Is ibuprofen (nonsteroidal anti-inflammatory drug, NSAID) safe during breastfeeding?

From the Guidelines

Ibuprofen is considered safe to use during breastfeeding, as stated in the 2020 guideline from the Association of Anaesthetists 1.

Key Points to Consider

• The amount of ibuprofen that passes into breast milk is very small, making it unlikely to cause adverse effects in most breastfed infants.
• The standard adult dosage is 200-400 mg every 4-6 hours as needed, not exceeding 1200 mg in 24 hours without medical supervision.
• Ibuprofen works by inhibiting prostaglandin synthesis, which reduces inflammation, pain, and fever.
• For nursing mothers experiencing pain or inflammation, ibuprofen may be preferable to some other pain medications because of its minimal transfer to breast milk and good safety profile.
• While generally safe, mothers should still use the lowest effective dose for the shortest duration needed.

Special Considerations

• If your infant has known kidney problems or is premature, consult with your healthcare provider before using ibuprofen, as these situations may warrant additional consideration.
• It's also important to note that other NSAIDs, such as diclofenac, naproxen, and celecoxib, are also considered safe for use during breastfeeding, as per the guideline 1.
• However, aspirin should be used with caution, as high doses can increase the risk of salicylate intoxication and bleeding problems in the neonate 1.

From the FDA Drug Label

It is not known whether this drug is excreted in human milk Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from ibuprofen tablets, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Ibuprofen and Breastfeeding:

• The FDA drug label states that it is unknown if ibuprofen is excreted in human milk.
• Due to the potential for serious adverse reactions in nursing infants, a decision should be made to either discontinue nursing or discontinue the drug, considering the importance of the drug to the mother 2.
• As a result, caution is advised when considering the use of ibuprofen in breastfeeding mothers.

From the Research

Ibuprofen and Breastfeeding

• Ibuprofen is considered a preferred analgesic during lactation, as stated in the study published in the American Family Physician in 2022 3.
• The amount of medication that enters breast milk varies based on the maternal serum concentration and the pharmacologic properties of the medication, according to the same study 3.
• When prescribing medications for a breastfeeding patient, those with the lowest risk to the infant should be selected, and dosing should be before the infant's longest sleep interval, as recommended in the study 3.

General Guidelines for Medication Use during Breastfeeding

• Most medicines can be used safely during breastfeeding at the recommended dose, however there are exceptions that necessitate caution, as stated in the Australian Family Physician in 2011 4.
• Breastfeeding women typically use relatively few medicines, and generally these are compatible with breastfeeding, according to the same study 4.
• If other medicines are required, information on their safety during breastfeeding can be accessed from pharmacy departments at maternity hospitals or from online resources, as suggested in the study 4.

Considerations for Medication Use during Breastfeeding

• Adverse reactions in infants from maternal drug ingestion depend largely on the amount of milk consumed by the infant, timing of breastfeeding in relation to dosing, dose of the medication, dosing interval, and duration of therapy, as explained in the Journal of Human Lactation in 1999 5.
• Mothers taking medications should be instructed to take their medication after breastfeeding, at the lowest effective dose and for the shortest duration, according to the same study 5.
• Excessive caution may lead health professionals to unnecessarily advise to interrupt breastfeeding, without assessing the latest evidence or considering the risk-benefit ratio of taking a medication versus terminating breastfeeding, as discussed in the Journal of Human Lactation in 2016 6.