
Monitor infants for any unusual signs (though adverse events have not been documented in the literature), and instruct mothers to contact their infant's healthcare provider if concerns arise. 4
Alternative Safe Analgesics
If ketorolac is contraindicated or unavailable, the following NSAIDs are equally safe during breastfeeding:
Ibuprofen is the first-line NSAID choice with the most reassuring safety data during lactation. 2, 5
Diclofenac is the second-safest NSAID option after ibuprofen. 2, 5
Naproxen is safe despite its longer half-life and is widely used postpartum. 2, 5
Paracetamol (acetaminophen) is equally safe and can be used as a first-line alternative or in combination with NSAIDs. 2, 5
Important Caveats and Contraindications
Avoid aspirin in analgesic doses during breastfeeding due to risk of salicylate intoxication and neonatal bleeding. 2
Opioids should not be used as default analgesics for breastfeeding mothers; they carry significantly higher risks of infant sedation, respiratory depression, and mortality compared with ketorolac and other NSAIDs. 2, 5
Follow standard NSAID contraindications: avoid in patients with active gastrointestinal bleeding, severe renal impairment, or hypersensitivity to NSAIDs. 4, 6
Limit duration of ketorolac therapy to minimize risk of adverse effects (gastrointestinal, renal, or bleeding complications increase with prolonged use beyond 5 days, especially in elderly patients—though this applies to maternal safety rather than infant exposure). 6