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Acetaminophen use while Breastfeeding

Drugs containing Acetaminophen: Tylenol, Norco, Percocet, Vicodin, Fioricet, Paracetamol, Lortab, Tylenol with Codeine #3, Excedrin, Ultracet, Show all 994 »Endocet, Percocet 5/325, Tylenol with Codeine, Percocet 10/325, Mapap, Panadol, Excedrin Migraine, Midrin, Aceta, Darvocet-N 50, Roxicet, Tylenol Extra Strength, Tylox, Lorcet, Tylenol Arthritis Pain, Tylenol with Codeine #4, Esgic, Darvocet-N 100, Ofirmev, Percocet 7.5/325, Alka-Seltzer Plus Cold, Coricidin HBP Cold & Flu, Tylenol PM, Bupap, Trezix, Arthritis Pain Relief, Fioricet with Codeine, Vicks Nyquil D Cold and Flu Nighttime Relief, Midol PMS, Sinarest, Tramapap, Vicks Dayquil Daytime Cold/Flu, Migraine Relief, Vicks NyQuil Cold & Flu Nighttime Relief, Percogesic, Hycet, Vicodin ES, Altenol, Vicks NyQuil Severe Cold & Flu, Anexsia, Tencon, Xartemis XR, Nodolor, Q-Pap, Norel AD, Zebutal, Dafalgan, Perfalgan, Panadol Osteo, Dologesic, Darvocet A500, Triad, Acephen, Theraflu Nighttime Severe Cold & Cough, Phrenilin, Vicodin 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C&C, Topcare Cough and Sore Throat, Contac Cold + Flu (Night) Cooling Relief Liquid, Delsym Night Time Cough & Cold, Night Time Cold & Flu, Sudafed PE Pressure+Pain+Cough, Tylenol Cold & Cough Daytime, Vicks Nature Fusion Cold & Flu Nighttime Relief, Coricidin HBP Nighttime Multi-Symptom Cold, Multi Symptom NiteTime, Delsym Night Time Multi-Symptom, Anatuss, Robitussin Cold Cough and Flu, Tylenol Cold Severe Congestion Daytime, Tylenol Cough & Severe Congestion Daytime, Sudafed PE Pressure+Pain+Cold, Mucus Relief Plus, Cold & Cough PE Multi-Symptom, Suphedrine PE Cold & Cough, All-Nite Multi-Symptom Cold/Flu Relief, NyCair, Tusnel-A, Multi-Symptom Nighttime, All-Nite Cold, Maxiflu DM, Flutabs, Phlemgesic, Balminil Cough and Flu Sugar Free, Theraflu Max-D Severe Cold & Flu, Mucus Relief Complete, ConRx Cold, Tylenol Cold Head Congestion Severe (old formulation), Mucinex Fast-Max Cold, Flu & Sore Throat Liquid Gels, Non-Pseudo Cold Relief, Mucinex Fast-Max Cold, Flu & Sore Throat, Mucinex Fast-Max Severe Congestion & Cold, Decorel Forte Plus, Alka-Seltzer Plus Severe Sinus, Cold & Cough Liquid Gels, Phenflu DM, Tylenol Cold Multi-Symptom Severe, Mucinex Fast-Max Severe Cold, Alka-Seltzer Plus Severe Cold, Mucus & Congestion, Alka-Seltzer Plus Day Severe Cold+Flu Hot Drink Mix, Cold Multi-Symptom Severe, Mucinex Children's Cold, Cough & Sore Throat, Mucinex Children's Multi-Symptom Cold & Fever, Mucinex Fast-Max Day Time Severe Cold, Delsym Cough+ Cold Day Time, Robitussin Peak Cold Daytime Cold + Flu, Contac Complete Cough, Cold & Flu Extra Strength, Tylenol Cold Multi-Symptom Nighttime Liquid, Alka-Seltzer Plus Night Cold Formula Liquid Gels, Alka-Seltzer Plus Day Non-Drowsy Cold & Flu Formula Liquid Gels, Alka-Seltzer Plus Day & Night Cold Formula (Night Cold) Liquid Gels, Alka-Seltzer Plus Night Cold Formula Liquid, Mucinex Fast-Max Night Time Cold & Flu Liquid Gels, Alka-Seltzer Plus Severe Sinus