Diclofenac use while Breastfeeding

Drugs containing Diclofenac: Voltaren, Voltaren Gel, Arthrotec, Flector Patch, Cataflam, Pennsaid, Cambia, Zipsor, Solaraze, Voltaren-XR, Show all 11 »Voltaren Ophthalmic

Diclofenac Levels and Effects while Breastfeeding

Summary of Use during Lactation

Data on excretion of diclofenac into milk are poor, but the drug has a short half-life and little glucuronide metabolite formation. Most reviewers consider diclofenac to be acceptable during breastfeeding.[1][2][3][4] Other agents having more published information may be preferred, especially while nursing a newborn or preterm infant.

Drug Levels

No original data on the excretion of diclofenac into milk are available. Data are limited to those reported in review articles in which no study details are reported.

Diclofenac was undetectable (<100 mcg/L) in the breastmilk over a 6-hour period after a 50 mg intramuscular injection in 6 women.[5][6]

Six mothers were given oral diclofenac 100 mg daily orally for one week postpartum. The drug was undetectable(<10 mcg/L) in milk of any of 59 samples of milk collected (collection times unspecified).[6]

A woman treated with 150 mg daily of diclofenac had a breastmilk diclofenac level of 100 mcg/L, equivalent to about 0.03 mg/kg daily for the infant.[7]

Effects in Breastfed Infants

In one study, 30 mothers undergoing elective cesarean section were allowed to use 25 mg diclofenac suppositories along with either spinal or spinal and epidural anesthesia with a local anesthetic after delivery. The spinal anesthetic group used an average of 56 mg of diclofenac on the day of delivery and 33 mg on the next day whereas the women receiving both spinal and epidural anesthesia used 21 and 18 mg. No mention was made of adverse effects on the breastfed infants.[8]

An breastfed infant developed urticaria on day 15 of life. Her mother had been taking diclofenac (dosage unspecified) for pain since her cesarean section delivery. Diclofenac is a possible cause of the urticaria; however, the infant had also received hepatitis B vaccination 7 days before and the authors thought that it was a more likely cause of the reaction.[9]

Possible Effects on Lactation

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

Alternate Drugs to Consider

Acetaminophen, Flurbiprofen, Ibuprofen, Indomethacin, Naproxen, Piroxicam

References

1. Brooks PM, Needs CJ. Antirheumatic drugs in pregnancy and lactation. Baillieres Clin Rheumatol. 1990;4:157-71. PMID: 2282661

2. Ostensen ME. Safety of non-steroidal anti-inflammatory drugs during pregnancy and lactation. Inflammopharmacology. 1996;4:31-41.

3. Spigset O, Hagg S. Analgesics and breast-feeding: safety considerations. Paediatr Drugs. 2000;2(3):223-38. PMID: 10937472

4. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy and lactation. Arch Intern Med. 2000;160:610-9. PMID: 10724046

5. Fowler PD. Voltarol: diclofenac sodium. Clin Rheum Dis. 1979;5:427-64.

6. Sioufi A, Stierlin H, Schweizer A et al. Recent findings concerning clinically relevant pharmacokinetics of diclofenac sodium. In: Kass E. Voltaren new findings. Bern: Hans Huber Publishers, 1982:19-30.

7. Todd PA, Sorkin EM. Diclofenac sodium. A reappraisal of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy. Drugs. 1988;35:244-85. PMID: 8638785

8. Hirose M, Hara Y, Hosokawa T et al. The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain. Anesth Analg. 1996;82:1166-9. PMID: 8638785

9. De Cerqueira AM, De Azevedo JO, Guimaraes MB, Afradique MC. Urticaria in a newborn. J Am Acad Dermatol. 2009;60:Abstract 148.

Diclofenac Identification

Substance Name

Diclofenac

CAS Registry Number

15307-86-5

Drug Class

Analgesic Agents
Nonsteroidal Antiinflammatory Agents

Administrative Information

LactMed Record Number

89

Information from the National Library of Medicine's LactMed Database.

Last Revision Date

2012-03-01

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.