What are the recommended NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) for treating mastitis?

NSAIDs for Mastitis in Breastfeeding Women

Ibuprofen is the recommended first-line NSAID for treating mastitis in breastfeeding women due to its established safety profile, efficacy for pain and inflammation, and compatibility with breastfeeding.

Recommended NSAIDs for Mastitis

First-Line Option:

• Ibuprofen
  • Dosage: 400-600 mg every 4-6 hours (not exceeding 2400 mg daily)
  • Safety: Considered safe during breastfeeding 1
  • Benefits: Effectively reduces inflammation, fever, and pain associated with mastitis

Alternative Options:

• Naproxen
  • Dosage: 250-500 mg twice daily
  • Safety: Also considered safe for breastfeeding women 1
  • Note: Longer half-life than ibuprofen, which may be beneficial for sustained pain relief

Clinical Rationale for NSAID Use in Mastitis

NSAIDs serve multiple important functions in mastitis management:

1. Pain relief: Reduces breast tenderness and discomfort
2. Anti-inflammatory effects: Decreases breast swelling and inflammation
3. Antipyretic properties: Helps reduce fever associated with mastitis

Evidence Supporting NSAID Use

The American Academy of Family Physicians supports the use of NSAIDs for symptomatic relief in mastitis 2. NSAIDs are a key component of mastitis management, particularly for:

• Reducing inflammation in the affected breast tissue
• Managing pain that may otherwise interfere with continued breastfeeding
• Controlling fever associated with infectious mastitis

Important Clinical Considerations

Breastfeeding Compatibility

• Both ibuprofen and naproxen are considered safe during breastfeeding 1
• Minimal amounts transfer into breast milk, posing negligible risk to the infant
• Continued breastfeeding is recommended during mastitis treatment 2

Duration of Therapy

• Short-term use (typically 3-5 days) is generally sufficient
• Longer courses may be needed for severe or persistent cases

Combination with Other Treatments

• NSAIDs should be used alongside:
  1. Frequent and complete breast emptying (crucial for mastitis resolution) 2
  2. Antibiotics when indicated (typically for infectious mastitis)
  3. Proper breastfeeding technique optimization, often with lactation consultant support 2

Cautions and Contraindications

• Avoid NSAIDs in women with:

  • History of NSAID-induced ulcers
  • Renal impairment
  • Severe hepatic disease
  • Concurrent anticoagulant therapy 1

• Monitor for potential side effects:

  • Gastrointestinal discomfort
  • Fluid retention
  • Potential renal effects with prolonged use

Clinical Pearl

When treating mastitis, prioritize continued breastfeeding from the affected breast despite discomfort, as this is crucial for resolution. NSAIDs can facilitate this by making breastfeeding more comfortable, which helps maintain milk flow and prevents complications like breast abscess formation 2.