Congestion & Cough (Night Formula), Alka-Seltzer Plus 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Tylenol Severe Allergy, Percogesic Extra Strength, Anacin PM Aspirin Free, Pharbetol PM, Headache Relief PM, Sominex Pain Relief Formula, Coricidin Night Time Cold Relief, Tylenol Sore Throat Nighttime, Dimetapp Children's Multi-Symptom Cold & Flu, Tylenol Plus Children's Cold & Allergy, Children's Triacting, Robitussin Multi-Symptom Cold Night Time, Mucinex Children's Night Time Multi-Symptom Cold, Mucinex Sinus-Max Day & Night (Night), Suphedrine PE Severe Cold, Night Time Severe Cold and Cough, Sudafed PE Severe Cold, Delsym Children’s Cough+ Cold Night Time, Mucinex Sinus-Max Night Time Congestion & Cough, Wal-Nadol PM Extra Strength, Midol PM, Severe Cold Multi-Symptom, Migragesic IDA, LarkaDrin, Migquin, Daytime Non-Drowsy, Daytime Cold and Flu Relief, Non-Drowsy Super Strength Contac Complete, Day Relief Cold and Flu, Tylenol Cold Non-Drowsy Gelcaps, Midchlor, Iso-Acetazone, Percogesic Original Strength, Unisom PM Pain, Genapap PM, Counteract PM Extra Strength, Night Time Pain, ConRx PM, Migrin-A, Duradrin, Bayer Select Max Strength Night Time Pain, Sudafed PE Nighttime Cold, Benadryl Severe Allergy Plus Sinus Headache, Emagrin Forte, Tylenol Cold Head Congestion Severe, Sudafed PE Triple Action, Coldonyl, Theraflu Warming Relief Cold and Chest Congestion, Mucinex Sinus-Max Day & Night (Day), Mucinex Sinus-Max Severe Congestion Relief, ConRx Sinus, Histenol-Forte II, Sudafed PE Pressure+Pain+Mucus, Mucinex Sinus-Max Day Time Severe Congestion Relief, Duradyne DHC, Hydrogesic, Margesic H, T-Gesic, Duocet, Co-Gesic, Tylenol Sinus Severe Congestion Daytime, Sudafed Triple Action, Verdrocet, Mucinex Fast-Max Cold & Sinus, LuSonex Plus, Benadryl Allergy Plus Cold, Benadryl Cold, Contac Day and Night Allergy, Sudafed Sinus Nighttime Plus Pain, Theraflu Warming Relief Sinus & Cold, Children's Tylenol Plus Cold And Allergy, Equate Allergy & Sinus Headache, Tylenol Allergy Multi-Symptom Nighttime, CVS Allergy & Sinus Headache, Tylenol Allergy Complete NightTime, Benadryl Severe Allergy & Sinus Headache, Tylenol Chest Congestion, Theraflu Flu & Chest Congestion, Comtrex Deep Chest Cold, Duratuss-A, Tylenol Sinus Day/Night Convenience Pack, Tylenol Sinus NightTime, Actifed Sinus Day and Night, Vicks Nyquil Sinus, Alka-Seltzer Plus Severe Allergy Sinus Congestion & Headache, Day Time Multi Symptom, Medicidin-D, Paracetamol Sandoz Conseil, Paracetamol Sandoz, Tycolene, Lloydspharmacy Paracetamol Six Plus, Paracetamol Winthrop, Tempra Quicklets, DG Health Pain Reliever, Liquiprin, Paracetamol Merck, Paracetamol Qualimed, BF-Paradac, Paracetamol RPG, Triaminic Fever Reducer Pain Reliever, Lloydspharmacy Paracetamol Infant, Mapap Rapid Tabs, Acetaminophen-odan, Jr. Tylenol, Elixsure Fever/Pain, Infadrops, Perfalgan Nourrissons Et Enfants, Tylenol Cool Caplet Extra Strength, Paracetamol Zydus, Triaminic Infant Drops, Atasol Forte, Paralyoc, Paracetamol Ivax, Country Chemists Paracetamol, Doliprane Sans Sucre, Genapap Extra