From the Research
Dextromethorphan syrup is generally considered safe for use in lactating women when taken at recommended doses for short periods, as the medication transfers into breast milk in small amounts, typically too low to cause adverse effects in most nursing infants. The safety profile of dextromethorphan during lactation is based on its limited passage into breast milk and minimal oral bioavailability in infants, as supported by a study published in the Journal of Clinical Pharmacology in 2022 1. This study found that the breast milk-to-plasma ratios of dextromethorphan and its active metabolite, dextrorphan, suggested extensive distribution into breast milk, but the estimated infant exposure was minimal, with relative infant doses of less than 1%. However, it's essential to use the lowest effective dose for the shortest duration needed to control symptoms, and breastfeeding women should be aware that higher doses or prolonged use might potentially cause drowsiness or irritability in some infants.
Some key points to consider when using dextromethorphan syrup in lactating women include:
- Standard adult dosing is typically 10-30 mg every 4-8 hours, not exceeding 120 mg in 24 hours
- Breastfeeding women should monitor their infants for any unusual symptoms, such as excessive sleepiness, difficulty feeding, or irritability, and discontinue the medication if necessary
- Alternative non-drug approaches for cough management, like staying hydrated, using a humidifier, and honey (for mothers, not for infants under 12 months), may be considered before turning to medication
- The risk of infant exposure to dextromethorphan and dextrorphan through breast milk is considered low, but one nursing infant developed an erythematous rash during the study, which warrants additional research to fully elucidate the risks 1.
Overall, the available evidence suggests that dextromethorphan syrup can be used safely in lactating women when taken at recommended doses for short periods, but it's crucial to prioritize caution and monitor for any potential adverse effects in the infant.