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