Is it safe to administer diclofenac (nonsteroidal anti-inflammatory drug) injection to a breastfeeding mother?

Diclofenac Injection in Breastfeeding Mothers

Diclofenac injection is compatible with breastfeeding and can be safely administered to breastfeeding mothers. 1

Evidence-Based Rationale

The Association of Anaesthetists guideline (2020) explicitly lists diclofenac among analgesics that are compatible with breastfeeding 1. This recommendation is part of their comprehensive guidance on medications used perioperatively in breastfeeding women.

Pharmacokinetic Considerations

• Diclofenac has low transfer into breast milk with minimal infant exposure
• The FDA drug label notes that in one study of 12 women using diclofenac (either 100 mg/day orally for 7 days or a single 50 mg intramuscular dose in the immediate postpartum period), diclofenac was not detectable in breast milk 2
• In another case, a woman treated with 150 mg/day oral diclofenac had milk levels of 100 mcg/L, equivalent to an infant dose of about 0.03 mg/kg/day 2 - a very small amount

Clinical Approach to Pain Management in Breastfeeding Mothers

Benefits of Using Diclofenac

• Provides effective pain relief without requiring interruption of breastfeeding
• Part of multimodal analgesia approach that can reduce opioid requirements
• Helps maintain maternal comfort, which supports successful breastfeeding

Administration Guidelines

1. Use the lowest effective dose for the shortest period of time
2. Consider timing administration after breastfeeding when possible to minimize peak concentration during feeding times
3. For post-operative pain, diclofenac can be used as part of a multimodal approach with paracetamol to reduce opioid requirements

Special Considerations

Infant Age

• Extra caution should be taken with infants less than 6 weeks of age due to immature hepatic and renal function 1
• For older infants, the risk is even lower due to more mature metabolism

Maternal Factors

• Ensure no contraindications to NSAIDs exist for the mother (e.g., renal impairment, history of GI bleeding, etc.)
• Monitor for maternal side effects which could indirectly affect breastfeeding

Practical Recommendations

• For acute pain management: Diclofenac injection can be administered without interruption of breastfeeding
• For post-operative pain: Include diclofenac as part of multimodal analgesia with paracetamol to minimize opioid use 1
• For ongoing pain management: If longer-term treatment is needed, consider switching to oral NSAIDs with short half-lives like ibuprofen 3

Common Pitfalls to Avoid

1. Unnecessary interruption of breastfeeding - This is not required with diclofenac use and can negatively impact breastfeeding success
2. Inadequate pain control - Untreated pain can interfere with successful breastfeeding by affecting milk letdown and positioning
3. Overreliance on opioids - NSAIDs like diclofenac should be used as first-line when appropriate to minimize opioid exposure

In conclusion, diclofenac injection can be safely administered to breastfeeding mothers without interruption of breastfeeding, with particular attention to using the lowest effective dose for the shortest duration needed.