Is it safe to breastfeed while taking full dose aspirin (acetylsalicylic acid)?

Breastfeeding Safety with Full Dose Aspirin

Full dose aspirin should not be used during breastfeeding due to potential risks of platelet dysfunction and GI bleeding in nursing infants. 1 Instead, alternative analgesics should be selected for breastfeeding mothers.

Safety Concerns with Full Dose Aspirin

• Although aspirin is a polar, acidic drug that is poorly lipid soluble and highly bound to plasma proteins, maternal aspirin ingestion is associated with excretion of salicylates into breast milk 1
• Potential risks to breastfed infants include:
  • Platelet dysfunction and GI bleeding, especially with high doses 1
  • Metabolic acidosis (reported in breast-fed infants of mothers taking several grams of aspirin per day) 1
  • Theoretical risk of developing Reye syndrome 1

Safe Alternatives for Breastfeeding Mothers

When analgesia is needed during breastfeeding, consider these safer options:

First-Line Analgesics (Safest Options)

• Paracetamol/Acetaminophen: Amount ingested via breast milk is significantly less than pediatric therapeutic doses 1
• Ibuprofen: Has been used extensively for postpartum pain and during lactation with established safety profile 1, 2
• Diclofenac: Small amounts detected in breast milk; extensively used during lactation 1

Other NSAID Options

• Naproxen: Despite longer half-life than diclofenac, widely used after cesarean section 1
• Ketorolac/Parecoxib: Low levels detected in breast milk without demonstrable adverse effects 1
• Celecoxib: Relative dose that infants are exposed to via milk is very low 1

Opioid Options (When Stronger Analgesia Required)

• Morphine: Transferred to breast milk in small amounts; recommended as opioid of choice if strong analgesia is required 1
• Single doses of morphine are not expected to cause detrimental effects to the infant 1

Low-Dose Aspirin Exception

• Low-dose aspirin (<100 mg/day) for vascular indications is considered safe during breastfeeding 1, 3
• Recent research shows acetylsalicylic acid is undetectable in breast milk after 81mg daily dose, with salicylic acid appearing in very low amounts (estimated relative infant dose of 0.4%) 4
• The American College of Chest Physicians suggests continuing low-dose aspirin for vascular indications in lactating women (Grade 2C recommendation) 1

Monitoring Recommendations

If a breastfeeding mother must take any medication:

• Use the lowest effective dose for the shortest time possible 1
• Monitor the infant for signs of:
  • Drowsiness
  • Poor feeding
  • Unusual bleeding or bruising
  • Respiratory depression (particularly with opioids)

Clinical Decision Algorithm

1. Is full-dose aspirin absolutely necessary?

   • If NO → Use alternative analgesics (paracetamol or ibuprofen as first line)
   • If YES → Consider temporary interruption of breastfeeding during treatment

2. Is low-dose aspirin (<100 mg/day) needed for vascular indications?

   • If YES → Can safely continue breastfeeding while taking low-dose aspirin

3. Is pain management required during breastfeeding?

   • For mild-moderate pain → Paracetamol or ibuprofen
   • For moderate-severe pain → Consider short-term morphine with monitoring

Remember that in almost all instances of medication use, the mother should be advised to continue breastfeeding 5, but full-dose aspirin represents one of the exceptions where safer alternatives should be selected.