Is etoricoxib (Nonsteroidal Anti-Inflammatory Drug (NSAID)) excreted in breast milk?

Etoricoxib Excretion in Breast Milk

There is no specific data available on etoricoxib excretion in breast milk, and it should be avoided during breastfeeding due to insufficient safety information. 1 Instead, other NSAIDs with established safety profiles should be used.

Safety of NSAIDs During Breastfeeding

• Ibuprofen is the first-line NSAID for breastfeeding mothers due to its extensive study and established safety profile during lactation 1, 2
• Diclofenac and naproxen are considered safe second-line options despite small amounts detected in breast milk 1
• Among COX-2 inhibitors, celecoxib has very low relative infant exposure via milk, making it compatible with breastfeeding 1
• Paracetamol (acetaminophen) is also considered safe during breastfeeding, with the amount an infant would ingest being significantly less than the pediatric therapeutic dose 2

Decision-Making Algorithm for Pain Management in Breastfeeding Mothers

1. First-line options:

   • Ibuprofen - extensively studied with established safety during lactation 1, 2
   • Paracetamol (acetaminophen) - safe with minimal infant exposure 2

2. Second-line options:

   • Diclofenac - small amounts detected in breast milk but considered safe 1
   • Naproxen - widely used postpartum despite longer half-life 1

3. If COX-2 inhibition specifically needed:

   • Celecoxib - preferred due to low infant exposure 1
   • Parecoxib - low levels detected in breast milk without demonstrable adverse effects 1

Important Considerations for Medication Use During Breastfeeding

• All medications are excreted into breast milk to some extent, but most can be taken safely during breastfeeding 3
• The amount of medication excreted in milk depends on chemical characteristics of the medication, maternal pharmacokinetics, and dosing 3
• When limited information is available about a specific drug (as with etoricoxib), it's prudent to choose alternatives with established safety profiles 4
• The benefits of breastfeeding are significant for both mother and infant, so decisions to withhold breastfeeding should not be taken lightly 3

Monitoring and Safety Precautions

• Unlike some medications requiring special monitoring, established safe NSAIDs like ibuprofen and paracetamol do not require special monitoring of the infant 2
• If a breastfed infant becomes ill or fails to thrive while the mother is taking medication, consider discontinuing the drug or temporarily suspending breastfeeding while maintaining lactation through pumping 5
• Non-pharmacological approaches like physical therapy and heat/cold therapy are also considered safe alternatives for breastfeeding women 2

Pitfalls to Avoid

• Avoid assuming all NSAIDs have the same safety profile in breastfeeding - there are significant differences in their excretion into breast milk 1
• Do not unnecessarily advise discontinuation of breastfeeding when safe medication alternatives exist 4
• Remember that the benefits of breastfeeding often outweigh theoretical risks of medication exposure through breast milk 6