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Acetaminophen use while Breastfeeding

Drugs containing Acetaminophen: Norco, Percocet, Tylenol, Vicodin, Fioricet, Paracetamol, Lortab, Tylenol with Codeine #3, Percocet 5/325, Percocet 10/325, Show all 959 »Ultracet, Endocet, NyQuil, Excedrin, Panadol, Roxicet, Midrin, Tylenol with Codeine #4, Tylenol with Codeine, Darvocet-N 100, Percocet 7.5/325, Excedrin Migraine, Mapap, Darvocet-N 50, Tylenol PM, Tylenol Extra Strength, Esgic, Alka-Seltzer Plus Cold, Vicks Dayquil Daytime Cold/Flu, Lorcet, Coricidin HBP Cold & Flu, Vicodin ES, Fioricet with Codeine, Hycet, Tylox, Tylenol Arthritis Pain, Bupap, Ofirmev, Xartemis XR, Floricet with Codeine, Q-Pap, Nyquil Cold Medicine, Paracetamol Teva, Vicks Nyquil Cold & Flu Relief, Theraflu Flu, Cold and Cough Powder, Dologesic, Tylenol Cold, Anexsia, Perfalgan, Trezix, Norel AD, Stagesic, Lorcet Plus, Children's Tylenol, Percogesic, Cough & Cold Relief, Headache Relief, Coricidin D, Tencon, Vicks Dayquil Cold & Flu Relief, Midol PMS, Doliprane, Infant's Tylenol, Percocet 7.5/500, 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Plus Day & Night Cold Formula (Day Cold) Liquid Gels, Alka-Seltzer Plus Day Non-Drowsy Cold Formula Liquid Gels, Tylenol Cold Multi-Symptom Daytime, Mapap Cold Formula, Theraflu Warming Relief Daytime Severe Cough & Cold, Vicks Nature Fusion Cold & Flu Multi-Symptom Relief, Theraflu Daytime Severe Cold & Cough, Alka-Seltzer Plus Severe Sinus Congestion & Cough (Day Formula), Cold Multi-Symptom (Daytime), Tylenol Cold Head Congestion Daytime, Multi Symptom Cold (Day Formula), Day Time Multi-Symptom Cold/Flu Relief, Day Relief PE, Vicks Dayquil Cold & Flu Symptom Relief Plus Vitamin C, Robitussin Cold + Flu (Daytime), Tylenol Plus Children's Cold & Cough, Duraflu, Maxiflu DM, Tusnel-A, Theraflu Max-D Severe Cold & Flu, Balminil Cough and Flu Sugar Free, Tylenol Cold Severe Congestion Daytime, Phlemgesic, Herron Paracetamol, Panamol, Robitussin Peak Cold Daytime Cold + Flu, Daytime Cold & Flu, Contac Complete Cough, Cold & Flu Extra Strength, Paineze Paracetamol, Health Care Chemist Paracetamol Infant Drops Colour Free, Herron Gold Paracetamol Tabsules, Buckley's Complete, Flu & Severe Cold & Cough Daytime Powder, Comtrex Non Drowsy Liquigel, Panadol Soluble, Panadol Rapid Handipak, Herron Paracetamol Tabsules, Paralgin Paracetamol Tabsules, Pharmacist Childrens Paracetamol Colourfree 1-5 Years, Gold Cross Paracetamol, Pharmacy Health Colour Free Childrens Paracetamol, Chemists Own Paracetamol, Migragesic IDA, LarkaDrin, IDA, Midchlor, Alidrin, Migquin, Mitride, Migrazone, Migrapap, Alpha First Aid Supplies Paracetamol, Guardian Childrens Paracetamol 5-12 Years, Guardian Paracetamol Tabsules, Theraflu Flu Cold & Cough, Comtrex Non-Drowsy, Topcare Arthritis Pain Relief, Accidental First Aid Supplies Paracetamol, Flu Strength Hot Lemon Powders, Panadol Jr, Contac Severe Cold and Flu Non Drowsy, Day Time Multi Symptom, Theraflu (pseudoephedrine) Daytime Severe Cold, Severe Cold Multi-Symptom, Guardian Paracetamol, Daytime Non-Drowsy, Tylenol Cold Non-Drowsy Gelcaps, Non-Drowsy Super Strength Contac Complete, Day Relief Cold and