Breastfeeding & OTC Medication: Safety Tips That You Need To Know
Medically reviewed on Jun 18, 2018 by L. Anderson, PharmD.
New Mother? Breastfeeding is Best.
Did you recently have a new bundle of joy? Congratulations! If you are like many new moms, you may be new to nursing, too. You know that breastfeeding is the best way to feed your baby.
But let's face it: headaches and sore muscles will still happen, coughs and colds will come and go, and you may need to take any number of medicines, even while you're nursing.
Although many over-the-counter (OTC) drugs are safe to use while breastfeeding, some will get into your milk to a degree and may even lessen your milk supply.
Here are a few answers about common OTC medicines and breastfeeding to help keep you and your baby on the right track.
What Are the Important Questions?
There are many issues to consider for medication use during breastfeeding. Questions you may want to address with your doctor include:
- How helpful will the drug be to you and your illness?
- Is there a risk the baby will stop nursing, even temporarily?
- How safe is the medicine if consumed by the baby through breast milk?
When you are sick or in need of medication, you may not feel like talking to your doctor for any length of time. So it may be wise to ask questions about common OTC medicines you might take before illness strikes:
- acetaminophen (Tylenol)
- ibuprofen (Advil, Motrin)
- allergy medicines like Bebadryl, Allegra, or Zyrtec
- OTC cough and cold products
- heartburn medications like Pepcid or Zantac
- medicines for constipation
Is There a Best Time to Take A Medication?
Your doctor and pediatrician are always the best resource for questions regarding timing of drug use during breastfeeding.
It may be recommended to take your medications that are given only once a day right after a feeding when your baby will have the longest period without nursing; for many women this is the last feeding of the night before the infant's bedtime. Check woth your doctor about this.
Answers for many common drugs are posted here, too.
What About OTC Medicines: Ibuprofen and Naproxen
Ibuprofen (common brands include Motrin, Advil), a nonsteroidal antiinflammatory drug (NSAID), is a common medicine for many new moms, with headaches, backaches, and muscle soreness happening almost daily. You can buy it over-the-counter (OTC) without a prescription.
Because of its extremely low levels in breast milk, short half-life and use in infants in doses much higher than those excreted in breast milk, ibuprofen is one preferred choice as an analgesic or anti-inflammatory drug in nursing mothers.
According to the LactMed database from the National Library of Medicine, at least 23 cases are reported in the literature in which infants (ages not stated) were breastfed during maternal ibuprofen use with no side effects reported.
Naproxen (Aleve) is a longer-acting NSAID that is also widely available without a prescription. Limited data suggests that levels of naproxen in breastmilk are low and side effects in breastfed infants seem to be uncommon. However, because of naproxen's long half-life and reported serious adverse reaction in a breastfed neonate, ibuprofen may be the preferred NSAID while nursing. Serious side effects like anemia, prolonged bleeding time, and thrombocytopenia (low platelet counts) have been reported in one infant.
The Go-To Med: Acetaminophen
While acetaminophen may not always work as well as ibuprofen for pain due to swelling, cramps, and muscle inflammation, acetaminophen is probably the OTC of choice -- especially when you have a pounding headache, non-inflammatory pain or need to quiet a fever.
Plus, acetaminophen is given to infants as a fever and pain reliever, too, so there's a good level of comfort with using it during breastfeeding. Amounts in milk are much less than doses usually given to infants. Acetaminophen is considered compatible with breastfeeding by the American Academy of Pediatrics.
Adverse effects in breastfed infants appear to be rare. Reports that acetaminophen can cause asthma in infants is not backed up by reliable data.
Avoid Aspirin in Most Cases
Check with your doctor before taking any aspirin while nursing.
For headaches and minor pains, acetaminophen or ibuprofen are usually the first choice while nursing. Experts state that aspirin is best avoided during breastfeeding; however, some opinion indicates that daily low-dose aspirin (75 to 325 mg daily) may be considered as a blood-thinning agent for use in breastfeeding women if required. After daily low-dose aspiring (75 to 325 mg daily), no aspirin is excreted into breastmilk and salicylate levels are low.
It is recommended to avoid high-dose aspirin. An alternate drug is preferred over continuous high-dose, aspirin therapy.
Seasonal Allergy Treatments
Seasonal allergies can wreak havoc for new moms, and there simply is no time for stuffiness and antihistamine drowsiness when caring for a new baby.
- watery eyes
- runny nose.
Because of low (or no) sedation and low milk levels, using the lowest dose possible of loratadine or fexofenadine for allergy symptoms would not be expected to cause side effects in infants.
Inhaled corticosteroids can be effective agents for seasonal and year-round, indoor allergies, such as house mites and pets. According to the NIH's ToxNet database LactMed, the amounts of inhaled corticosteroids absorbed into the mother's bloodstream and excreted into breastmilk are probably too small to affect a breastfed infant. Reviewers and an expert panel consider inhaled corticosteroids, such as fluticasone (Flonase Allergy Relief) acceptable to use during breastfeeding.
Heartburn (dyspepsia) can be a common problem for new moms. Lack of sleep, a hurried eating schedule, coupled with a baby propped on your belly, can often be to blame. But in usual doses, most antacids are safe while nursing.
Minerals used in antacids, like calcium, magnesium, and aluminum, are also found in human milk. Plus, oral absorption of magnesium and aluminum are poor. Common products include:
Generics and store brands can be found these, too.
Antacids may also contain alginic acid or simethicone (for gas), but these are not absorbed orally. Experts generally consider antacid use at normal doses during breastfeeding to be acceptable with no special precautions.
