Can Ponstel (Mefenamic Acid) Be Given to Breastfeeding Mothers?
Mefenamic acid (Ponstel) should be used with caution during breastfeeding, and a decision must be made whether to discontinue nursing or discontinue the drug, according to the FDA label. 1
FDA Drug Label Guidance
The FDA label for mefenamic acid explicitly states that:
- Trace amounts of mefenamic acid may be present in breast milk and transmitted to the nursing infant 1
- Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother 1
This represents the most authoritative guidance available and indicates mefenamic acid is not considered a preferred choice during lactation.
Safer Alternative NSAIDs for Breastfeeding
Instead of mefenamic acid, consider these NSAIDs that have established safety profiles during breastfeeding:
- Ibuprofen - Compatible with breastfeeding and preferred for long-term use as a short-acting agent without active metabolites 2, 3
- Diclofenac - Listed as safe for breastfeeding women 2
- Ketorolac - Safe with minimal transfer into breast milk, recommended by the Association of Anaesthetists 4
- Naproxen - Compatible with breastfeeding 2
Clinical Reasoning
The key distinction is that while short-term use of NSAIDs generally appears compatible with breastfeeding 3, 5, mefenamic acid specifically lacks the safety data that other NSAIDs possess. The FDA's cautionary language about "potential for serious adverse reactions" 1 contrasts sharply with the explicit safety endorsements given to ibuprofen, diclofenac, and ketorolac in professional guidelines 2, 4.
Practical Recommendation
If NSAID therapy is needed in a breastfeeding mother, choose ibuprofen or another well-studied alternative rather than mefenamic acid. 2, 3 This approach prioritizes infant safety while still providing effective maternal analgesia. The lowest effective dose should be used for the shortest duration possible 2, and the infant should be monitored for any adverse effects if any NSAID is used 3.