Flu, Febridol Clear Effervescent, Lemsip Headcold, Congespirin Aspirin Free, Sudafed PE Sinus Headache, Mapap Sinus Congestion and Pain, Day Relief Sinus PE, D-Time Sinus, Suphedrine PE Sinus Headache, Robitussin Peak Cold Nasal Relief, Dilotab II, Non-Pseudo Sinus Pain & Pressure, Sinutab Sinus Maximum Strength, Phenagesic, Genasec, Q-Gesic, Duogesic, Apagesic, Major-gesic, Phenylgesic, Tylenol Plus Children's Cold & Stuffy Nose, Contac Cold + Flu (Day Formula), PMS Relief, Pharmore Paracetamol, Tylenol GoTabs, PMS Formula Multi-Symptom, Syncol, Midol PMS Maximum Strength, Menstrual PMS, Pacimol Caplets, Theraflu Sinus & Cold, Terry White Chemists Paracetamol Colourfree Children 5-12 Years, Pharmacist Advice Paracetamol, Terry White Chemists Paracetamol, Paracare, Tylenol Childrens Paracetamol, Panadol Gel Caps, Conney Aspirin-Free, Uni-Perr, Vitoxapap, Ornex, Sinutab Maximum Strength Non Drowsy, Bayer Select Sinus Pain 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Paracetamol Colour Free Childrens, Co-Gesic, Chem Mart Chemadol Colourfree, Chem Mart Chemadol Colourfree Children 5-12 Years, Histenol-Forte II, Theraflu Warming Relief Cold and Chest Congestion, Emagrin Forte, ConRx Sinus, LuSonex Plus, Tylenol Sinus Congestion & Pain Severe, Duratuss-A, Sudafed PE Triple Action, Coldonyl, Chemists Own Childrens Paracetamol 1-5 Years, Tempra 2, Chemists Own Chiildrens Paracetamol 5-12 Years, Lemsip Max, Sudafed Triple Action, Sudafed PE Pressure+Pain+Mucus, Tylenol Sinus Severe Congestion Daytime, Lorcet HD, Hy-Phen, Pain-Eze Paracetamol Infant Drops Colour Free, Bi-Lo Paracetamol, Roxilox, Pharmaction Paracetamol, Biochemie Paracetamol, Pharmacist Advice Paracetamol Infant Drops, Black And Gold Paraceatmol, Healthsense Pain Relief Drops Children 1 Month to 2 Years, Perloxx, Pharmacist Paracetamol Infant Drops Colour Free, Lurline PMS, Panadol Colourfree Drops, Paraspen Drops, PainAid Premenstrual Formula, Tylenol Women's Menstrual Relief, Pharmacist 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Headache, Lemsip Childrens Cold & Flu, Mandanol 6+, Parmol, KneeRelief, Combiflex ES, Silapap Infants, Cuprofen for Children, Mandanol Infant, DHC Plus, Emagrin Forte (old formulation), Triaminic Multi-Symptom Fever, PediaCare Cough & Runny Nose Plus Acetaminophen, Alka-Seltzer Plus Flu Formula, Dimetapp Children's Nighttime Flu, Comtrex Cold and Flu Maximum Strength, Comtrex Maximum Strength Cold Relief, Multi Symptom Cold Relief, Multi Symptom Cold (Night Formula), Comtrex Nighttime Cold & Cough, Theraflu Warming Relief Caplets Nighttime Multi-Symptom Cold, Cold Multi-Symptom (Nighttime), Contac Severe Cold and Flu Maximum Stength, Medinol Paediatric, Comtrex Cold and Flu Maximum Strength Tablet, Comtrex Cold and Flu Maximum Strength Liquid, Genacol Maximum Strength, Comtrex Day and Night, Disprol Soluble Paracetamol, Calpol Paediatric, Paldesic, Disprol Paracetamol, Tylenol Cold Head Congestion Day and Night, Theraflu Nighttime Severe Cold & Cough Caplets, Paracets, Nortemp Children's, Medinol Over 6, Tylenol Plus Children's Cough & Runny Nose, Coricidin HBP Multi-Symptom Cold (Night), Mapap Cough & Sinus Formula, Vicks Formula 44 Custom Care