Aspirin use while Breastfeeding
Drugs containing Aspirin: Aggrenox, Ecotrin, Excedrin, Acetylsalicylic Acid, Fiorinal, Butalbital Compound, Excedrin Migraine, Bayer Aspirin, Percodan, Norgesic, Show all 180 »Arthritis Pain, Anacin, Easprin, Ascriptin, Excedrin Extra Strength, Bufferin, Aspir-Low, Midol Traditional, Aspir 81, Fiorinal with Codeine, Norgesic Forte, Sloprin, BC Fast Pain Relief, Alka-Seltzer Plus Cold Formula, Soma Compound with Codeine, Soma Compound, Buffered Aspirin, Fasprin, Ascomp with Codeine, Carisoprodol Compound, Bayer Back & Body, Fiorinal with Codeine III, St. Joseph Aspirin, Goody's Extra-Strength Headache Powders, Endodan, St. Joseph 81 mg Aspirin Enteric Safety-Coated, Acuprin 81, Aspirin Low Strength, Goody's Extra Strength, Excedrin Back & Body, Arthritis Pain Formula, Adalat XL Plus, Miniprin, Low Dose ASA, Empirin, Ecotrin Adult Low Strength, ZORprin, Anacin Advanced Headache Formula, Synalgos-DC, Axotal, Painaid, Equagesic, Roxiprin, Alka-Seltzer Extra Strength, Pamprin Max Menstrual Pain Relief, Adult Strength, Alka-Seltzer Original, Bayer Migraine Formula, Alka-Seltzer Lemon-Lime, Bayer Advanced Aspirin, Darvon Compound-65, Blowfish for Hangovers, Fiormor, Ecpirin, Emagrin, Stanback Fast Pain Relief, Bayer Aspirin with Heart Advantage, Pravigard Pac, Bufferin Low Dose, Halfprin, Momentum, Ascriptin Enteric, Robaxisal, Arthritis Foundation Pain Reliever, Micrainin, Backaid Inflammatory Pain Formula, Entercote, Damason-P, Buffex, Bayer Aspirin Extra Strength Plus, St. Joseph 81 mg Chewable Aspirin, Bayer Headache Relief, Panasal 5/500, Lortab ASA, Anacin Max Strength, Bayer AM, P-A-C, Alka-Seltzer Plus Sinus Formula, Cope, Aspircaf, P-A-C Analgesic, Ursinus, Alor 5/500, Percodan-Demi, Talwin Compound, Genasan, Alka-Seltzer Wake-Up Call!, Orphengesic, Stanback, Bayer Women's Low Dose Plus Calcium, BC Headache, B C Powder Arthritis Strength, Alka-Seltzer Plus Flu Formula (old formulation), Alka-Seltzer Plus Cold & Cough Formula, Empirin with Codeine, Effervescent Pain Relief, Medique Medi-Seltzer, B C Powder, Alka-Seltzer Plus Night Cold Formula, Alka-Seltzer PM, Orphengesic Forte, Bayer PM, PC-CAP, Alka-Seltzer Plus Day & Night Cold Formula (Day Cold), Alka-Seltzer Plus Day & Night Cold Formula (Night Cold), Darvon Compound 32, Propoxyphene Compound 65, Azdone, Bayer Women's Aspirin With Calcium, Rhinocaps, Magnaprin, Excedrin PM Headache, Excedrin PM Triple Action, Exaprin, Levacet, Aspirin Buffered, Aspir-Mox, Aspergum, Aspiritab, Medi-Seltzer, Aspirtab, Aspir-Mox IB, Ascriptin Maximum Strength, Saleto, Extra Pain Relief, Uricalm Intensive, Goody's Headache Powders, ConRx Pain Reliever, Arthriten, Goody's Body Pain, Excedrin Menstrual Complete, Genace, Supac, Medique Pain-Off, Vanquish, CVS Extra Strength Headache Relief, PainAid Extra-Strength Formula, Arthriten Inflammatory Pain Formula, Bayer Children's Aspirin, Durlaza, Heartline, Buffasal, Migralex, Bayer Aspirin Regimen, YSP Aspirin, Aspirin Lite Coat, Fiortal, Fortabs, BC, BC Arthritis, Fiortal with Codeine, Farbital, Idenal, Laniroif, Zero-Order Release, Norwich Aspirin, Genprin, Litecoat Aspirin, Gennin-FC, Genacote, Ecotrin Maximum Strength, Extra Strength Bayer, Minitabs, Tri-Buffered Aspirin, Therapy Bayer, Stanback Analgesic, Bufferin Extra Strength, Bufferin Arthritis Strength, Entaprin, Bayer Extra Strength Back & Body