OTC Oral Tablets for Heartburn
Sometimes the heartburn a new mom experiences needs a little more than an antacid. Many women use oral tablets like over-the-counter (OTC) famotidine (Pepcid AC) or ranitidine (Zantac 150) before pregnancy. For acid indigestion, these agents appear to also be safe while nursing.
The doses of famotidine or ranitidine in breast milk are less than the dose used in newborn infants. The usual dose of famotidine or ranitidine that the mother would take would not be expected to cause any side effects in the breastfed baby. No special precautions are required with these drugs, although follow dosing recommendations.
A Cup 'O Joe may be needed for many sleep-deprived new moms, but caffeine is a stimulant to the newborn, too. There's no way to get around it.
Caffeine appears in breast milk rapidly after the mom consumes it. Fussiness, jitteriness and poor sleep patterns have been reported in the infants of mothers with very high caffeine intakes equivalent to about 10 or more cups of coffee daily.
Experts suggest no more than 300 mg per day (roughly 2 to 3 eight ounce cups of coffee). It's best to avoid highly concentrated energy drinks, multiple espressos, or caffeine tablets. Breastfeed prior to having your coffee, too, so that high levels are not consumed by the infant.
Mothers of preterm babies should avoid caffeine or consume lower levels. Find more information about caffeine content levels here.
Decongestant Nasal Sprays
We all love that new baby smell. But a clogged-up nose is no fun when you are trying to cuddle your little one.
Over-the-counter (OTC) nasal spray decongestants used to treat stuffy noses are recommended over oral decongestants like pseudoephedrine or phenylephrine, which can decrease milk production and lead to fussiness in your baby.
The spray products, which may contain nasal oxymetazoline or phenylephrine (Afrin, Neo-Synephrine, Dristan) have limited absorption into the blood stream, as they act locally on the nose. Use nasal decongestant sprays only for 3 days on and then 3 days off, as you can develop rebound congestion, which makes it hard to get rid of the stuffy nose at all.
Laxatives for Constipation
Most new moms will tell you that constipation is a common occurrence after pregnancy. Dehydration may contribute to this problem, as well as higher levels of the hormone progesterone, a slowed digestive tract, or use of constipating pain relievers.
In the days right after having your baby, get back to a normal diet, keep moving around, drink lots of water and eat high-fiber foods to keep your bowels moving.
If needed, and as directed by your doctor, bulk-forming and stool softener laxatives like psyllium (Metamucil) or docusate (Colace) may be the preferred agents for constipation prevention. For acute constipation, lactulose may be a safe option, but check with your doctor first.
Yeast infections that occur on the breasts lead to sore breasts and swollen nipples. Breasts may turn pink or shiny and itch. The yeast infection feeds on the milk left on the breast. The baby can develop diaper rash or thrush in the mouth that may appear as white spots.
Many women may consider prematurely giving up breastfeeding due to the pain. But with the right treatment, women can overcome the yeast infection and continue nursing without problems.
Miconazole cream (Monistat-Derm), Clotrimazole (Lotrimin or Mycelex) are topical antifungal medicines, do not absorb into the bloodstream very well, and are unlikely to cause problems in the breastfed infant. Resitance to nystatin cream is being reported.
Visit your doctor to determine if a breast yeast infection is present. Only use water-soluble creams or gels products should be used on the breast; ointments may expose the infant to paraffins. Any excess cream or ointment should be removed from the breast and nipple before breastfeeding. If your baby has thrush in the mouth, that will need to be treated as well, with an oral suspension antifungal medication.
Where Else Can I Find Reliable Information?
Other accurate sources of information to aid you and your doctor or pharmacist about medications in breastfeeding are the online LactMed Database, a free and searchable database of drugs and other chemicals to which nursing mothers may be exposed. It includes both OTC and prescription drugs.
The levels of substances in breast milk and infant blood, and the possible adverse effects in the nursing infant are also outlined, if known.
Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from the scientific literature.
Join the Drugs.com Breastfeeding Support Group
Support groups for nursing moms can be a great way to discuss breastfeeding topics and concerns.
While any medical advice should only come from your health care provider, discussing what works and what doesn't, sharing stories, and having a group to lean on for moral support can help boost a new nursing mother's confidence.
Consider joining the Drugs.com Breastfeeding Support group if you have information to share or would like to read about other nursing mom's questions and experiences.
This is also an easy way to stay up-to-date with the latest news on breastfeeding.
Finished: Breastfeeding and OTC Medication: Safety Tips That You Need To Know
- Dennis CL, Schottle N, Hodnett E, McQueen K. An all-purpose nipple ointment versus lanolin in treating painful damaged nipples in breastfeeding women: A randomized controlled trial. Breastfeed Med. 2012;7:473-9. PMID: 22428572
- LactMed. National Institutes of Health (NIH). US National Library of Medicine. Accessed June 17, 2018 at http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm
- Healthy Children.org. Medications and Breastfeeding. Accessed June 17, 2018 at http://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Medications-and-Breastfeeding.aspx
- Medicine Use While Breastfeeding. Drugs.com. Accessed June 17, 2018 at https://www.drugs.com/breastfeeding/
- Bakkeheim E, Carlsen KH, Lodrup Carlsen KC. Paracetamol exposure during breastfeeding and risk of allergic disease. Acta Paediatr. 2011;100:e3. June 17, 2018 at https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1651-2227.2011.02340.x
- Ito S, Blajchman A, Stephenson M. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: 8498418 Accessed June 17, 2018 at https://www.ncbi.nlm.nih.gov/pubmed/8498418?dopt=Abstract