Last update Dec. 30, 2021

(±)-5-Benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid compound with 2-amino-2-(hydroxymethyl)-1,3-propanediol (1 : 1)


Safe substance and/or breastfeeding is the best option.

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)


  • Ibuprofen (Safe substance and/or breastfeeding is the best option.)
  • Paracetamol (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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

(±)-5-Benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid compound with 2-amino-2-(hydroxymethyl)-1,3-propanediol (1 : 1) is Ketorolac Trometamol in Chemical name.

Is written in other languages:


(±)-5-Benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid compound with 2-amino-2-(hydroxymethyl)-1,3-propanediol (1 : 1) belongs to this group or family:


Main tradenames from several countries containing (±)-5-Benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid compound with 2-amino-2-(hydroxymethyl)-1,3-propanediol (1 : 1) in its composition:


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
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 %


  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. Lamvu G, Feranec J, Blanton E. Perioperative pain management: an update for obstetrician-gynecologists. Am J Obstet Gynecol. 2018 Feb;218(2):193-199. Abstract
  5. 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
  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. Martin LD, Jimenez N, Lynn AM. A review of perioperative anesthesia and analgesia for infants: updates and trends to watch. F1000Res. 2017 Abstract
  8. 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)
  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. 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
  11. Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007 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. 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
  14. 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)
  15. 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)
  16. Brocks DR, Jamali F. Clinical pharmacokinetics of ketorolac tromethamine. Clin Pharmacokinet. 1992 Abstract
  17. 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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