Aspirin Levels and Effects while Breastfeeding
Summary of Use during Lactation
Aspirin is best avoided during breastfeeding; however, some expert opinion indicates that low-dose (75 to 162 mg daily) aspirin may be considered as an antiplatelet drug for use in breastfeeding women. After aspirin ingestion, salicylic acid is excreted into breastmilk, with high doses resulting in disproportionately high milk levels. Long-term, high-dose maternal aspirin ingestion probably caused metabolic acidosis in one breastfed infant. Reye's syndrome is associated with aspirin administration to infants with viral infections, but the risk of Reye's syndrome from salicylate in breastmilk is unknown. If low-dose aspirin is taken, avoid breastfeeding for 1 to 2 hours after a dose to minimize antiplatelet effects in the infant. An alternate drug is preferred over continuous high-dose, aspirin therapy.
Aspirin is rapidly metabolized to salicylate after ingestion, so most studies have measured salicylate levels in breastmilk after aspirin administration to the mother; however, some studies have not measured salicylate metabolites in breastmilk that may be hydrolyzed in the infant's gut and absorbed as salicylate.
Maternal Levels. A woman taking aspirin 4 grams daily for rheumatoid arthritis was nursing her 5 kg infant (age not reported). Salicylate was not detectable (< 50 mg/L) in breastmilk with the relative insensitive assay used.
Six nursing mothers who were 2 to 8 months postpartum (average 5 months) were given aspirin doses of 500, 1000 and 1500 mg of aspirin orally on 3 separate occasions. Peak breastmilk salicylate levels were 5.8 mg/L, 15.8 mg/L, and 38.8 mg/L, respectively. The time of the peak levels occurred between 2 and 6 hours after ingestion, with little variation in levels over time. The disproportionate increase in milk levels as the dose increased was attributed to nonlinear metabolism and protein binding.
Milk and blood levels of the salicylate metabolites of aspirin were determined in 8 lactating women following oral administration of 1 g of aspirin. Peak salicylic acid milk levels averaging 2.4 mg/L occurred 3 hours after the dose. Milk contents of salicyluric acid were greater than those of salicylic acid; a mean peak level of 10.2 mg/L was reached after 9 hours, and averaged 4.4 mg/L 24 hours after the dose. Total salicylate and metabolite levels were 5.1 mg/L at 3 hours, 9.9 mg/L at 6 hours, 11.2 mg/L at 9 hours and 10.2 mg/L at 12 hours after the dose. Acid labile conjugates were less than 0.2 mg/L. Using an average salicylate plus salicylurate level over the first 12 hours, a fully breastfed infant would receive an average of 9.4% of the maternal weight-adjusted dosage.
Two women given aspirin 454 mg orally had peak salicylate milk levels of about 1 mg/L 1 hour after the dose. The authors estimated that about 0.1% of the mothers' total dose would appear in breastmilk in 48 hours. However, salicylate metabolites were not measured in milk.
