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Aspirin use while Breastfeeding

Drugs containing Aspirin: Ecotrin, Aspir 81, Aggrenox, Excedrin, Aspir-Low, Butalbital Compound, Aspirin Low Strength, Fiorinal, Bayer Aspirin, Acetylsalicylic Acid, Show all 192 »Excedrin Migraine, Percodan, Migraine Relief, Anacin, Ecotrin Adult Low Strength, Bufferin, Norgesic, Easprin, Ascriptin, Fiorinal with Codeine, Arthritis Pain, Aspirin Buffered, Yosprala, Excedrin Extra Strength, Bufferin Low Dose, Soma Compound, Acuprin 81, Vanquish, Aspirin Lite Coat, Bayer Back & Body, Empirin, Bayer Children's Aspirin, Aspiritab, Fasprin, Ascriptin Enteric, BC, Propoxyphene Compound 65, St. Joseph 81 mg Aspirin Enteric Safety-Coated, Aspergum, Levacet, Ascomp with Codeine, Norgesic Forte, Buffered Aspirin, ZORprin, Endodan, Picot Plus, Stanback, Aspircaf, Cope, Equagesic, Orphengesic, Migraine Formula, Bayer AM, Halfprin, Alka-Seltzer Plus Cold Formula Sparkling Original Effervescent Tablets, Goody's Headache Powders, Emagrin, Alka-Seltzer Lemon-Lime, Soma Compound with Codeine, Carisoprodol Compound, Excedrin Back & Body, BC Fast Pain Relief, Alka-Seltzer Wake-Up Call!, Laniroif, Fiorinal with Codeine III, Synalgos-DC, Idenal, Midol Traditional, Axotal, Alka-Seltzer Extra Strength, Anacin Max Strength, Litecoat Aspirin, Rhinocaps, Lortab ASA, Entaprin, Norwich Aspirin, Zero-Order Release, Micrainin, Robaxisal, Genace, Goody's Extra-Strength Headache Powders, Pravigard Pac, Alka-Seltzer Plus Sinus Formula, Percodan-Demi, Bayer Aspirin Regimen, Bayer Aspirin Extra Strength Plus, Empirin with Codeine, Medique Medi-Seltzer, Roxiprin, Talwin Compound, Adalat XL Plus, Alka-Seltzer Plus Cold Formula Cherry Burst Effervescent Tablets, Panasal 5/500, Damason-P, Alka-Seltzer Original, Effervescent Pain Relief, Momentum, P-A-C, Back & Body Extra Strength, Blowfish for Hangovers, Ache and Pain Relief to Go, Ursinus, Bromo Seltzer, Vida Mia Pain Relief, Winco Foods Effervescent Antacid and Pain Relief, Alor 5/500, Alka-Seltzer Plus Cold Formula Orange Zest Effervescent Tablets, Alka-Seltzer Plus Flu Formula (old formulation), Alka-Seltzer Plus Cold & Cough Formula Effervescent Tablets, Darvon Compound-65, B C Powder, B C Powder Arthritis Strength, Bayer Women's Low Dose Plus Calcium, Stanback Fast Pain Relief, BC Headache, Bayer Headache Relief, Darvon Compound 32, Bayer PM, Orphengesic Forte, Alka-Seltzer Plus Day & Night Cold Formula (Night Cold), Alka-Seltzer PM, Alka-Seltzer Plus Day & Night Cold Formula (Day Cold), PC-CAP, Zee-Seltzer Antacid and Pain Reliever, Alka-Seltzer Plus Night Cold Formula Effervescent Tablets, Azdone, Migralex, Magnaprin, Arthritis Pain Formula, Aspir-Mox, Excedrin PM Headache, Painaid, Saleto, Exaprin, Aspir-Mox IB, Ascriptin Maximum Strength, Medi-Seltzer, Sloprin, Aspirtab, Aspi-Cor, Arthritis Foundation Pain Reliever, Bayer Aspirin with Heart Advantage, Extra Pain Relief, Medique Pain-Off, Pamprin Max Menstrual Pain Relief, ConRx Pain Reliever, Arthriten, Excedrin Menstrual Complete, Goody's Body Pain, Bayer Migraine Formula, Uricalm Intensive, Supac, PainAid Extra-Strength Formula, CVS Extra Strength Headache Relief, Arthriten Inflammatory Pain Formula, Backaid Inflammatory Pain Formula, Goody's Extra Strength, Anacin Advanced Headache Formula, St. Joseph 81 mg Chewable Aspirin, Low Dose ASA, Bayer Advanced Aspirin, Buffasal, Fiormor, Heartline, Miniprin, Bayer Women's Aspirin With Calcium, YSP Aspirin, Fiortal, Fortabs, P-A-C Analgesic, Genasan, Bayer Extra Strength Back & Body, BC Arthritis, Farbital, Fiortal with Codeine, Ecpirin, Stanback Analgesic, Extra Strength Bayer, Genacote, Entercote, Ecotrin Maximum Strength, Buffex, Durlaza, Gennin-FC, Genprin, Therapy Bayer, St. Joseph Aspirin, Bufferin Extra Strength, Bufferin Arthritis Strength, Minitabs, Tri-Buffered Aspirin, Adult Strength

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.[1][2] 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.

Drug Levels

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.[3]

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.[4]

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.[5]

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.[6] 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.[7] 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.[8] 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.[9]

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.[10]

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.[11]

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.[12]

In a telephone follow-up study, mothers reported no side effects among 15 infants exposed to aspirin (dose and infant age unspecified) in breastmilk.[13]

Effects on Lactation and Breastmilk

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

Alternate Drugs to Consider

Acetaminophen, Ibuprofen

References

1. Bell AD, Roussin A, Cartier R et al. The use of antiplatelet therapy in the outpatient setting: Canadian Cardiovascular Society guidelines executive summary. Can J Cardiol. 2011;27:208-21. PMID: 21459270

2. Bates SM, Greer IA, Middeldorp S et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141 (2 Suppl):e691S-736S. PMID: 22315276

3. 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.

4. Erickson SH, Oppenheim GL. Aspirin in breast milk. J Fam Pract. 1979;8:189-90. PMID: 759544

5. Jamali F, Keshavarz E. Salicylate excretion in breast milk. Int J Pharm. 1981;8:285-90.

6. 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

7. Findlay JWA, DeAngelis RL et al. Analgesic drugs in breast milk and plasma. Clin Pharmacol Ther. 1981;29:625-33. PMID: 7214793

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

Aspirin Identification

Substance Name

Aspirin

CAS Registry Number

50-78-2

Drug Class

Analgesic Agents, Nonsteroidal Antiinflammatory Agents, Platelet Aggregation Inhibitors

Administrative Information

LactMed Record Number

332

Last Revision Date

20170411

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