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Acetaminophen use while Breastfeeding

Drugs containing Acetaminophen: Tylenol, Percocet, Norco, Vicodin, Paracetamol, Fioricet, Tylenol with Codeine #3, Lortab, Percocet 5/325, Percocet 10/325, Show all 962 »Ultracet, Endocet, Panadol, Tylenol with Codeine #4, Excedrin, Tylenol with Codeine, Midrin, Roxicet, Darvocet-N 100, Mapap, Percocet 7.5/325, Excedrin Migraine, Tylenol Extra Strength, Tylenol PM, Darvocet-N 50, Fioricet with Codeine, Lorcet, Hycet, Alka-Seltzer Plus Cold, Vicodin ES, Vicks Dayquil Daytime Cold/Flu, Esgic, Dologesic, Ofirmev, Tylox, Xartemis XR, Percogesic Original Strength, Q-Pap, Bupap, Coricidin HBP Cold & Flu, Midol PMS, Trezix, Perfalgan, Percocet 10/650, Tylenol Arthritis Pain, Anexsia, Doliprane, Panadol Osteo, Cough & Cold Relief, Vicodin HP, Norel AD, Dolmar, Tylenol Cold, Children's Tylenol, Excedrin Extra Strength, Vanquish, Midol Maximum Strength Menstrual, Dologen, Floricet with Codeine, Paracetamol Teva, Percocet 7.5/500, Pamprin Multi-Symptom Menstrual Relief, Phrenilin, Sinarest, 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Strength, Sinutab Maximum Strength Non Drowsy, Tavist Sinus, Phlemgesic, Pharmacist Advice Paracetamol Infant Drops, Anatuss, Sudafed PE Pressure+Pain+Cold, Migrapap, Balminil Cough and Flu Sugar Free, Theraflu Max-D Severe Cold & Flu, Healthsense Pain Relief Drops Children 1 Month to 2 Years, Biochemie Paracetamol, Black And Gold Paraceatmol, Tusnel-A, Flutabs, Maxiflu DM, Suphedrine PE Cold & Cough, Cold & Cough PE Multi-Symptom, Non-Pseudo Cold Relief, CounterAct Day, Tylenol Cold Head Congestion Severe (old formulation), Mucinex Fast-Max Severe Cold, Mucinex Fast-Max Day Time Severe Cold, Sine-Off Maximum Strength, Mucinex Children's Cold, Cough & Sore Throat, Contac Sinus, Dristan Cold Non-Drowsy, ConRx Cold, Mucus Relief Plus, Alka-Seltzer Plus Severe Cold, Mucus & Congestion, Phenflu DM, Ephed Plus, Bayer Select Sinus Pain Formula, Benadryl Allergy Sinus Headache, Flextra-DS, PMS Relief, Theraflu Flu & Chest Congestion, Comtrex Deep Chest Cold, Tylenol Sinus Day/Night Convenience Pack, Tylenol Sinus NightTime, Scot-Tussin Original, Vicks Nyquil Sinus, Conney Aspirin-Free, Tylenol Childrens Paracetamol, Tylenol Sinus Congestion & Pain Severe, Duratuss-A, Lurline PMS, Beechams All-in-One, PMS Formula Multi-Symptom, Midol PMS Maximum Strength, Contac Cold + Flu (Day Formula), Tylenol Plus Children's Cold & Stuffy Nose, Benadryl Allergy Plus Sinus Headache, Robitussin Peak Cold Nasal Relief, Theraflu Warming Relief Sinus & Cold, Children's Tylenol Plus Cold And Allergy, Tylenol Allergy Multi-Symptom Nighttime, CVS Allergy & Sinus Headache, Benadryl Cold, Contac Day and Night Allergy, Multi Symptom NiteTime, Suphedrine PE Sinus Headache, Vicks QlearQuil Daytime Sinus & Congestion, Actifed Sinus Day and Night, Sudafed Sinus Nighttime Plus Pain, Tylenol Allergy Complete NightTime, LuSonex Plus, Mucinex Sinus-Max Severe Congestion Relief, Duocet, Duradyne DHC, Hydrogesic, Co-Gesic, Verdrocet, Roxilox, Otis Clapp Back Quell, Margesic H, Hy-Phen, Anolor DH5, 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Paracetamol, Alpain, RhinoFlex, Hyflex-650, Hyflex-DS, Basics Paracetamol, Pharmore