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In the past I have seen that Toradol is an L2 category for breastfeeding moms. Our anesthesia departments and OB departments are now saying it is contraindicated in nursing moms due to effects of prostaglandins. I know the manufacturers say it is contraindicated but is there new research out there? We find this a tremendously effective post-op drug for moms both for pain relief and and the fact that it is non sedating and they can therefore care for their babies. And isn't this what they used to say about Motrin which we give our moms once on oral meds.
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Smweers:
Much of the information on Toradol (ketorolac) is somewhat misplaced and misunderstood. It is true that Ketorolac has an FDA warning on its use FOLLOWING delivery, because it can increase the risk of hemorrhage. Everyone knows that ALL NSAIDs increase the risk of bleeding, but if the mom is not at risk for hemorrhage, there is is really no risk to the mom. Many if not most obstetricians in the USA, still use Ketorolac post-delivery because it is a wonderful analgesic, with minimal complications.
As for a risk to the infant, it is negligible at best. First, very little ketorolac is present in human milk, maybe 3-8 micrograms per day. Secondly, the volume of colostrum is minimal (30-60 cc/day), then the dose the infant receives early postpartum is miniscule.
The only possible contraindication that I could think of would be in premature infants in whom they want to keep the patent ductas open. I doubt that this dose would have any effect whatsoever on the closing an open duct. Even significant doses of indomethacin have problems keeping it open.
So I personally think most of the fright associated with the use of Ketorolac in breastfeeding mothers is simply incorrect. If the physician is careful, and does not use it in women susceptible to hemorrhage, then it should be fine.
Tom Hale Ph.D.
Professor
TTUHSC
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