Last update Dec. 30, 2021

Ketorolac Trometamol

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Non-steroidal anti-inflammatory drug (NSAID) structurally related to indometacin, with less anti-inflammatory effect than other NSAIDs. Oral or intravenous administration every 6 hours.

It is excreted in breast milk in clinically insignificant amounts (Wischnik 1989). No problems have been observed in infants whose mothers received ketorolac during caesarean section (Hadley 2019). Administration of a dose of ketorolac during or immediately after caesarean section did not affect breastfeeding rates (Yurashevich 2020, Hadley 2019).

Pain control with sufficient doses of ketorolac improves exclusive breastfeeding rates. (Teigen 2020)

Authorized use in neonates from 21 days old. (Martin 2017, Cohen 2011, Aldrink 2011, Papacci 2004)

Various medical societies and expert consensus consider the use of this medication safe during breastfeeding (Wagner 2018, Reece 2017, Worthington 2013, Østensen 2007, Lee 1993), although most recommend limited dosage and duration and oral administration. Since the possibility of harmful effects on the blood and kidney among treated patients is controversial (not through breast milk) high dosing would better be avoided within 21 days post delivery. (Reece 2017, Worthington 2013)

Keratolac eye drops are very safe because a low content of drug.

American Academy of Pediatrics: medication usually compatible with breastfeeding.(AAP 2001)

Alternatives

  • Ibuprofen ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Paracetamol ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Ketorolac Trometamol in other languages or writings:

Group

Ketorolac Trometamol belongs to this group or family:

Tradenames

Main tradenames from several countries containing Ketorolac Trometamol in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 81 %
Molecular weight 255 daltons
Protein Binding 99 %
VD 0.2 l/Kg
pKa 3.5 -
Tmax 0.5 - 1 hours
T1/2 4 - 6 hours
M/P ratio 0.02 - 0.04 -
Theoretical Dose 0.0012 mg/Kg/d
Relative Dose 0.18 %
Ped.Relat.Dose 0.059 %

References

  1. Teigen NC, Sahasrabudhe N, Doulaveris G, Xie X, Negassa A, Bernstein J, Bernstein PS. Enhanced recovery after surgery at cesarean delivery to reduce postoperative length of stay: a randomized controlled trial. Am J Obstet Gynecol. 2020 Apr;222(4):372.e1-372.e10. Abstract
  2. Yurashevich M, Pedro C, Fuller M, Habib AS. Intra-operative ketorolac 15 mg versus 30 mg for analgesia following cesarean delivery: a retrospective study. Int J Obstet Anesth. 2020 Nov;44:116-121. Abstract
  3. Hadley EE, Monsivais L, Pacheco L, Babazade R, Chiossi G, Ramirez Y, Ellis V, Simon M, Saade GR, Costantine M. Multimodal Pain Management for Cesarean Delivery: A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial. Am J Perinatol. 2019 Sep;36(11):1097-1105. Abstract
  4. Wagner-Kovacec J, Povalej-Brzan P, Mekis D. Efficacy of continuous in-wound infusion of levobupivacaine and ketorolac for post-caesarean section analgesia: a prospective, randomised, double-blind, placebo-controlled trial. BMC Anesthesiol. 2018 Nov 10;18(1):165. Abstract
  5. Martin LD, Jimenez N, Lynn AM. A review of perioperative anesthesia and analgesia for infants: updates and trends to watch. F1000Res. 2017 Abstract
  6. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  7. Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ; Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Sep;40(5 Suppl 3):S1-S80. Review. Abstract Full text (in our servers)
  8. Cohen MN, Christians U, Henthorn T, Vu Tran Z, Moll V, Zuk J, Galinkin J. Pharmacokinetics of single-dose intravenous ketorolac in infants aged 2-11 months. Anesth Analg. 2011 Abstract
  9. Aldrink JH, Ma M, Wang W, Caniano DA, Wispe J, Puthoff T. Safety of ketorolac in surgical neonates and infants 0 to 3 months old. J Pediatr Surg. 2011 Abstract
  10. Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007 Abstract
  11. Papacci P, De Francisci G, Iacobucci T, Giannantonio C, De Carolis MP, Zecca E, Romagnoli C. Use of intravenous ketorolac in the neonate and premature babies. Paediatr Anaesth. 2004 Abstract
  12. Nice FJ, De Eugenio D, Dimino TA, Freeny IC, Rovnack MB, Gromelski JS. Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and Other Healthcare Professionals. Part I. J Pharm Technol 2004;20:17-27. doi: 10.1177/875512250402000106.
  13. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  14. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993 Jul;48(7):616-25. Review. Abstract Full text (link to original source) Full text (in our servers)
  15. Brocks DR, Jamali F. Clinical pharmacokinetics of ketorolac tromethamine. Clin Pharmacokinet. 1992 Abstract
  16. Wischnik A, Manth SM, Lloyd J, Bullingham R, Thompson JS. The excretion of ketorolac tromethamine into breast milk after multiple oral dosing. Eur J Clin Pharmacol. 1989 Abstract

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