Aspirin use while Breastfeeding
Drugs containing Aspirin: Aggrenox, Ecotrin, Excedrin, Fiorinal, Acetylsalicylic Acid, Butalbital Compound, Percodan, Excedrin Migraine, Norgesic, Bayer Aspirin, Show all 184 »Anacin, Arthritis Pain, Excedrin Extra Strength, Aspir 81, Aspir-Low, Ascomp with Codeine, Fiorinal with Codeine, Bufferin, Soma Compound, Fiorinal with Codeine III, Alka-Seltzer Extra Strength, Easprin, Soma Compound with Codeine, Low Dose ASA, Aspirin Low Strength, Bayer Back & Body, Robaxisal, Migraine Relief, Durlaza, Midol Traditional, Empirin, Ecotrin Adult Low Strength, Halfprin, Ascriptin, Alka-Seltzer Plus Cold Formula Sparkling Original Effervescent Tablets, Painaid, Arthritis Pain Formula, Lortab ASA, Acuprin 81, Ecpirin, Roxiprin, Vanquish, CVS Extra Strength Headache Relief, Goody's Extra Strength, Goody's Extra-Strength Headache Powders, Buffered Aspirin, Goody's Headache Powders, Alka-Seltzer Wake-Up Call!, Norgesic Forte, Exaprin, Aspergum, Aspirtab, Endodan, Bayer Aspirin Regimen, Empirin with Codeine, Alka-Seltzer Plus Cold Formula Cherry Burst Effervescent Tablets, Buffasal, B C Powder, BC, Cope, Synalgos-DC, Fiortal, Ascriptin Enteric, Darvon Compound-65, Goody's Body Pain, St. Joseph 81 mg Chewable Aspirin, Saleto, Genprin, Bayer Aspirin Extra Strength Plus, Equagesic, Percodan-Demi, Fasprin, Arthriten Inflammatory Pain Formula, Aspirin Buffered, Supac, St. Joseph Aspirin, Stanback Analgesic, Uricalm Intensive, Orphengesic Forte, Bayer AM, Panasal 5/500, Micrainin, Damason-P, P-A-C, Adalat XL Plus, Alka-Seltzer Plus Sinus Formula, Ursinus, Anacin Max Strength, Adult Strength, Genasan, Pravigard Pac, Momentum, Talwin Compound, Orphengesic, Bayer Headache Relief, Blowfish for Hangovers, Darvon Compound 32, Alka-Seltzer Lemon-Lime, Alka-Seltzer Original, Alka-Seltzer Plus Cold Formula Orange Zest Effervescent Tablets, Aspircaf, Alka-Seltzer Plus Cold & Cough Formula Effervescent Tablets, Medique Medi-Seltzer, Effervescent Pain Relief, Alka-Seltzer PM, Alka-Seltzer Plus Day & Night Cold Formula (Day Cold), Alka-Seltzer Plus Night Cold Formula Effervescent Tablets, Alka-Seltzer Plus Day & Night Cold Formula (Night Cold), Alka-Seltzer Plus Flu Formula (old formulation), Carisoprodol Compound, BC Fast Pain Relief, Azdone, Propoxyphene Compound 65, PC-CAP, B C Powder Arthritis Strength, BC Headache, Bayer PM, Bayer Women's Low Dose Plus Calcium, Stanback Fast Pain Relief, Emagrin, Alor 5/500, Bayer Women's Aspirin With Calcium, Ascriptin Maximum Strength, Arthritis Foundation Pain Reliever, Aspir-Mox IB, Aspir-Mox, Rhinocaps, Magnaprin, Bayer Aspirin with Heart Advantage, Bufferin Low Dose, Bayer Children's Aspirin, Buffex, Aspiritab, ZORprin, Medi-Seltzer, Sloprin, Excedrin PM Headache, Excedrin PM Triple Action, Pamprin Max Menstrual Pain Relief, ConRx Pain Reliever, Arthriten, Excedrin Menstrual Complete, Excedrin Back & Body, Bayer Migraine Formula, Genace, Migraine Formula, Extra Pain Relief, Levacet, Medique Pain-Off, PainAid Extra-Strength Formula, Anacin Advanced Headache Formula, Backaid Inflammatory Pain Formula, Ecotrin Maximum Strength, Entercote, Axotal, Fiormor, Bayer Advanced Aspirin, Heartline, Aspirin Lite Coat, Migralex, Fortabs, Idenal, Bayer Extra Strength Back & Body, Stanback, BC Arthritis, Fiortal with Codeine, Laniroif, Farbital, Miniprin, YSP Aspirin, Minitabs, Tri-Buffered Aspirin, Litecoat Aspirin, Gennin-FC, Extra Strength Bayer, Genacote, Entaprin, Bufferin Arthritis Strength, St. Joseph 81 mg Aspirin Enteric Safety-Coated, Zero-Order Release, Norwich Aspirin, Therapy Bayer, Bufferin Extra Strength, P-A-C Analgesic
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. If low-dose aspirin is taken, avoiding breastfeeding for 1 to 2 hours after a dose might minimize the risks of antiplatelet effects in the infant.
After aspirin ingestion, salicylic acid is excreted into breastmilk, with higher doses resulting in disproportionately higher 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. 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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CAS Registry Number
Analgesic Agents, Nonsteroidal Antiinflammatory Agents, Platelet Aggregation Inhibitors
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Last Revision Date
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