Since I don't know the drug with this brand name, I've wondered what it is,
and what it would be used for.  Turns out it is marketed in Norway under the
same name.  From Roche's website I learned it is ketorolac tromethamine, a
very potent non-steroidal antiprostaglandin drug, used for postoperative
pain.  Again according to Roche, it is contraindicated in labor because of
the theoretical risk of premature closure of the ductus arteriosus in the
fetus.  They cite a protein binding percent of 99.2, which leaves only 0.8%
of the drug available to get into milk, but still say it is contraindicated
in breastfeeding women because of the potential risks to the baby, mainly of
hemorrhage.  The maximum milk-to-plasma ratio achieved in tests was 0.037,
and after 24 hours on Toradol, with four doses, the ratio actually sank, to
0.025.  If I am not mistaken that is twenty-five one-thousandths of the
maternal plasma concentration, which sounds small to me.  The Norwegian
reference work on breastfeeding and medication states that 'transfer to
breast milk is minimal' but as far as I know this drug is not in use in
obstetrics here at all.  We do use antiprostaglandins for afterpains and for
postoperative pain and suture pain, and we don't see any problems in babies
from it.

We also don't use Stadol (R), and since the name resembles the brand name of
ketorolac, I thought perhaps they were related drugs.  They sure aren't!
Stadol is the brand name of butorphanol tartrate, an opioid analgesic, which
is nothing like antiprostaglandins at all, in mechanism of action nor in
side effects.  The 'grandmother' of opioid drugs is morphine.  The
'grandmother' of non-steroidal antiprostaglandins is aspirin
(acetylsalicylic acid).  Both mothers have descendants in use today that
only remotely resemble them, but you will never find a warning not to
operate heavy machinery after taking antiprostaglandins, while you will
always find them with opioids.

Once again, I make a plea for the use of GENERIC drug names on this list.
Often that will give you more of a clue about the drug category than the
brand name, which is thought up by a committee of marketing staff to sound
scientific and solidly reassuring, and is usually just a string of syllables
that means nothing.

Rachel Myr
Kristiansand, Norway

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