Ketorolac Tromethamine (Toradol) and Pregnancy: Essential Insights for Expecting Mothers

Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug (NSAID), is commonly used to manage pain. However, it is not considered safe during pregnancy due to potential risks to the developing fetus.

Risks During Pregnancy

NSAIDs, including ketorolac tromethamine, can cause premature closure of the fetal ductus arteriosus—a vital blood vessel in the developing heart—if taken at about 30 weeks gestation or later. Premature closure can lead to serious complications for the baby.

Use of ketorolac tromethamine at around 20 weeks gestation or later may also affect fetal kidney function, sometimes leading to reduced amniotic fluid (oligohydramnios) and, in rare cases, neonatal kidney problems. If treatment is necessary between 20 and 30 weeks, the lowest effective dose should be used for the shortest time possible. Ultrasound monitoring may be recommended if treatment extends beyond 48 hours.

While the risks earlier in pregnancy (before 20 weeks) are less well-defined, ketorolac may still affect fetal development, so its use should only occur under an obstetrician’s supervision.

Data from Studies

Human studies have reported cases of fetal kidney dysfunction and reduced amniotic fluid associated with maternal NSAID use after 20 weeks. While some effects are reversible upon stopping the medication, severe cases may require medical intervention after birth.

Animal studies suggest that NSAIDs can affect fetal kidney development and may increase the risk of complications during labor if used late in pregnancy. Ketorolac is contraindicated during labor due to its potential to reduce uterine contractions and increase bleeding risk.

Other Considerations

• Fertility: Prostaglandin inhibitors like ketorolac may impair fertility and are not recommended for women trying to conceive.

• Breastfeeding: Low levels of ketorolac are detected in breast milk. Although adverse effects in nursing infants are rare, caution is advised.

Key Takeaway for Pregnancy

Ketorolac tromethamine (Toradol) is not considered safe during pregnancy, especially after 20 weeks gestation, due to risks to the baby’s heart and kidneys. Use of Toradol should only occur under the direct supervision of an obstetrician. At our clinic, we do not provide Toradol to pregnant women. Always consult your healthcare provider before taking any NSAID during pregnancy.