Cough & Cold PM, Flu Relief BP, Masophen, Lemsip Pharmacy Non-Decongestant Formula, Codral Cold and Flu + Cough Day and Night, Tylenol Cold Head Congestion Nighttime, Comtrex Cold & Cough Day Night, PediaCare Flu Plus Acetaminophen, Alka-Seltzer Plus Cold & Cough Formula Liquid, Medinol Under 6, Tylenol Plus Children's Flu, PediaCare Multi-Symptom Cold Plus Acetaminophen, Alphapharm Paracetamol, No Frills Paracetamol, Rhinocaps, Comtrex Acute Head Cold, Dristan Cold Maximum Strength, Soul Pattinson Colourfree Childrens Paracetamol, Excedrin PM Headache, Excedrin PM Triple Action, API Healthcare Coloufree Childrens Paracetamol, Panadol Gel Tabs, Saleto, Soul Pattinson Colour Free Paracetamol Drops, Soul Pattinson Colour Free Paracetamol 1-5 Years, Pharmacist Formula Infants, Pharmacist Formula Paracetamol, Guardian Childrens Paracetamol, RP Scherer Paracetamol, RP Scherer Paracetamol Liquid-Filled Capsules, Soul Pattinson Childrens Paracetamol Elixir, Signature Range Paracetamol, Savings Paracetamol, Soul Pattinson Paracetamol, Medique Pain-Off, Panadol Mini Caps, Soul Pattinson Paracetamol Clear Effervescent, API Healthcare Colourfree Childrens Paracetamol Double Strength, API Healthcare Paracetamol, Pharmacy Health Paracetamol, Terry White Chemists Colour Free Paracetamol Infant Drops, Pharmacist Paracetamol, Terry White Chemists Colour Free Paracetamol 1-5 Years, Bayer Migraine Formula, Excedrin Menstrual Complete, Backaid Inflammatory Pain Formula, PainAid Extra-Strength Formula, CVS Extra Strength Headache Relief, Anacin Advanced Headache Formula, Supac, Arthriten, ConRx Pain Reliever, Genace, Pharmacist Advice Colourfree Childrens Paracetamol Double Strength, Orbivan CF, Tencet, Dolmar, Endolor, Geone, Femcet, Two-Dyne, Tenake, Anolor 300, Ide-cet, G-1, Americet, Nonbac, Nova Paracetamol, Alagesic, Pacaps, Medigesic, Minotal, Mygracet, Anoquan, Pharmagesic, Amcal Paracetamol Infant Drops 1 Month to 2 Years, Topcare 8 Hour Pain Relief, Ordov Febrigesic Paracetamol, Pain-Eze Paracetamol Infant Drops, Febridol Syrup for Children, Sedapap, Promacet, Amcal Paracetamol Tabsules, Amcal Paracetamol Pain Relief, Orajel Maximum Strength Toothache, Mapap Meltaway, Alagesic LQ, Isocet, Numark Paracetamol, Amcal Childrens Paracetamol 1-5 Years, Amcal Childrens Paracetamol 5-12 Years, Medi-Tabs, Nyal Paracetamol, Theraflu Flu & Cough, Allpanto-S, Dolotec, Robitussin Peak Cold Nighttime Cold + Flu, Contac Cold + Flu (Night) Cooling Relief Liquid, Vicks NyQuil Cold & Flu Nighttime Relief, Vicks Formula 44 Custom Care Body Aches, James Dean Pharmacy Paracetamol, Efferalganodis, Uniserts, Efferalgan Pediatrique, Robitussin Cold + Flu (Nighttime), Vicks Nature Fusion Cold & Flu Nighttime Relief, Dolko Enfants, Delsym Night Time Multi-Symptom, Alka-Seltzer Plus Night Cold Formula Liquid Gels, Clear Cough PM Multi-Symptom, Vicks Nyquil Cold & Flu Symptom Relief Plus Vitamin C, Multi Symptom NiteTime, Vicks NyQuil Multi-Symptom, Tylenol Cough & Sore Throat Nightime, Contac Day and Night Cold and Flu, Respa C&C IR, Hexaflu, Expandox, PediaCare Cough & Sore Throat Plus Acetaminophen, Drixoral Sinus, Drixoral Allergy Sinus, Drixoral Cold/Flu, Complete Sinus