What are the best over-the-counter (OTC) medications for relieving Upper Respiratory Infection (URI) symptoms in breastfeeding mothers?

OTC Symptom Relievers for URI Symptoms While Breastfeeding

Acetaminophen and ibuprofen are the safest and most effective OTC medications for relieving URI symptoms in breastfeeding mothers, with saline nasal sprays and honey for cough as complementary non-pharmacological options. 1

First-Line Medications

Pain and Fever Relief

• Acetaminophen (Tylenol): 650mg every 4-6 hours as needed 2, 1

  • Considered completely safe during breastfeeding
  • Minimal transfer into breast milk
  • No reported adverse effects in breastfed infants

• Ibuprofen (Advil, Motrin): 200-400mg every 4-6 hours as needed 1, 3

  • Safe for short-term use during breastfeeding
  • Very low levels pass into breast milk
  • Preferred NSAID for breastfeeding mothers

Cough Relief

• Dextromethorphan (cough suppressant) 4, 5
  • Safe during breastfeeding when used as directed
  • Minimal transfer to breast milk
  • Avoid combination products with multiple ingredients

Second-Line Medications

Nasal Congestion

• Pseudoephedrine (decongestant) 5
  • Use with caution and for short duration
  • May decrease milk supply in some women
  • Take after breastfeeding to minimize infant exposure

Antihistamines

• Loratadine (non-sedating) or Triprolidine (first-generation) 5
  • Low levels reach breastfed infants
  • Short-term use is considered compatible with breastfeeding
  • First-generation antihistamines may cause infant drowsiness

Non-Pharmacological Approaches

1. Saline nasal sprays/rinses

   • No systemic absorption
   • Safe and effective for nasal congestion

2. Increased hydration

   • Helps thin mucus secretions
   • Supports milk production

3. Honey (for cough, not for infants)

   • Effective for cough in adults
   • No impact on breastfeeding

4. Humidification

   • Relieves congestion and cough
   • No medication exposure to infant

Medications to Avoid or Use with Caution

• Codeine-containing products 5, 3

  • While considered compatible with short-term use, can cause infant sedation
  • Risk varies based on maternal metabolism

• Aspirin 3, 6

  • Low doses (<100mg/day) are likely safe
  • Higher doses should be avoided due to theoretical risks

• Combination cold products

  • Often contain multiple ingredients, increasing risk of side effects
  • Many contain alcohol, which should be avoided

Key Principles for Medication Use While Breastfeeding

1. Use the lowest effective dose for the shortest duration
2. Time medication administration right after breastfeeding or before infant's longest sleep period
3. Monitor infant for unusual drowsiness, irritability, or feeding changes
4. Single-ingredient products are preferred over multi-symptom formulations

Special Considerations

• If antibiotics are needed for bacterial complications, most are compatible with breastfeeding 6
• For severe symptoms requiring prescription medications, consult LactMed database or healthcare provider
• The American Academy of Pediatrics notes that most medications are compatible with breastfeeding 7

Remember that untreated severe symptoms may interfere with breastfeeding success and maternal wellbeing, so appropriate treatment is important for both mother and infant.