Is ibuprofen (Nonsteroidal Anti-Inflammatory Drug (NSAID)) safe to use during breastfeeding?

Ibuprofen Safety During Breastfeeding

Ibuprofen is safe to use during breastfeeding and is considered a preferred analgesic option for breastfeeding mothers. 1

Evidence and Pharmacokinetics

Ibuprofen has been extensively studied in the context of breastfeeding and demonstrates several favorable characteristics:

• It has been used extensively for postpartum pain and during lactation with an established safety profile 1
• Only small amounts are transferred into breast milk, resulting in minimal infant exposure 2
• It is specifically listed as a compatible analgesic for breastfeeding mothers in current guidelines 1, 3

Clinical Decision Making Algorithm

When considering pain management for breastfeeding mothers:

1. First-line options:

   • Ibuprofen (preferred NSAID)
   • Acetaminophen (paracetamol)

2. For longer-term NSAID use:

   • Ibuprofen is particularly suitable as it has a short half-life and no active metabolites 2
   • No special timing of doses relative to breastfeeding is required

3. Avoid in breastfeeding:

   • Aspirin at analgesic doses (can be used cautiously at low anti-platelet doses if strongly indicated) 1
   • Combination products containing multiple ingredients 4

Dosing Considerations

• Use the lowest effective dose for the shortest duration needed
• Standard adult dosing is appropriate (no dose adjustment needed for breastfeeding status)
• No need to time doses around breastfeeding sessions

Monitoring

• No special monitoring of the infant is required when using ibuprofen
• Unlike some medications (e.g., codeine, tramadol, oxycodone), there is no need to observe for drowsiness or other adverse effects in the infant 1

Important Caveats

• While ibuprofen is safe during breastfeeding, remember that NSAIDs should be avoided during pregnancy at about 30 weeks gestation and later due to risk of premature closure of the fetal ductus arteriosus 5
• For mothers with pre-existing conditions where NSAIDs are contraindicated (severe renal impairment, active peptic ulcer disease, etc.), the same contraindications apply regardless of breastfeeding status
• Single-ingredient products are preferable to combination products that may contain additional medications 4

Ibuprofen represents an excellent choice for pain management in breastfeeding mothers due to its established safety profile, minimal transfer into breast milk, and effectiveness as an analgesic and anti-inflammatory agent.