Strength, Dolitabs, Home 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Infant Drops, Cuprofen for Children, Masophen, Cetafen, Medinol Over 6, Nortemp Children's, Paracets, Lemsip Pharmacy Non-Decongestant Formula, Infantaire Drops, Paldesic, Calpol Paediatric, Medinol Paediatric, Medinol Under 6, Anadin Paracetamol, Hedex, Febridol, Parahexal, Mid West Products Numol Paracetamol, Parmol, Silapap Infants, Paralgin, Panamax 240, UN-Aspirin Extra Strength, Actimol Children's, Dakota Paracetamol, Umphamol, Herron Paracetamol Handy Pack, Pharbetol, PediaCare Children's Acetaminophen Fever Reducer/Pain Reliever, PediaCare Infants' Acetaminophen Fever Reducer/Pain Reliever, Pharmacy Health Paracetamol Colour Free Childrens, PediaCare Smooth Melts Acetaminophen Fever Reducer/Pain Reliever, Pharmacy Health Paracetamol Colour Free Infants and Childrens Drops 1 Month-4 Years, ConRx Extra Strength, Actimol Infant, Abenol, Paracetamol Soluble, Bristol Pharma Paracetamol, Sigma Paracetamol, Mapap Children's, Capital Chemist Paracetamol, Chem Mart Chemadol Colourfree Children 5-12 Years, Chem Mart Chemadol Colourfree, Chemists Own Chiildrens Paracetamol 5-12 Years, Lemsip Headcold, Chemists Own Childrens Paracetamol 1-5 Years, Chem Mart Chemadol Children 1 to 5 Years, Accidental Rapatabs, Children's Silapap, Febrol Solution, Pharmacy Health Own Name Paracetamol for Children, Febridol Infant Drops, Panadol Extend, Blooms the Chemist Paracetamol, Pharmore Paracetamol, Panadol Gel Caps, Basics Paracetamol, Sigma Pain Relief, Pain Clear Paracetamol, Priceline Paracetamol, Conney Aspirin-Free, Terry White Chemists Paracetamol, Pharmacist Advice Paracetamol, Terry White Chemists Paracetamol Colourfree Children 5-12 Years, Tylenol Childrens Paracetamol, Paraspen Drops, Panadol Colourfree Drops, Black And Gold Paraceatmol, Healthsense Pain Relief Drops Children 1 Month to 2 Years, Pharmacist Advice Paracetamol Infant Drops, Black and Gold Paracetamol, Hexal Comfarol, Biochemie Paracetamol, Pharmaction Paracetamol, Pharmacist Paracetamol Infant Drops, Pharmacist Paracetamol Infant Drops Colour Free, Bi-Lo Paracetamol, Pain-Eze Paracetamol Infant Drops Colour Free, Lemsip Max, Chemists Own Paracetamol, Alpha First Aid Supplies Paracetamol, Tylenol Cold Sore Throat, Guardian Childrens Paracetamol 5-12 Years, Guardian Paracetamol, Guardian Paracetamol Tabsules, Gold Cross Paracetamol, Pharmacy Health Colour Free Childrens Paracetamol, Panadol Soluble, Paralgin Paracetamol Tabsules, Pharmacist Childrens Paracetamol Colourfree 1-5 Years, Pharmacist Childrens Paracetamol Colourfree 5-12 Years, Rex Paracetamol, Topcare Arthritis Pain Relief, Tempol, Herron Paracetamol, Herron Paracetamol Capseals, Tempra 3, Herron Paracetamol Capseals Handy Pack, Tylenol Regular Strength, Herron Gold Paracetamol Tabsules, Accidental First Aid Supplies Paracetamol, Flu Strength Hot Lemon Powders, Paineze Paracetamol, Health Care Chemist Paracetamol Infant Drops Colour Free, Panadol Rapid Handipak, Herron Paracetamol Tabsules, Chemworld Colourfree Childrens