Paracetamol, Tylenol Sore Throat Nighttime, Apagesic, Delsym Cough+ Cold Night Time, Delsym Children’s Cough+ Cold Night Time, Mucinex Sinus-Max Night Time Congestion & Cough, Theraflu Warming Relief Nighttime Severe Cold & Cough, Sudafed PE Severe Cold, Vicks Dayquil Sinus, Tylenol Plus Children's Cold & Allergy, CounterAct Night, Mucinex Children's Night Time Multi-Symptom Cold, Robitussin Peak Cold Nighttime Multi-Symptom Cold, Benadryl Severe Allergy Plus Sinus Headache, Robitussin Night Time Cough, Cold & Flu, Sudafed PE Nighttime Cold, Excedrin Sinus Headache, Mucinex Sinus-Max Day & Night (Night), Dilotab II, D-Time Sinus, Acetaminophen PM Extra Strength, Aceta-Gesic, Dologesic DF, Phenylgesic, Pharbetol PM, Non-Aspirin PM Extra Strength, Anacin PM Aspirin Free, Pacimol Caplets, Congespirin Aspirin Free, Day Relief Sinus PE, Mapap Sinus Congestion and Pain, Non-Pseudo Sinus Pain & Pressure, 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Infant, Mapap Infant Drops, Febridol, Mid West Products Numol Paracetamol, Parmol, Cuprofen for Children, Aldi Hedanol Paracetamol, Under Ten Care Infant, Numark Paracetamol, Amcal Childrens Paracetamol 1-5 Years, Nyal Paracetamol, Medi-Tabs, Mapap Meltaway, Nova Paracetamol, Alphapharm Paracetamol, No Frills Paracetamol, Tylenol Sore Throat Daytime, API Healthcare Colourfree Childrens Paracetamol Double Strength, Soul Pattinson Paracetamol Clear Effervescent, Rhinocaps, Staflex, Comtrex Acute Head Cold, Dristan Cold Maximum Strength, Excedrin PM Headache, Excedrin PM Triple Action, Medique Pain-Off, Extra Pain Relief, Paralgin Paracetamol Tabsules, Saleto, Panadol Soluble, Panadol Rapid Handipak, Prominol, Axocet, Childrens Panadol 5 - 12 Years, Childrens Panadol 5 - 12 Years Colourfree, Marten-Tab, Dolgic, Herron Paracetamol Tabsules, Febridol Clear Effervescent, Equaline Pain Relief, Bucet, CVS Extra Strength Headache Relief, PainAid Extra-Strength Formula, Goody's Body Pain, Excedrin Back & Body, Alpha First Aid Supplies Paracetamol, Tylenol Cold Sore Throat, Terry White Chemists Colour Free Paracetamol Infant Drops, Pharmacist Paracetamol, Panadol Mini Caps, API Healthcare Paracetamol, Pharmacy Health Paracetamol, Terry White Chemists Colour Free Paracetamol 1-5 Years, Gold Cross Paracetamol, Pharmacy Health Colour Free Childrens Paracetamol, Supac, Goody's Extra Strength, Anacin Advanced Headache Formula, Backaid Inflammatory Pain Formula, Genace, ConRx Pain Reliever, Pharmacist Childrens Paracetamol Colourfree 5-12 Years, Pharmacist Childrens Paracetamol Colourfree 1-5 Years, Arthriten, Parahexal, Paralgin, Dolitabs, Home Brand Paracetamol, Q-Pap Extra Strength, Dolko, Doliprane Sans Sucre, Genapap Extra Strength, Claradol, Anacin Aspirin Free, Doliprane Adultes, Coles Paracetamol, ICN Paracetamol, Redutemp, Uniserts, Efferalganodis, Expandox, Dolono Infant, Efferalgan Pediatrique, Pain-Eze, Dolko Enfants, Dolotec, Vicks Formula 44 Custom Care Body Aches, James Dean Pharmacy Paracetamol, Q-Nol, Herron Paracetamol Handy Pack, Flu Strength Hot Lemon Powders, Paineze Paracetamol, Health Care Chemist Paracetamol Infant Drops Colour Free, Genebs, Panadol Jr, Accidental First Aid Supplies Paracetamol, Guardian Paracetamol, Guardian Paracetamol