Is Ketorolac Trometamol compatible with breastfeeding? Do we have alternatives for Ketorolac Trometamol?

Ketorolac Trometamol

March 2, 2018 (Very Low Risk)

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.

Excretion into breast milk is insignificant (Wischnik 1989).

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

Various medical societies and expert consensus consider the use of this medication safe during breastfeeding (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

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • Κετορολάκη Τρομεταμόλη (Greek)
  • Кеторолак Трометамол (Cyrillic)
  • ケトロラクトロメタミン (Japanese)
  • C19 H24 N2 O6 (Molecular formula)
  • (±)-5-Benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid compound with 2-amino-2-(hydroxymethyl)-1,3-propanediol (1 : 1) (Chemical name)
  • M01AB15; S01BC05 (ATC Code/s)

References

  1. 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. Breastfeeding Medicine. 2017 Full text (link to original source) Full text (in our servers)
  2. Martin LD, Jimenez N, Lynn AM. A review of perioperative anesthesia and analgesia for infants: updates and trends to watch. F1000Res. 2017Abstract
  3. 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. 2013Abstract Full text (in our servers)
  4. 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. 2011Abstract
  5. 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. 2011Abstract
  6. Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007Abstract
  7. 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. 2004Abstract
  8. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001Abstract Full text (link to original source) Full text (in our servers)
  9. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993Abstract Full text (link to original source) Full text (in our servers)
  10. Brocks DR, Jamali F. Clinical pharmacokinetics of ketorolac tromethamine. Clin Pharmacokinet. 1992Abstract
  11. 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. 1989Abstract