Breastfeeding and OTC Medication: Top Safety Tips
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on April 27, 2021.
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.
Important Note: Always consult your doctor or healthcare specialist for medical advice in relation to drug use while pregnant or breastfeeding. Your doctor and pediatrician are always the best resource for questions regarding safety and timing of drug use during breastfeeding.
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
And if you enjoy a much needed coffee, learn about caffeine safety in your breast milk.
Is There a Best Time to Take A Medication?
For some medications, your doctor may suggest you take your medication 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.
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.
- It is now recommended to avoid naproxen during breastfeeding because of naproxen's long half-life and reported serious adverse reactions in breastfed infants. Serious side effects like anemia, prolonged bleeding time, and thrombocytopenia (low platelet counts) were reported. Other agents, such as acetaminophen or ibuprofen may be preferred while nursing.
The Go-To Med: Acetaminophen
Acetaminophen is often considered the OTC of choice for mild pain or fever during breastfeeding. Acetaminophen may not always work as well as ibuprofen for pain due to swelling, cramps, and muscle inflammation.
- 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 at the correct dose.
- Acetaminophen is also considered compatible with breastfeeding by the American Academy of Pediatrics.
- According to Lactmed, acetaminophen is a good choice for pain relief 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. Reports from studies state that asthma due to acetaminophen use in infants is not backed up by reliable data. Much of that data linking pain relievers like acetaminophen to asthma comes from observational studies, not controlled, clinical trials.
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 aspirin (75 to 325 mg daily), no aspirin is excreted into breastmilk and salicylate levels are low. Aspirin use in breastfeeding should be directed by your physician only.
The risk of Reye's syndrome from salicylate in breastmilk is unknown.
It is recommended to avoid high-dose aspirin. An alternate pain reliever, like acetaminoophen or ibuprofen, is preferred over continuous high-dose, aspirin therapy.
Seasonal Allergy Treatments
Seasonal allergies can wreak havoc for new moms. There is simply 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. You should avoid Allegra-D or Claritin-D, as the combination with the decongestant pseudoephedrine or phenylephrine might slow down your milk production.
Inhaled corticosteroids can be effective agents for seasonal and year-round, indoor allergies, such as house mites and pets. It is not known if corticosteroids like fluticasone nasal spray (Flonase) passes into your breast milk and if it can harm your baby.
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.
The product label for Flonase states that caution should be use as it is not known whether fluticasone propionate is excreted in human breast milk.
Heartburn (dyspepsia) and gas 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 for 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: Pepcid
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) before their pregnancy. For acid indigestion, Pepcid AC appear to also be safe while nursing.
The doses of famotidine in breast milk are less than the dose used in newborn infants.
- The usual dose of famotidine 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 of caffeine (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.
Drinking more than about 2 cups (450 mL) of coffee per day may also lower iron levels in the breastmilk, leading to a mild iron deficiency anemia in some breastfed infants.
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. Phenylephrine, if absorbed into the blood, may decrease your milk supply, so speak with your doctor before using a decongestant nasal spray.
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.
A nasal saline spray like Ayr or Altamist Spray or a Neti Pot (follow directions for use closely) are drug-free options if you prefer.
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 slow-moving 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), which has no absorption, or docusate (Colace), which has limited absorption, may be the preferred agents for constipation prevention.
According to Mother to Baby, ducosate sodium use while breastfeeding has not been studied. While some of the docusate is absorbed by the mother, the amount that passes into breast milk is likely low. No reports of problems in breastfeeding children while the mother is taking docusate sodium have been reported. Be sure to talk to your healthcare provider about all of your breastfeeding questions.
For acute constipation, lactulose (MiraLax) may be an option, but check with your doctor first. There are no data on the excretion of lactulose into human milk. While the manufacturer recommends cautious use during lactation, side effects in the nursing infant are unlikely due to poor absorption.
Breastfeeding can have its own set of side effects in new moms.
- Yeast infections that occur on the breasts lead to sore breasts and swollen nipples. Breasts may turn pink or shiny and itch. Visit your doctor to determine if a breast yeast infection is present.
- 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.
- Lanolin may be preferred for treating just sore nipples during breastfeeding. Miconazole ointment appears to have no advantage over lanolin for treating sore nipples during breastfeeding.
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) and clotrimazole (Lotrimin) are topical antifungal medicines. They do not absorb into the bloodstream very well, and are unlikely to cause problems in the breastfed infant. Miconazole cream is rarely used to treat thrush, and resistance to nystatin cream is being reported, so check with your doctor.
Only use water-soluble creams or gels products on the breast; ointments may expose the infant to paraffins or waxes.
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?
Sources of reliable information to help you learn about medication use in breastfeeding can be found in several sources. Always check with your doctor, too.
- Search the Breastfeeding database in Drugs.com.
- LactMed Database, from the National Library of Medicine, is a free and searchable database of drugs and other chemicals to which nursing mothers may be exposed. It includes both OTC and prescription drugs.
- Mother-to-Baby is a no-cost website from The Organization of Teratology Information Specialists (OTIS). It contains a search engine for learning about substances in pregnancy and during breastfeeding.
The levels of substances in breast milk and infant blood, and the possible adverse effects in the nursing infant are 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: Top Safety Tips
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- Datta P, Rewers-Felkins K, Kallem RR et al. Transfer of low dose aspirin into human milk. J Hum Lact. 2017;33:296-9.
- Sordillo J, Scirica C, Rifas-Shiman S, et al. Prenatal and infant exposure to acetaminophen and ibuprofen and the risk for wheeze and asthma in children. J Allergy Clin Immunol. 2015 Feb; 135(2): 441–448. https://doi.org/10.1016/j.jaci.2014.07.065
- 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. http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm
- Healthy Children.org. Medications and Breastfeeding. http://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Medications-and-Breastfeeding.aspx
- Medicine Use While Breastfeeding. Drugs.com. https://www.drugs.com/breastfeeding/
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- 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
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.