Tabsules, Rex Paracetamol, Topcare Arthritis Pain Relief, Buckley's Complete, Herron Gold Paracetamol Tabsules, Herron Paracetamol Capseals, Tempra 3, Herron Paracetamol Capseals Handy Pack, Pharbetol, Tempol, Tempra 2, Tylenol Regular Strength, Panamol, Herron Paracetamol, Geluprane, Paracetamol Arrow, Paldesic, Medinol Paediatric, Medinol Under 6, Infantaire Drops, Galpamol, Disprol Paracetamol, Jr. Tylenol, Elixsure Fever/Pain, Infadrops, Disprol Soluble Paracetamol, Lemsip Pharmacy Non-Decongestant Formula, Masophen, Dakota Paracetamol, Umphamol, Remedol, Panamax 240, Actimol Children's, Valorin, Nortemp Children's, Paracets, Anadin Paracetamol, UN-Aspirin Extra Strength, Mapap Rapid Tabs, Acetaminophen-odan, Adprin B, BF-Paradac, Paracetamol RPG, DG Health Pain Reliever, Paracetamol Qualimed, Liquiprin, Ed-APAP, Paracetamol EG, St. Joseph Aspirin-Free, Country Chemists Paracetamol, Tempra Quicklets, Bromo Seltzer, Triaminic Infant Drops, Atasol Forte, Tylenol Cool Caplet Extra Strength, Perfalgan Nourrissons Et Enfants, Lloydspharmacy Paracetamol Infant, Triaminic Fever Reducer Pain Reliever, Tycolene, Lloydspharmacy Paracetamol Six Plus, Paracetamol Winthrop, Childrens Panadol 1 - 5 Years, Chem Mart Chemadol Colourfree Childrens 1-5 Years, Alumadrine, Duadacin, Pharmacy Health Own Name Paracetamol for Children, Febrol Solution, Febridol Infant Drops, Rhinogesic, HEB Allergy, Dryphen, Covangesic, Trital SR, Children's Silapap, Lemsip Cold and Flu Liquid Capsule, Tylenol Allergy Sinus, Comtrex Allergy Sinus Maximum Strength, Comtrex Allergy Sinus Night and Day, Allerest Headache Strength, Kolephrin, Comtrex Allergy Sinus, Comtrex Sinus and Nasal, Comtrex Nighttime Flu Therapy, Simplet, Tricom, Alka-Seltzer Plus Cold & Flu, Tylenol Sinus Congestion and Pain Cool Burst Day Night, Allergy Pain Relief, Allergy Sinus PE Pain Relief, Pyrroxate, Robitussin Peak Cold Nighttime Nasal Relief, ConRx Allergy Sinus, Contac Cold + Flu (Night Formula), Gelpirin-CCF, Chem Mart Chemadol Colourfree, Chem Mart Chemadol Children 1 to 5 Years, Accidental Rapatabs, Relief-PE, Onset Forte, Comtrex Severe Cold & Sinus, Comtrex Flu Therapy, Tylenol Plus Children's Cold, Sine-Off Sinus/Cold, Tylenol Sinus Congestion & Pain Nighttime, Tylenol Allergy Multi-Symptom, GNP Cold Relief Plus, Gendecon, Dristan Cold Multi Symptom Formula, Sinarest Extra Strength, Triaminicin, Tylenol Plus Children's Cough & Sore Throat, Children's Triacting, Tylenol Cold & Cough Daytime, Topcare Cough and Sore Throat, Triaminic Softchews Cough & Sore Throat, Tylenol Cough and Sore Throat Daytime, Drixoral Sinus, Hexaflu, PediaCare Cough & Sore Throat Plus Acetaminophen, Drixoral Cough/Sore Throat, Diabetic Tussin Night Time Cold & Flu, Diabetic Tussin Night Time Formula, Delsym Night Time Cough & Cold, Robitussin Cold + Flu (Nighttime), Vicks Nature Fusion Cold & Flu Nighttime Relief, Tylenol Cold & Cough Nighttime, Vicks NyQuil Cold & Flu Nighttime Relief, Contac Cold + Flu (Night) Cooling Relief Liquid, Respa C&C, Respa C&C IR, Contac Day and Night Cold and Flu, ConRx Extra Strength, Drixoral Cold and Flu, Guardian Childrens Paracetamol 5-12 Years, Pharmacy Health Paracetamol Colour Free Infants and Childrens Drops 1 Month-4 Years, PediaCare Smooth