Aspirin use while Breastfeeding
Drugs containing Aspirin: Aspir 81, Ecotrin, Aggrenox, Excedrin, Butalbital Compound, Bayer Aspirin, Aspir-Low, Fiorinal, Aspirin Low Strength, Excedrin Migraine, Show all 192 »Acetylsalicylic Acid, Bufferin, Anacin, Bayer Back & Body, Easprin, Ascriptin, Ecotrin Adult Low Strength, Percodan, Vanquish, Aspiritab, Arthritis Pain, Fasprin, Aspirin Buffered, Aspirin Lite Coat, Halfprin, Bayer PM, Excedrin Extra Strength, Buffered Aspirin, Acuprin 81, Norgesic, Migraine Relief, Bayer Children's Aspirin, Ascomp with Codeine, Alka-Seltzer Original, Fiorinal with Codeine, Ascriptin Enteric, Aspergum, BC, Propoxyphene Compound 65, Bayer Aspirin Regimen, Carisoprodol Compound, Low Dose ASA, Yosprala, Miniprin, St. Joseph 81 mg Aspirin Enteric Safety-Coated, Durlaza, Tri-Buffered Aspirin, Litecoat Aspirin, Empirin, Bufferin Low Dose, Alka-Seltzer Extra Strength, Goody's Headache Powders, Entercote, Effervescent Pain Relief, Aspirtab, Soma Compound with Codeine, Painaid, Levacet, Pravigard Pac, Roxiprin, Aspir-Mox, Pamprin Max Menstrual Pain Relief, Goody's Extra-Strength Headache Powders, Migraine Formula, Momentum, Migralex, Ecpirin, Sloprin, BC Headache, Midol Traditional, Robaxisal, Stanback, Vida Mia Pain Relief, BC Fast Pain Relief, Bayer Extra Strength Back & Body, Alka-Seltzer Plus Cold Formula Cherry Burst Effervescent Tablets, Fortabs, Axotal, Darvon Compound-65, Excedrin Back & Body, Soma Compound, Fiorinal with Codeine III, Goody's Body Pain, Synalgos-DC, Extra Strength Bayer, Backaid Inflammatory Pain Formula, Arthriten Inflammatory Pain Formula, Endodan, Equagesic, Exaprin, Excedrin PM Headache, Lortab ASA, Azdone, St. Joseph 81 mg Chewable Aspirin, ZORprin, Bayer Aspirin Extra Strength Plus, Buffex, Damason-P, Zero-Order Release, YSP Aspirin, Bayer Advanced Aspirin, Bayer Women's Aspirin With Calcium, Alka-Seltzer Plus Cold Formula Orange Zest Effervescent Tablets, Talwin Compound, Stanback Fast Pain Relief, Emagrin, B C Powder Arthritis Strength, B C Powder, PC-CAP, Alka-Seltzer Plus Sinus Formula, Darvon Compound 32, Percodan-Demi, Empirin with Codeine, Alka-Seltzer Plus Day & Night Cold Formula (Night Cold), Orphengesic, Orphengesic Forte, Bayer Women's Low Dose Plus Calcium, Micrainin, Medique Medi-Seltzer, Adalat XL Plus, Zee-Seltzer Antacid and Pain Reliever, Winco Foods Effervescent Antacid and Pain Relief, Panasal 5/500, Picot Plus, Alor 5/500, Bromo Seltzer, Alka-Seltzer Plus Night Cold Formula Effervescent Tablets, Alka-Seltzer Lemon-Lime, Alka-Seltzer Plus Flu Formula (old formulation), Alka-Seltzer Plus Cold & Cough Formula Effervescent Tablets, Alka-Seltzer PM, Alka-Seltzer Plus Cold Formula Sparkling Original Effervescent Tablets, Alka-Seltzer Plus Day & Night Cold Formula (Day Cold), Norwich Aspirin, Norgesic Forte, Saleto, Genacote, Ecotrin Maximum Strength, Medi-Seltzer, Aspi-Cor, Bayer Aspirin with Heart Advantage, Arthritis Foundation Pain Reliever, Ascriptin Maximum Strength, Aspir-Mox IB, Arthritis Pain Formula, Magnaprin, Rhinocaps, Extra Pain Relief, Genprin, Medique Pain-Off, CVS Extra Strength Headache Relief, PainAid Extra-Strength Formula, Anacin Advanced Headache Formula, Goody's Extra Strength, Supac, Genace, Uricalm Intensive, ConRx Pain Reliever, Arthriten, Excedrin Menstrual Complete, Bayer Migraine Formula, Gennin-FC, Minitabs, Ache and Pain Relief to Go, BC Arthritis, Bayer AM, P-A-C, Back & Body Extra Strength, Blowfish for Hangovers, Bayer Headache Relief, Anacin Max Strength, Alka-Seltzer Wake-Up Call!, Adult Strength, Genasan, Cope, Aspircaf, P-A-C Analgesic, Fiortal with Codeine, Entaprin, Farbital, Laniroif, Idenal, Fiortal, Fiormor, Buffasal, Heartline, Stanback Analgesic, St. Joseph Aspirin, Therapy Bayer, Bufferin Extra Strength, Bufferin Arthritis Strength, Ursinus
Aspirin Levels and Effects while Breastfeeding
Summary of Use during Lactation
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. After daily low-dose aspiring (75 to 325 mg daily), no aspirin is excreted into breastmilk and salicylate levels are low. Daily low-dose aspirin therapy may be considered as an antiplatelet drug for use in breastfeeding women..
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.
Seven nursing mothers between 1 and 8 months postpartum were taking enteric-coated aspirin daily; 6 took 81 mg and 1 took 325 mg. Aliquots of a complete collection of milk from both breasts were analyzed for aspirin and salicylic acid 6 times over the following 24-hour period. Aspirin was undetectable (<0.61 mcg/L) in all samples. In mothers taking 81 mg of aspirin daily, the peak salicylate concentration in milk was 115 mcg/L at 2 to 4 hours after the dose and the average milk concentration was 24 mcg/L. In the woman taking 325 mg of aspirin, the peak milk salicylate concentration was 745 mcg/L at 1 hour after the dose and the average salicylate concentration was 107.4 mcg/L. The authors calculated a weight-adjusted infant salicylate dosage of 0.4%.
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 aspirin or 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 (dosages and infant ages were unspecified) in breastmilk.
Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.
Alternate Drugs to Consider
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. Datta P, Rewers-Felkins K, Kallem RR et al. Transfer of low dose aspirin into human milk. J Hum Lact. 2017;33:296-9. PMID: 28418802
4. 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.
5. Erickson SH, Oppenheim GL. Aspirin in breast milk. J Fam Pract. 1979;8:189-90. PMID: 759544
6. Jamali F, Keshavarz E. Salicylate excretion in breast milk. Int J Pharm. 1981;8:285-90.
7. 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
8. Findlay JW, DeAngelis RL, Kearney MF et al. Analgesic drugs in breast milk and plasma. Clin Pharmacol Ther. 1981;29:625-33. PMID: 7214793
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
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.
More about aspirin
- Side Effects
- During Pregnancy or Breastfeeding
- Dosage Information
- Drug Images
- Drug Interactions
- Compare Alternatives
- Support Group
- Pricing & Coupons
- 29 Reviews – Add your own review/rating
- Drug class: platelet aggregation inhibitors
- Aspirin rectal
- Aspirin Chewable Tablets
- Aspirin Tablets
- Aspirin Extended-Release Capsules
- ... +3 more