Which nonsteroidal anti-inflammatory drug (NSAID) is safe during lactation?

Which NSAID is Safe During Lactation

Ibuprofen is the safest NSAID during lactation, with the most extensive safety data supporting its use without interrupting breastfeeding. 1, 2

Primary Recommendation: Ibuprofen

Ibuprofen should be the first-line NSAID for breastfeeding mothers based on the following evidence:

• The 2025 EULAR guidelines explicitly state that "most reassuring data are available for ibuprofen" among all NSAIDs during lactation 1
• Multiple clinical guidelines confirm ibuprofen is compatible with breastfeeding with no requirement to interrupt nursing or express and discard breast milk 2
• Ibuprofen has low excretion in human milk and has been used extensively for postpartum pain with an established safety profile 2
• The American Academy of Pediatrics recommends ibuprofen as a preferred non-opioid analgesic for breastfeeding mothers 2

Second-Line Alternative: Diclofenac

Diclofenac is the next safest option after ibuprofen:

• The 2025 EULAR guidelines rank diclofenac second after ibuprofen, stating it is "followed by diclofenac" in terms of reassuring safety data 1
• The Association of Anaesthetists confirms diclofenac is compatible with breastfeeding 3
• No need to express and discard breast milk when using diclofenac 3

Other Acceptable NSAIDs

Naproxen can be used but with less supporting data:

• The American Academy of Pediatrics considers naproxen safe for breastfeeding mothers with minimal excretion in breast milk 2
• Naproxen concentrations in breast milk are approximately 1% of maximum maternal plasma concentration 4
• However, naproxen has a longer half-life (12-17 hours) compared to ibuprofen, which is less ideal 4

Practical Dosing Strategy

Use the lowest effective dose for the shortest duration:

• Take the medication at the time of breastfeeding, with the next feed occurring after one drug half-life has elapsed 5
• Multimodal analgesia combining ibuprofen with paracetamol (acetaminophen) is encouraged to minimize NSAID requirements 2
• Short-acting NSAIDs without active metabolites are preferred for long-term use 6

Special Considerations and Cautions

Exercise extra caution in specific situations:

• Infants less than 6 weeks of age (corrected for gestational age) require additional caution due to immature hepatic and renal function, though ibuprofen remains safe 2
• Preterm infants have the highest sensitivity to medications and warrant closer monitoring 2
• If the infant has jaundice, use NSAIDs with caution as they can displace bilirubin 2

NSAIDs to Avoid

COX-2 inhibitors should be avoided:

• The 2025 EULAR guidelines note that "data for COX-2 inhibitors are limited" during lactation 1

Aspirin requires caution:

• Large doses of aspirin should be avoided due to risk of salicylate intoxication and bleeding in the neonate 2
• Low-dose aspirin (up to 100 mg/day) is considered compatible, but higher doses require safer alternatives 7

Key Clinical Pitfall to Avoid

Do not unnecessarily interrupt breastfeeding: The most common error is advising mothers to "pump and dump" or interrupt breastfeeding when taking ibuprofen or diclofenac—this is completely unnecessary and undermines the significant benefits of breastfeeding 2. These medications can be taken immediately before nursing without any waiting period 2.