Relief, Sinadrin Plus, Drixoral Cough/Sore Throat, Tylenol Cough and Sore Throat Daytime, Silapap Childrens, Diabetic Tussin Night Time Cold & Flu, Respa C&C, Topcare Cough and Sore Throat, Tylenol Cold & Cough Daytime, Triaminic Softchews Cough & Sore Throat, Tylenol Plus Children's Cough & Sore Throat, Children's Triacting, Tylenol Cold Multi-Symptom Nighttime Liquid, Alka-Seltzer Plus Day & Night Cold Formula (Night Cold) Liquid Gels, Non-Pseudo Cold Relief, CounterAct Day, Tylenol Cold Head Congestion Severe (old formulation), Phenflu DM, Mucinex Fast-Max Day Time Severe Cold, Mucinex Children's Cold, Cough & Sore Throat, Pharbetol, Herron Paracetamol Capseals Handy Pack, Tempra 3, Alka-Seltzer Plus Severe Cold, Mucus & Congestion, Cold Head Congestion, Sudafed PE Pressure+Pain+Cold, Tylenol Cough & Severe Congestion Daytime, Herron Paracetamol Capseals, Suphedrine PE Cold & Cough, Cold & Cough PE Multi-Symptom, ConRx Cold, Adult Cold, Flu & Sore Throat, Mucus Relief Plus, Herron Paracetamol Handy Pack, Q-Nol, Dolko, All-Nite Cold, Tylenol Severe Cold & Flu Night Time, ICN Paracetamol, Redutemp, Alka-Seltzer Plus Night Cold Formula Liquid, Alka-Seltzer Plus Multi-Symptom Cold & Flu (Night Formula), Alka-Seltzer Plus Severe Sinus Congestion & Cough (Night Formula), Multi-Symptom Nighttime, NyCair, Coles Paracetamol, Dolono, Conacetol, Genapap Extra Strength, Doliprane Sans Sucre, All-Nite Multi-Symptom Cold/Flu Relief, Home Brand Paracetamol, Dolitabs, Dolono Infant, Dologen 325, Hybrid CF, Sine-Off Sinus/Cold, Tylenol Sinus Congestion and Pain Cool Burst Day Night, HEB Allergy, Protid, Tylenol Plus Children's Cold, Tylenol Sinus Congestion & Pain Nighttime, Comtrex Severe Cold & Sinus, Comtrex Flu Therapy, Dryphen, Covangesic, Duadacin, Sinulin, Chlor-Trimeton Sinus, Paracetamol Winthrop, Triaminic Fever Reducer Pain Reliever, Triaminic Infant Drops, Lloydspharmacy Paracetamol Infant, Rhinogesic, Tylenol Allergy Multi-Symptom, Gendecon, Elixsure Fever/Pain, Mapap Rapid Tabs, Acetaminophen-odan, Infadrops, Gelpirin-CCF, Co-Apap, Alka-Seltzer Plus-D, Triaminic Flu, Cough & Fever, Tylenol Cool Caplet Extra Strength, Paralyoc, Allergy Multi-Symptom, Robitussin Peak Cold Nighttime Nasal Relief, Onset Forte, Allergy Sinus PE Pain Relief, Allergy Pain Relief, Atasol Forte, Contac Cold + Flu (Night Formula), ConRx Allergy Sinus, Lloydspharmacy Paracetamol Six Plus, Paracetamol Sandoz Conseil, Paracetamol EG, Ed-APAP, Paracetamol Biogaran, St. Joseph Aspirin-Free, Country Chemists Paracetamol, Paracetamol Qualimed, Liquiprin, Paracetamol Ivax, EZ III, Capital with Codeine Suspension, Maxiflu CD, Maxiflu CDX, Paracetamol Arrow, Phenflu CD, Phenflu CDX, Aceta w/ Codeine, Capital w/Codeine, Codrix, Tavist Allergy/Sinus/Headache, Allergy Sinus Maximum Strength, Actamin, Comtrex Sinus and Nasal, Comtrex Nighttime Flu Therapy, Adprin B, BF-Paradac, Tempra Quicklets, DG Health Pain Reliever, Paracetamol RPG, Simplet, Tricom, Allerest Headache Strength, Sinarest Extra Strength, Sinutab Maximum Strength Caplets, Comtrex Allergy Sinus Night and Day, Comtrex Allergy Sinus Maximum Strength, Comtrex Allergy Sinus, Allerest Sinus, Tylenol Allergy Sinus, Goody's Body Pain

