What pain medications are safe to use while breastfeeding?

Safe Pain Medications During Breastfeeding

Paracetamol (acetaminophen) and NSAIDs such as ibuprofen and diclofenac are the safest pain medications to use while breastfeeding, with morphine being the preferred opioid when stronger analgesia is required. 1

First-Line Pain Medications

Non-Opioid Analgesics

• Paracetamol (Acetaminophen):

  • Extremely safe during breastfeeding
  • Amount transferred to breast milk is significantly less than pediatric therapeutic doses
  • No waiting period required before breastfeeding 1

• NSAIDs:

  • Ibuprofen: Has been used extensively during lactation and is considered very safe 1, 2
  • Diclofenac: Small amounts detected in breast milk; extensively used and considered safe 1
  • Naproxen: Safe for breastfeeding despite longer half-life 1
  • Ketorolac: Low levels in breast milk with no demonstrable adverse effects 1, 2
  • Celecoxib: Very low infant exposure via milk; compatible with breastfeeding 1

Important Caution

• Aspirin: Should NOT be used in analgesic doses during breastfeeding. Low-dose aspirin (≤100 mg/day) for anti-platelet action is acceptable if strongly indicated 1, 3

Second-Line Pain Medications (When Stronger Analgesia Required)

Opioids

• Morphine:

  • Recommended as the opioid of choice when strong analgesia is required 1
  • Transferred to breast milk in small amounts
  • Single doses not expected to cause detrimental effects to infants
  • For repeated doses, monitor infant for sedation and respiratory depression 1, 4

• Codeine:

  • Probably compatible with short-term breastfeeding 5
  • Effects of long-term exposure not fully understood
  • Use with caution due to variable metabolism (CYP2D6 variants) 6

Algorithm for Pain Management During Breastfeeding

1. Start with non-opioid analgesics:

   • First choice: Paracetamol (acetaminophen)
   • Second choice: Ibuprofen or other NSAIDs (except aspirin)

2. If inadequate pain control:

   • Consider short-term morphine (lowest effective dose)
   • Monitor infant for sedation and respiratory depression
   • Limit newly initiated opioids to 2-3 days in outpatient settings 6

3. Administration timing:

   • When possible, take medication immediately after breastfeeding
   • This maximizes clearance time before next feeding

Special Considerations

• Sedatives:

  • Short-acting benzodiazepines (midazolam, lorazepam) preferred over diazepam if needed 1
  • Diazepam has active metabolites with prolonged half-life and transfers in significant levels to breast milk 1

• Infant age matters:

  • Infants under 6 weeks require extra caution with medications
  • Older infants (>6 months) generally have more mature metabolism 2

• Untreated pain risks:

  • Inadequate pain control can interfere with successful breastfeeding by affecting milk letdown and positioning 2
  • Benefits of maternal pain control often outweigh minimal risks to infant 2

Remember that most pain medications used for short durations pose minimal risk to breastfed infants, and interrupting breastfeeding is rarely necessary. When prescribing pain medications to breastfeeding mothers, use the lowest effective dose for the shortest time possible.