Viscous Lidocaine and Maalox Safety During Breastfeeding
Both viscous lidocaine and Maalox (aluminum hydroxide/magnesium hydroxide) can be used during breastfeeding with minimal risk to the infant.
Viscous Lidocaine Safety
Local anesthetics, including lidocaine, can be used in lactating women with no need to interrupt breastfeeding 1. The Association of Anaesthetists explicitly states that these amino amide compounds are lipid soluble and may be secreted in small amounts in breast milk, but extensive investigation has shown no evidence of harm 1.
Key Safety Points for Lidocaine:
- No waiting period is required before resuming breastfeeding after lidocaine administration 1
- The drug has been extensively studied during labor analgesia and obstetric anesthesia with no evidence of neonatal harm from direct placental transfer, which represents far greater exposure than breast milk transfer 1
- The FDA label notes that "it is not known whether this drug is excreted in human milk" and recommends caution, but this conservative language is standard when definitive studies are lacking 2
Important Caveat for Oral/Topical Use:
When viscous lidocaine is used in the mouth or throat, food should not be ingested for 60 minutes following use due to impaired swallowing and aspiration risk 2. This applies to the mother's safety, not the infant's. The numbness can also increase biting trauma risk 2.
Maalox (Antacids) Safety
Antacids containing aluminum hydroxide and magnesium hydroxide are among the safest gastrointestinal medications during breastfeeding 3. These agents are not systemically absorbed, making them first-line therapy for heartburn and gastric symptoms in breastfeeding women 3.
Key Safety Points for Antacids:
- The safest gastrointestinal medications are those that are not absorbed, and antacids fall into this category 3
- Magnesium sulfate (a related compound) is specifically identified by the American Academy of Pediatrics as compatible with breastfeeding 3
- Most gastrointestinal medications are used short-term and pose minimal risk 3
Clinical Recommendations:
- No need to pump and dump or interrupt breastfeeding when using either medication 1
- Use the lowest effective dose of viscous lidocaine for the shortest duration needed 2
- For infants less than 6 weeks of age (corrected for gestation), exercise extra caution with any medication due to immature hepatic and renal function, though this concern is far more relevant for systemically absorbed drugs than for topical lidocaine or non-absorbed antacids 1
- Monitor the infant for unusual drowsiness or feeding difficulties only if using multiple medications or if the infant shows any concerning symptoms 1
Alternative Considerations:
If additional pain relief is needed beyond topical lidocaine, paracetamol (acetaminophen) and ibuprofen are explicitly compatible with breastfeeding and can be used without interruption 4. These systemic analgesics have been extensively studied and pose no risk to breastfed infants 4.