Paracetamol Double Strength 5-12 Years, Chemplus Paracetamol, Chemworld Colourfree Childrens Paracetamol Junior 1-5 Years, Chemworld Paracetamol, Chemworld Paracetamol Infant Colour Free, A-Pak Laboratories Paediatric Analgesic Paracetamol, Chemists Own Paracetamol Pain and Fever 5 to 12 Years, Lemsip Original, Chemists Own Paracetamol Capseals, Chemists Own Paracetamol Pain & Fever 1 Month to 2 Years, Chemists Own Paracetamol Pain & Fever 1 to 5 Years, Chem Mart Chemadol, Leader 8 Hour Pain Reliever, Childrens Panadol 5 - 12 Years, Childrens Panadol 5 - 12 Years Colourfree, Equaline Pain Relief, Help I Have A Headache, Febridol Clear Effervescent, Childrens Panadol 1 - 5 Years, Childrens Panadol 1 - 5 Years Colourfree, Children's ElixSure, Mapap Rapid Release Gelcaps, Benylin Sore Throat, Chem Mart Chemadol Colourfree Childrens 1-5 Years, Febridol Syrup for Children, Amcal Paracetamol Tabsules, Contac Cold and Flu Maximum Strength, Childrens Tylenol Cold Plus Cough, Theraflu Flu & Cough, Allpanto-S, Co-Apap, Genacol Maximum Strength, Comtrex Cold and Flu Maximum Strength Liquid, Contac Severe Cold and Flu Maximum Stength, Comtrex Day and Night, Cough Formula M Multi-Symptom, Comtrex Cold and Flu Maximum Strength Tablet, Alka-Seltzer Plus-D Multi-Symptom Sinus & Cold Liquid Gels, Triaminic Flu, Cough & Fever, Robitussin Peak Cold Nighttime Nasal Relief, Allergy Multi-Symptom, Onset Forte, Gendecon, Dristan Cold Multi Symptom Formula, PX Allergy Sinus PE, Allergy Sinus PE Pain Relief, Gelpirin-CCF, Contac Cold + Flu (Night Formula), ConRx Allergy Sinus, Allergy Pain Relief, Comtrex Maximum Strength Cold Relief, Comtrex Cold and Flu Maximum Strength, Alka-Seltzer Plus Cold & Cough Formula Liquid, PediaCare Multi-Symptom Cold Plus Acetaminophen, PediaCare Flu Plus Acetaminophen, Tylenol Cold Multi-Symptom Nighttime, Tylenol Cold Head Congestion Nighttime, Alka-Seltzer Plus Cold & Cough Formula Liquid Gels, Tylenol Plus Children's Flu, Tylenol Plus Children's Cough & Runny Nose, Coricidin HBP Day & Night Multi-Symptom Cold, Dimetapp Children's Multi-Symptom Cold & Flu (old formulation), Tylenol Plus Children's Multi-Symptom Cold, Comtrex Cold & Cough Day Night, Theraflu Nighttime Severe Cold & Cough Caplets, Alka-Seltzer Plus Severe Sinus & Cold Hot Drink Mix, Alka-Seltzer Plus Flu Formula, Dimetapp Children's Nighttime Flu, Theraflu Warming Relief Nighttime Multi-Symptom Cold Caplets, Triaminic Multi-Symptom Fever & Cold, Alka-Seltzer Plus Severe Cold & Flu Formula Effervescent Tablets, Multi Symptom Cold (Night Formula), Tylenol Cold Head Congestion Day and Night, Comtrex Nighttime Cold & Cough, XL-3 Xtra Cold and Cough, Cold Multi-Symptom (Nighttime), Comtrex Severe Cold & Sinus, Comtrex Flu Therapy, Cocet, Cocet Plus, Phenflu CDX, Phenflu CD, Maxiflu CD, Aceta w/ Codeine, Capital with Codeine Suspension, Allergy Sinus Maximum Strength, Actifed Cold & Sinus, Tavist Allergy/Sinus/Headache, EZ III, Maxiflu CDX, Dologen 325, PediaCare Cough & Sore Throat Plus Acetaminophen, Hexaflu, Drixoral Cough/Sore Throat, Tylenol Cough and