Acetaminophen Levels and Effects while Breastfeeding

Summary of Use during Lactation

Acetaminophen is a good choice for analgesia, and fever reduction in nursing mothers. Amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare.

Drug Levels

Maternal Levels. A single oral dose of 650 mg of acetaminophen was given to 12 nursing mothers who were 2 to 22 months postpartum. Peak milk levels of 10 to 15 mg/L occurred between 1 and 2 hours after the dose in all patients. Acetaminophen was undetectable (<0.5 mg/L) in all mothers 12 hours after the dose. The authors calculated that an infant who ingested 90 mL of breastmilk every 3 hours would receive an average of 0.88 mg of acetaminophen or 0.14% (range 0.04 to 0.23%) of the mother's absolute dosage.[1] Using data from this study, an infant would receive a maximum of about 2% of the maternal weight-adjusted dosage.

Three women took a single 500 mg dose of acetaminophen. Peak milk levels averaging 4.2 mg/L occurred within 2 hours after the dose.[2] Using data from this study, an infant would receive a maximum of about 3.6% of the maternal weight-adjusted dosage.

Four women who were 2 to 8 months postpartum were given a single 1 gram dose of acetaminophen. Peak milk levels occurred between 1 and 2.5 hours after the dose. The authors estimated that a breastfed infant would receive an average of 1.1% and a maximum of 1.8% of the maternal weight-adjusted dosage. This dose is about 0.5% of the lowest recommended infant dose of acetaminophen.[3]

Infant Levels. No acetaminophen was detected in the urine of 12 breastfed infants aged 2 to 22 months after maternal ingestion of 650 mg of acetaminophen.[1]

Urine was collected for 1 to 3.5 hours after nursing in 6 infants aged 2 to 6 days whose mothers received 1 to 2 grams of acetaminophen 2 to 4 hours before nursing their infant. Infants excreted an average of 401 mcg of acetaminophen and its metabolites in urine during the collection interval. These neonates excreted a greater percentage of drug as acetaminophen and much less as the sulfate metabolite than adults.[3]

Effects in Breastfed Infants

A maculopapular rash on the upper trunk and face of a 2-month-old infant was probably caused by acetaminophen in breastmilk. The rash occurred after 2 days of therapy in the mother at a dose of 1 gram at bedtime. It subsided when the drug was discontinued and recurred 2 weeks later after another acetaminophen dose of 1 gram was taken by the mother.[4]

Two papers report 14 women who breastfed after taking acetaminophen or its prodrug phenacetin with no adverse effects to their infants.[1][5]

In a telephone follow-up study, mothers reported no side effects among 43 infants exposed to acetaminophen in breastmilk.[6]

Two clinicians speculated that breastmilk exposure to acetaminophen during breastfeeding might be a risk factor for asthma and wheezing in the breastfed infants based on their personal observations.[7] However, these observations were uncontrolled and cannot be considered to be valid proof of an association.[8]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Ibuprofen

References

1. Berlin CM Jr, Yaffe SJ, Ragni M. Disposition of acetaminophen in milk, saliva and plasma of lactating women. Pediatr Pharmacol. 1980;1:135-41. PMID: 7202185

2. Bitzen PO, Gustafsson B, Jostell KG et al. Excretion of paracetamol in human breast milk. Eur J Clin Pharmacol. 1981;20:123-5. PMID: 7262173

3. Notarianni LJ, Oldham HG, Bennett PN. Passage of paracetamol into breast milk and its subsequent metabolism by the neonate. Br J Clin Pharmacol. 1987;24:63-7. PMID: 3620287

4. Matheson I, Lunde PKM, Notarianni L. Infant rash caused by paracetamol in breast milk? Pediatrics. 1985;76:651-2. Letter. PMID: 2931668

5. Findlay JWA, DeAngelis RL et al. Analgesic drugs in breast milk and plasma. Clin Pharmacol Ther. 1981;29:625-33. PMID: 6529531

6. Ito S, Blajchman A, Stephenson M et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: 8498418

7. Nadal-Amat J , Verd S. Paracetamol and asthma and lactation. Acta Paediatr. 2011;100:e2-3. PMID: 21244486

8. Bakkeheim E, Carlsen KH, Lodrup Carlsen KC. Paracetamol exposure during breastfeeding and risk of allergic disease. Acta Paediatr. 2011;100:e3. PMID: 21535130

Acetaminophen Identification

Substance Name

Acetaminophen

CAS Registry Number

103-90-2

Drug Class

Analgesics, Non-Narcotic

Administrative Information

LactMed Record Number

330

Last Revision Date

20140401

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