Ketorolac Tromethamine in Pregnancy and Lactation: Risks by Trimester

Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2), reducing prostaglandin synthesis. Prostaglandins mediate inflammation, pain, fever, and maintain renal blood flow, gastric mucosal protection, and uterine quiescence.

Pregnancy Risk by Trimester

• First Trimester: Slightly increased miscarriage risk (prostaglandin inhibition may impair implantation/decidualization). Avoid unless benefits clearly outweigh risks.
• Second Trimester: Generally avoided. May be used if no safer alternative exists and benefits justify risk. Monitor fetal renal function/amniotic fluid.
• Third Trimester: Contraindicated. High risk of premature closure of fetal ductus arteriosus (critical for fetal circulation), leading to pulmonary hypertension, right heart failure, and hydrops fetalis. Also risks: oligohydramnios (fetal renal impairment), necrotizing enterocolitis, intracranial hemorrhage, platelet dysfunction, and prolonged maternal labor/postpartum hemorrhage.

Lactation

Ketorolac is excreted in breast milk in small amounts. Not recommended during breastfeeding due to potential adverse effects on infant (GI bleeding, renal impairment, platelet dysfunction). If essential, consider pumping/discarding milk for 24–48 hours after last dose.

Clinical Guidance

Always consult obstetrician/prescriber. Safer alternatives for pain in pregnancy include acetaminophen (first-line), certain opioids (short-term), and non-pharmacologic measures. Ketorolac use is generally limited to ≤5 days in non-pregnant adults.