To Rachel Myr
Thank you for reminding us to use generic names for drugs. I totally
forgot but from now on will make a real effort to remember that this
list is cosmopolitan and I am not just speaking to the USA.
Jan Aken Rn IBCLC
> -----Original Message-----
> From: Lactation Information and Discussion
> [mailto:[log in to unmask]] On Behalf Of Rachel Myr
> Sent: Saturday, July 16, 2005 12:22 AM
> To: [log in to unmask]
> Subject: What Toradol (R) is, and what Stadol (R) is
>
> 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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