Diclofenac Use in Breastfeeding Mothers
Diclofenac is safe to use in breastfeeding mothers due to its minimal transfer into breast milk, with a low milk-to-plasma ratio of 0.093. 1
Safety Profile and Evidence
The Association of Anaesthetists' 2020 guidelines explicitly list diclofenac among the analgesics that are compatible with breastfeeding 2. This recommendation is reinforced by Praxis Medical Insights, which includes diclofenac among safe medications for breastfeeding mothers 3.
The safety of diclofenac during breastfeeding is supported by pharmacokinetic data:
- Recent research shows diclofenac has a very low milk-to-plasma drug concentration ratio of 0.093, indicating minimal mammary transfer 1
- In one study, diclofenac was not detectable in breast milk in 12 women using diclofenac (after either 100 mg/day orally for 7 days or a single 50 mg intramuscular dose) 4
Recommendations for Use
When prescribing diclofenac to breastfeeding mothers:
- Use the lowest effective dose for the shortest duration possible 3
- Standard adult dosing is appropriate with no special dosage adjustment needed for lactation 3
- For optimal safety, administer immediately after breastfeeding to maximize clearance time before the next feeding 3
Special Considerations
Infant Age
- Extra caution should be taken when the nursing infant is less than 6 weeks of age due to immature hepatic and renal function 2, 3
- Older infants (>6 months) generally have more mature metabolism and are at lower risk for adverse effects 3
Duration of Treatment
- Short-term use of NSAIDs like diclofenac is clearly compatible with breastfeeding 5
- For long-term treatment, while diclofenac is considered safe, some sources suggest short-acting agents without active metabolites (such as ibuprofen) might be preferred 5
Benefits vs. Risks
The benefits of adequate pain control for breastfeeding mothers include:
- Improved maternal comfort
- Support for successful breastfeeding by facilitating comfortable positioning
- Maintenance of the milk letdown reflex 3
These benefits clearly outweigh the minimal risks to the nursing infant from diclofenac exposure through breast milk.
Clinical Approach
- Confirm that pain control is needed for the breastfeeding mother
- Consider diclofenac as a safe option, particularly for short-term use
- Use standard adult dosing, administering after breastfeeding when possible
- For long-term treatment needs, reassess periodically and consider alternatives if needed
- Advise the mother that diclofenac has minimal transfer to breast milk and is considered safe during breastfeeding
In conclusion, diclofenac can be safely prescribed to breastfeeding mothers with minimal risk to the nursing infant, especially when used for short-term pain management.