What painkillers are safe to use during lactation (breastfeeding)?

Safe Painkillers During Lactation

Paracetamol (acetaminophen) and ibuprofen are the safest first-line analgesics for breastfeeding mothers and can be used immediately without interrupting nursing. 1, 2

First-Line Safe Options (No Breastfeeding Interruption Required)

Paracetamol (Acetaminophen)

• The amount transferred to breast milk is significantly less than pediatric therapeutic doses, making it extremely safe. 3, 1
• No waiting period is needed after taking paracetamol—breastfeeding can occur immediately. 1
• No special monitoring of the infant is required. 1

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)

Ibuprofen is the gold standard NSAID during lactation:

• Has the most reassuring safety data among all NSAIDs. 1
• Used extensively for postpartum pain with minimal milk excretion. 3, 1
• No need to express and discard milk or wait between doses and feeding. 1

Diclofenac is the second-best NSAID option:

• Small amounts detected in breast milk with extensive safe use history. 3, 2
• Ranked second after ibuprofen for safety data. 1

Other safe NSAIDs:

• Naproxen: Widely used after cesarean section despite longer half-life; breastfeeding continues normally. 3, 2
• Ketorolac: Low milk levels without adverse neonatal effects; compatible with breastfeeding. 3, 2, 4
• Celecoxib: Very low infant exposure via milk. 3, 2

Dosing Strategy

• Use the lowest effective dose for the shortest duration. 3, 2
• Combine paracetamol with ibuprofen (multimodal analgesia) to minimize need for stronger medications. 1
• Taking medication immediately after breastfeeding can further reduce infant exposure, though this is not necessary with first-line agents. 5

Second-Line Options (Use with Caution and Monitoring)

Opioids (When Stronger Analgesia Required)

Morphine is the preferred opioid:

• Transferred to milk in small amounts; recommended as opioid of choice. 3, 2
• Single doses pose no risk; repeated doses require infant monitoring for drowsiness and poor feeding. 3, 2

Codeine: Probably compatible with short-term use, though long-term effects not fully studied. 5, 6

Tramadol: Use with caution; monitor infant for unusual drowsiness. 2

Oxycodone: Doses >40 mg/day carry greater drowsiness risk; requires infant monitoring. 2

Medications to Avoid

• Aspirin in analgesic doses: Should NOT be used during breastfeeding. 3, 2
• Low-dose aspirin (≤100 mg/day) for antiplatelet action is acceptable if strongly indicated. 3, 6
• COX-2 inhibitors (except celecoxib): Limited data; should be avoided. 1

Special Considerations for Young Infants

• Extra caution for infants <6 weeks of age (corrected for gestation) due to immature hepatic and renal function. 1, 4
• This caution applies more to opioids than to paracetamol or NSAIDs. 1
• Preterm infants have highest medication sensitivity. 1

Critical Safety Points

• Never co-sleep with infant when taking sedating medications (opioids), as maternal responsiveness may be inhibited. 2
• No need to "pump and dump" with paracetamol or ibuprofen—this is completely unnecessary. 1
• Breastfeeding can resume as soon as the mother has recovered from the procedure when these medications are used. 3, 1