Aceclofenac is NOT explicitly contraindicated during breastfeeding, but it should be avoided due to lack of safety data—safer NSAIDs with established breastfeeding compatibility should be used instead.
Aceclofenac-Specific Evidence Gap
Aceclofenac does not appear in any major breastfeeding safety guidelines or compatibility lists, which is a critical red flag. The Association of Anaesthetists 2020 guidelines explicitly list compatible NSAIDs for breastfeeding (ibuprofen, diclofenac, naproxen, celecoxib, ketorolac, parecoxib) but aceclofenac is notably absent 1. This absence from authoritative guidelines indicates insufficient safety data rather than proven safety.
Recommended Safe Alternatives
Instead of aceclofenac, use ibuprofen or diclofenac—both have extensive safety data during breastfeeding:
Ibuprofen is the first-line NSAID choice during lactation, with the most reassuring safety data according to EULAR guidelines and explicit compatibility designation by the Association of Anaesthetists 1, 2
Diclofenac ranks as the second safest NSAID option after ibuprofen, with established compatibility during breastfeeding 1, 2
Both medications can be used immediately without interrupting breastfeeding or expressing and discarding milk 1, 2
Clinical Algorithm for NSAID Selection During Breastfeeding
When a breastfeeding mother requires NSAID therapy:
First choice: Ibuprofen at the lowest effective dose for the shortest duration 1, 2
Second choice: Diclofenac if ibuprofen is contraindicated or ineffective 1, 2
Other acceptable options: Naproxen, ketorolac, celecoxib (though data for COX-2 inhibitors are more limited) 1, 2
Avoid: Aceclofenac and other NSAIDs not listed in breastfeeding guidelines due to insufficient safety data
Special Considerations for Young Infants
Exercise extra caution when the infant is less than 6 weeks of age (corrected for gestation) due to immature hepatic and renal function, though this applies more significantly to opioids than NSAIDs 1, 2. Even in this vulnerable population, ibuprofen and diclofenac remain the preferred NSAID options if anti-inflammatory therapy is necessary 1, 2.
Multimodal Analgesia Approach
Combine NSAIDs with paracetamol (acetaminophen) to minimize NSAID dosing requirements 1, 2. Paracetamol is explicitly compatible with breastfeeding and the combination provides superior pain control while reducing individual drug exposure 1, 2.
Common Pitfall to Avoid
Do not assume all NSAIDs are equivalent during breastfeeding. The absence of aceclofenac from established compatibility lists means it lacks the safety documentation that ibuprofen and diclofenac possess 1, 2. While aceclofenac may be effective for musculoskeletal pain 3, efficacy alone does not establish breastfeeding safety—transfer into breast milk and infant exposure data are required.