Viscous Lidocaine is Safe During Breastfeeding
Viscous lidocaine can be used safely during breastfeeding with no need to interrupt nursing or discard breast milk. 1, 2
Evidence-Based Safety Profile
The Association of Anaesthetists explicitly states that local anesthetics, including lidocaine, may be secreted in small amounts in breast milk but can be used in lactating women with no need to interrupt breastfeeding. 1 This recommendation is based on extensive investigation during labor analgesia and obstetric anesthesia showing no evidence of harm from direct placental transfer—a far greater exposure than what occurs through breast milk. 1, 2
No Waiting Period Required
- Breastfeeding can resume immediately after lidocaine administration with no need to pump and discard milk. 2
- The drug has been extensively studied in obstetric settings where direct fetal exposure occurs, demonstrating safety even with higher systemic levels than would be achieved through breast milk. 1, 2
Pharmacokinetic Considerations
Research demonstrates that even after parenteral lidocaine administration (which produces higher systemic levels than topical viscous lidocaine), breast milk concentrations remain low and safe:
- After dental procedures using 3.6-7.2 mL of 2% lidocaine, calculated infant daily exposure was only 73.41 ± 38.94 mcg/day—well below any threshold for concern. 3
- Local anesthetics are lipid-soluble amino amide compounds that transfer into milk in minimal amounts. 1
- Viscous lidocaine, being a topical formulation with limited systemic absorption, poses even less risk than the parenteral forms studied. 1, 2
Special Considerations for Young Infants
- For infants less than 6 weeks of age (corrected for gestational age), exercise extra caution with any medication due to immature hepatic and renal function. 2
- However, this concern is far more relevant for systemically absorbed drugs than for topical lidocaine, which has minimal systemic bioavailability. 2
- Monitor the infant for unusual drowsiness or feeding difficulties only if using multiple medications simultaneously or if the infant shows concerning symptoms. 2
Common Pitfall to Avoid
Do not advise mothers to "pump and dump" or delay breastfeeding after using viscous lidocaine—this is unnecessary and may discourage breastfeeding without any safety benefit. 2 The amounts transferred to breast milk are negligible and pose no risk to healthy term infants. 1, 3