A woman who was breastfeeding a 4-month-old was taking long-term aspirin therapy in dosages ranging from 2 to 5.9 g daily. During this therapy, milk was obtained 4 hours after a 650 mg dose and just before taking a dose of 975 mg. The trough milk salicylate level was 2 mg/L and a peak level of 10 mg/L occurred 3 hours after the dose. Salicylate levels ranged from 4 to 7 mg/L over the 5 hours after the peak. Using the peak level from this study, a fully breastfed infant would receive about 10% of the maternal weight-adjusted dosage of salicylate. The assay method used should have measured both salicylate and metabolites in milk.
Infant Levels. A 9-week-old infant who was born at 36 weeks gestation was receiving about 50% breastmilk and 50% formula. The infant's mother was taking 2.4 g of aspirin daily and the infant's serum contained 65 mg/L of salicylate.
Effects in Breastfed Infants
A 16-day-old breastfed infant developed metabolic acidosis with a salicylate serum level of 240 mg/L and salicylate metabolites in the urine. The mother was taking 3.9 g/day of aspirin for arthritis, and salicylate in breastmilk probably caused the infant's illness, but the possibility of direct administration to the infant could not be ruled out.
Thrombocytopenia, fever, anorexia and petechiae occurred in a 5-month-old breastfed infant 5 days after her mother started taking aspirin for fever. One week after recovery, the infant was given a single dose of aspirin 125 mg and the platelet count dropped once again. The original symptoms were probably caused by salicylate in breastmilk.
Hemolysis after aspirin and phenacetin taken by the mother of a 23-day-old, G-6-PD-deficient infant was possibly due to aspirin in breastmilk.
In a telephone follow-up study, mothers reported no side effects among 15 infants exposed to aspirin (dose and infant age unspecified) in breastmilk.
Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.
Alternate Drugs to Consider
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2. Levy G. Salicylate pharmacokinetics in the human neonate. In: Morselli PL, Garattini S, Sereni F, eds. Basic and therapeutic aspects of perinatal pharmacology. New York: Raven Press, 1975:319-30.
3. Erickson SH , Oppenheim GL. Aspirin in breast milk. J Fam Pract. 1979;8:189-90. PMID: 759544
4. Jamali F, Keshavarz E. Salicylate excretion in breast milk. Int J Pharm. 1981;8:285-90.
5. Putter J, Satravaha P, Stockhausen H. Quantitative analysis of the main metabolites of acetylsalicylic acid. Comparative analysis in the blood and milk of lactating women. Z Geburtshilfe Perinatol. 1974;178:135-8. PMID: 4422623
6. Findlay JWA, DeAngelis RL et al. Analgesic drugs in breast milk and plasma. Clin Pharmacol Ther. 1981;29:625-33. PMID: 7214793
7. Bailey DN, Welbert RT, Naylor A. A study of salicylate and caffeine excretion in the breast milk of two nursing mothers. J Anal Toxicol. 1982;6:64-8. PMID: 7098450
8. Unsworth J, d'Assis-Fonseca A, Beswick DT. Serum salicylate levels in a breast fed infant. Ann Rheum Dis. 1987;46:638-9. PMID: 3662653
9. Clark JH, Wilson WG. A 16-day-old breast-fed infant with metabolic acidosis caused by salicylate. Clin Pediatr. 1981;20:53-4. PMID: 7214793
10. Terragna A, Spirito L. [Thrombocytopenic purpura in an infant after administration of acetylsalicylic acid to the wet-nurse]. Minerva Pediatr. 1967;19:613-6. PMID: 6069440
11. Harley JD, Robin H. "Late" neonatal jaundice in infants with glucose-6-phosphate dehydrogenase-deficient erythrocytes. Aust Ann Med. 1962;11:148-55. PMID: 13960788
12. Ito S, Blajchman A, Stephenson M, Eliopoulos C 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
CAS Registry Number
Analgesic Agents, Nonsteroidal Antiinflammatory Agents, Platelet Aggregation Inhibitors
LactMed Record Number
Last Revision Date
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