Sore Throat Daytime, Triaminic Softchews Cough & Sore Throat, Drixoral Sinus, Drixoral Cold and Flu, Drixoral Cold/Flu, Complete Sinus Relief, Sinadrin Plus, Drixoral Allergy Sinus, Sinutab Maximum Strength Caplets, Triaminicin, Norel SR, Covangesic, Trital SR, Rhinogesic, Duadacin, Dryphen, HEB Allergy, Tylenol Plus Children's Cold, XL-3 Cold Medicine, Hybrid CF, Sine-Off Sinus/Cold, Sinulin, Chlor-Trimeton Sinus, Tylenol Allergy Sinus, Allerest Sinus, Comtrex Allergy Sinus Maximum Strength, Comtrex Allergy Sinus Night and Day, Sinarest Extra Strength, Kolephrin, Codimal, Comtrex Sinus and Nasal, Comtrex Nighttime Flu Therapy, Tricom, Comtrex Allergy Sinus, Coricidin HBP Multi-Symptom Cold (Night), Flu Relief BP, Supac, Genace, Goody's Extra Strength, Anacin Advanced Headache Formula, Backaid Inflammatory Pain Formula, Goody's Headache Powders, Uricalm Intensive, Bayer Migraine Formula, Excedrin Menstrual Complete, Arthriten, ConRx Pain Reliever, Arthriten Inflammatory Pain Formula, PainAid Extra-Strength Formula, Orbivan CF, Comtrex Acute Head Cold, Phrenilin Forte, Bucet, Dolgic, Staflex, Rhinocaps, CVS Extra Strength Headache Relief, Medique Pain-Off, Extra Pain Relief, Excedrin PM Headache, Excedrin Back & Body, Terry White Chemists Colour Free Paracetamol Infant Drops, Savings Paracetamol, RP Scherer Paracetamol Liquid-Filled Capsules, Signature Range Paracetamol, Dymadon, Soul Pattinson Childrens Paracetamol Elixir, RP Scherer Paracetamol, Paraspen, Pharmacist Advice Colourfree Childrens Paracetamol Double Strength, Guardian Childrens Paracetamol, Pharmacist Formula Paracetamol, Pharmacist Formula Infants, Soul Pattinson Colour Free Paracetamol 1-5 Years, Soul Pattinson Colour Free Paracetamol Drops, API Healthcare Paracetamol, Panadol Mini Caps, Pharmacy Health Paracetamol, Terry White Chemists Colour Free Paracetamol 1-5 Years, Pharmacist Paracetamol, Soul Pattinson Paracetamol Clear Effervescent, API Healthcare Colourfree Childrens Paracetamol Double Strength, Soul Pattinson Colourfree Childrens Paracetamol, Panadol Gel Tabs, API Healthcare Coloufree Childrens Paracetamol, Soul Pattinson Paracetamol, Marten-Tab, Isocet, Cafgesic Forte, Durabac Forte, Saleto-D, Flextra Plus, Durabac, Combiflex ES, Emagrin Forte (old formulation), Sinapils, Panlor DC, Panlor SS, DHC Plus, Menstrual Relief Extra Strength, Menstrual Relief Maximum Strength, Colrex, Colrex Compound, PediaCare Cough & Runny Nose Plus Acetaminophen, Mapap Cough & Sinus Formula, Vicks Formula 44 Custom Care Cough & Cold PM, Cotabflu, Congestant, Menstrual Relief, Menstrual Complete, Rid-A-Pain Compound, Ninjacof-A, Hycomine Compound, Excedrin Quick Tab, Dolmar, Fiorpap, Endolor, Ezol, Ide-cet, Tencet, Femcet, Pharmagesic, Anoquan, Two-Dyne, Tenake, G-1, Medigesic, Dolgic LQ, Dolgic Plus, Orbivan, Excedrin Mild Headache, Valorin Extra, Nonbac, Americet, Minotal, Mygracet, Pacaps, Alagesic, Tylenol Plus Children's Cough & Sore Throat

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

20160204

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