Are Afrin (oxymetazoline) and Tylenol Cold and Flu Severe (acetaminophen) safe to use while breastfeeding?

Safety of Afrin and Tylenol Cold and Flu Severe During Breastfeeding

Both Afrin (oxymetazoline) and Tylenol Cold and Flu Severe (acetaminophen with other ingredients) should be used with caution while breastfeeding, with acetaminophen being safer than the combination product.

Acetaminophen (Tylenol) Safety

• Acetaminophen alone is considered safe during breastfeeding and is a preferred analgesic for breastfeeding mothers 1
• The FDA label for acetaminophen recommends consulting a healthcare professional before use during breastfeeding 2
• Acetaminophen transfers into breast milk in very low amounts with no demonstrable adverse effects in breastfed infants 3

Oxymetazoline (Afrin) Safety

• The FDA label for oxymetazoline (Afrin) recommends consulting a healthcare professional before use during breastfeeding 4
• Limited data exists on oxymetazoline use during breastfeeding
• As a topical nasal decongestant, systemic absorption is generally low when used as directed, which reduces the risk of significant transfer into breast milk 5
• Short-term use at the lowest effective dose is preferable if needed

Tylenol Cold and Flu Severe Considerations

• Tylenol Cold and Flu Severe contains multiple ingredients beyond acetaminophen, including:

  • Decongestants (often pseudoephedrine or phenylephrine)
  • Antihistamines
  • Potentially dextromethorphan (cough suppressant)

• These combination products pose greater concerns:

  • Decongestants may decrease milk supply 6
  • Antihistamines may cause paradoxical central nervous system stimulation in infants 6
  • Combination products often contain alcohol as a vehicle 6

Recommendations for Breastfeeding Mothers

1. For pain/fever management:

   • Use plain acetaminophen instead of combination products 1, 3
   • Ibuprofen is also considered safe and may be preferable for inflammatory conditions 7

2. For nasal congestion:

   • If Afrin (oxymetazoline) is necessary, use:
     • At the lowest effective dose
     • For the shortest duration possible (no more than 3 days to avoid rebound congestion)
     • After breastfeeding to minimize infant exposure 6

3. For cold/flu symptoms:

   • Use single-ingredient products rather than combination formulations 6
   • Consider non-pharmacological approaches first (saline nasal spray, humidifier, etc.)

Important Precautions

• Monitor breastfed infants for:

  • Unusual drowsiness or irritability
  • Changes in feeding patterns
  • Insomnia (particularly with decongestants) 6

• When using any medication while breastfeeding:

  • Take immediately after breastfeeding to maximize time before next feeding 6
  • Use the lowest effective dose for the shortest duration 6
  • Avoid combination products when possible 6

• Infants younger than 6 weeks require extra caution with any medication exposure through breast milk 7