Ketorolac

Drug Levels and Effects:




Summary of Use during Lactation:


Milk levels of ketorolac are low with the usual oral dosage, but have not been measured after higher injectable dosages. The US Food and Drug Administration requires a "black box" warning against breastfeeding during maternal ketorolac use of the injection or tablets and nursing is listed as a contraindication with the nasal spray product. Therefore, medicolegal issues may weigh against its use during breastfeeding. Maternal use of ketorolac eye drops do not carry this warning and would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.


Drug Levels:


Maternal Levels.

Ten women who were 2 to 6 days postpartum and were taking ketorolac 10 mg orally four times daily had their milk ketorolac levels measured at various times during 2 days of drug administration. Milk levels were undetectable (<5 mcg/L) in 4 of the patients at all collection times. In the other 6 patients, ketorolac was detectable 2 hours after the first dose of the day in concentrations from 5.2 to 7.3 mcg/L on day 1 and from 5.9 to 7.9 mcg/L on day 2. Ketorolac was not detectable in milk in any patient 10 hours after the last dose.[1] The paper erroneously states that the breastfed infant would receive an estimated 3.16 to 7.9 mg daily based on a calculation error. The correct calculation yields an estimated maximum daily intake of 7.9 mcg or 0.18% of the maternal weight-adjusted dosage.

Infant Levels.

Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:


Relevant published information was not found as of the revision date.


Possible Effects on Lactation:


Relevant published information was not found as of the revision date.


Alternate Drugs to Consider:


Acetaminophen,Flurbiprofen,Ibuprofen,Indomethacin,Naproxen,Piroxicam


References:


1. Wischnik A, Manth SM, Lloyd J et al. The excretion of ketorolac tromethamine into breast milk after multiple oral dosing. Eur J Clin Pharmacol. 1989;36:521-4. PMID:2787750



Substance Identification:




Substance Name:

Ketorolac

CAS Registry Number:

74103-06-3

Drug Class:


  • Analgesic Agents

  • Nonsteroidal Antiinflammatory Agents


  • Administrative Information:




    LactMed Record Number:


    153


    Last Revision Date:


    Disclaimer:Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.