Melts Acetaminophen Fever Reducer/Pain Reliever, Pharmacy Health Paracetamol Colour Free Childrens, EZ III, Mapap Children's, Capital Chemist Paracetamol, Sinutab Maximum Strength Caplets, Allergy Sinus Maximum Strength, Actifed Cold & Sinus, Tavist Allergy/Sinus/Headache, Aceta w/ Codeine, Cocet Plus, PediaCare Infants' Acetaminophen Fever Reducer/Pain Reliever, G-Dologen, Dologen 325, Sinadrin Plus, Maxiflu CDX, Maxiflu CD, Capital w/Codeine, Phenflu CDX, Phenflu CD, Triaminic Flu, Cough & Fever, Alka-Seltzer Plus-D, Sinapils, Chemworld Colourfree Childrens Paracetamol Junior 1-5 Years, Panlor DC, Emagrin Forte (old formulation), Hycomine Compound, Excedrin Quick Tab, Chemworld Paracetamol Infant Colour Free, Chemworld Paracetamol, Excedrin Mild Headache, Valorin Extra, Chemworld Colourfree Childrens Paracetamol Double Strength 5-12 Years, A-Pak Laboratories Paediatric Analgesic Paracetamol, Chemists Own Paracetamol Pain & Fever 1 Month to 2 Years, Chemists Own Paracetamol Capseals, Rid-A-Pain Compound, Ninjacof-A, Chemists Own Paracetamol Pain & Fever 1 to 5 Years, Flextra Plus, MigraTen, Durabac Forte, Saleto-D, Chemists Own Paracetamol Pain and Fever 5 to 12 Years, Chem Mart Chemadol, Leader 8 Hour Pain Reliever, Pharmagesic, Anoquan, Two-Dyne, Tenake, Isocet, Alagesic LQ, Fawns & McAllan Paracetamol, Mapap Rapid Release Gelcaps, Little Fevers, Children's ElixSure, Margesic, Tencet, Minotal, Pacaps, Nonbac, Dolgic LQ, Medigesic, G-1, Fiorpap, Endolor, Ide-cet, Chemists Own Paracetamol, Congestant, Theraflu Warming Relief Nighttime Multi-Symptom Cold Caplets, Triaminic Multi-Symptom Fever & Cold, Comtrex Cold and Flu Maximum Strength, Comtrex Maximum Strength Cold Relief, Dimetapp Children's Nighttime Flu, Alka-Seltzer Plus Flu Formula, XL-3 Xtra Cold and Cough, Cold Multi-Symptom (Nighttime), Multi Symptom Cold (Night Formula), Multi Symptom Cold Relief, Contac Severe Cold and Flu Maximum Stength, Chemists Own Chiildrens Paracetamol 5-12 Years, Contac Cold and Flu Maximum Strength, Theraflu Flu & Cough, Allpanto-S, Co-Apap, Childrens Tylenol Cold Plus Cough, Genacol Maximum Strength, Chem Mart Chemadol Colourfree Children 5-12 Years, Cough Formula M Multi-Symptom, Comtrex Cold and Flu Maximum Strength Tablet, Comtrex Cold and Flu Maximum Strength Liquid, Comtrex Nighttime Cold & Cough, Theraflu Nighttime Severe Cold & Cough Caplets, Mapap Cough & Sinus Formula, Vicks Formula 44 Custom Care Cough & Cold PM, Flu Relief BP, Coricidin HBP Multi-Symptom Cold (Night), PediaCare Cough & Runny Nose Plus Acetaminophen, Triaminic Multi-Symptom Fever, Cotabflu, Colrex Compound, Colrex, Vicks NyQuil Cold & Flu Nighttime Relief (Alcohol Free), Tylenol Plus Children's Cough & Runny Nose, Chemists Own Childrens Paracetamol 1-5 Years, Alka-Seltzer Plus Cold & Cough Formula Liquid, PediaCare Flu Plus Acetaminophen, Tylenol Cold Head Congestion Nighttime, Comtrex Cold & Cough Day Night, PediaCare Multi-Symptom Cold Plus Acetaminophen, Alka-Seltzer Plus Cold & Cough Formula Liquid Gels, Lemsip Headcold, Tylenol Plus Children's Multi-Symptom Cold, Tylenol Plus Children's Flu, Night Time Cold & Flu

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

20150310

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