Are ibuprofen (nonsteroidal anti-inflammatory drug) and paracetamol (acetaminophen) safe to use during breastfeeding?

Safety of Ibuprofen and Paracetamol During Breastfeeding

Both ibuprofen and paracetamol (acetaminophen) are considered safe to use during breastfeeding and can be used without interrupting breastfeeding. 1

Evidence for Safety

• Ibuprofen has been used extensively for postpartum pain and during lactation, and is considered safe to use during breastfeeding 1
• Paracetamol (acetaminophen) transfers into breast milk in varying concentrations, but the amount an infant would ingest is significantly less than the pediatric therapeutic dose 1
• NSAIDs, including ibuprofen, are generally considered preferable to aspirin when breastfeeding 2
• The American Academy of Pediatrics recommends non-opioid drugs such as paracetamol and NSAIDs as they are compatible with breastfeeding 3, 4

Clinical Considerations for Ibuprofen

• Ibuprofen is excreted in human milk in very low levels, making it a safe choice for breastfeeding mothers 5
• Short-term use of NSAIDs like ibuprofen is compatible with breastfeeding 6
• For long-term treatment, short-acting agents without active metabolites, such as ibuprofen, are preferred 6
• Ibuprofen is considered safer than aspirin at analgesic doses during breastfeeding 7

Clinical Considerations for Paracetamol

• Paracetamol (acetaminophen) should be regarded as safe during breastfeeding 6
• The FDA label for acetaminophen recommends consulting a healthcare professional before use during breastfeeding, but this is standard cautionary language 8
• Paracetamol is considered a first-line choice for pain relief in breastfeeding mothers 7

Best Practices for Use

• Use the lowest effective dose for the shortest duration possible 7
• If possible, take medication after breastfeeding to minimize infant exposure 9
• Single-ingredient products are preferable to combination products that may contain multiple active ingredients 9
• Monitor the infant for any unusual symptoms, though adverse effects are rare with these medications 9

Potential Concerns and Monitoring

• Unlike some medications that require caution during breastfeeding, paracetamol and ibuprofen do not require special monitoring of the infant 3
• While there are concerns about paracetamol use during pregnancy 10, these concerns do not extend to its use during breastfeeding 1

Alternative Options

• Non-pharmacological approaches like physical therapy and heat/cold therapy are also considered safe alternatives for breastfeeding women 3, 4