From the Guidelines
Breastfeeding mothers can safely use ibuprofen, diclofenac, naproxen, celecoxib, ketorolac, and parecoxib for analgesia, as these medications have been found to have minimal transfer into breast milk and pose little risk to infants 1. When considering analgesic options for breastfeeding mothers, it is essential to prioritize medications with a proven safety profile.
- Ibuprofen, diclofenac, and naproxen are all considered safe for use during breastfeeding, with minimal amounts detected in breast milk 1.
- Celecoxib, ketorolac, and parecoxib have also been found to be compatible with breastfeeding, with low levels detected in breast milk and no demonstrable adverse effects in neonates 1.
- Aspirin, on the other hand, should be used with caution, as it is not recommended for analgesic doses due to theoretical risks, although low-dose aspirin for anti-platelet action can be used if strongly indicated 1. It is crucial to note that codeine should be avoided due to its unpredictable metabolism, which can lead to dangerous levels in some infants, as highlighted in the guideline on anaesthesia and sedation in breastfeeding women 2020 1. In general, the safety of these medications during breastfeeding stems from their limited passage into breast milk, with most transferring in very small amounts that are well below therapeutic doses for infants.
- Timing medication doses immediately after breastfeeding can further minimize infant exposure. Always consult with a healthcare provider before taking any medication while breastfeeding, especially for chronic pain requiring long-term management.
From the FDA Drug Label
Oxycodone is present in breast milk. Published lactation studies report variable concentrations of oxycodone in breast milk with administration of immediate-release oxycodone to nursing mothers in the early postpartum period. Infants exposed to oxycodone hydrochloride tablets through breast milk should be monitored for excess sedation and respiratory depression.
The FDA drug label does not provide a list of safe analgesics during lactation. However, based on the information provided for oxycodone, it is not recommended due to the potential risk of excess sedation and respiratory depression in breastfed infants 2.
From the Research
Analgesics Safe During Lactation
The following analgesics are considered safe for use during lactation:
- Paracetamol (acetaminophen) 3, 4
- Low-dose aspirin (acetylsalicylic acid) [up to 100 mg/day] 3
- Ibuprofen 4
- Codeine 3, 5
- Morphine 3
- Propoxyphene 3
- Short-term treatment with NSAIDs 3, 6
Analgesics to be Used with Caution
The following analgesics should be used with caution or avoided during lactation:
- Aspirin at a dosage >100 mg/day 3
- Dipyrone 3
- Pethidine (meperidine) 3
- Opioids, as they can cause infant sedation 4
General Guidelines
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 4. It is also recommended to use current, accurate resources, such as LactMed, to determine the safety of medications during lactation 4.