Recommended Cough Medications for Breastfeeding Mothers
For breastfeeding mothers with cough, dextromethorphan at 60 mg is the recommended first-line antitussive, with codeine or pholcodine reserved only for short-term use when necessary, while simple remedies like honey and lemon remain reasonable initial options. 1
First-Line Treatment Approach
Non-Pharmacologic and Simple Remedies
- Home remedies such as honey and lemon are the simplest and cheapest initial approach for acute viral cough, which is almost invariably benign 1
- Simple voluntary suppression of cough through central modulation of the cough reflex may be sufficient to reduce cough frequency 1
- Simple drinks and linctuses may work through this central modulation mechanism 1
Pharmacologic Options Compatible with Breastfeeding
Dextromethorphan (Preferred)
- Dextromethorphan is the antitussive of choice as it has been shown to suppress acute cough in meta-analysis and has a favorable safety profile 1
- The maximum cough reflex suppression occurs at 60 mg and can be prolonged, though generally recommended dosages are probably subtherapeutic 1
- This non-sedating opiate is a component of many over-the-counter cough remedies 1
- Exercise caution with higher doses as some combined preparations contain other ingredients such as paracetamol 1
Menthol
- Menthol by inhalation suppresses the cough reflex acutely but is short-lived 1
- May be prescribed as menthol crystals or in proprietary capsules 1
Sedative Antihistamines
- First-generation antihistamines with sedative properties suppress cough but cause drowsiness 1
- May be suitable specifically for nocturnal cough 1
- Triprolidine combined with pseudoephedrine should be first-line choices among antihistamine-decongestant combinations, as both are considered compatible with breastfeeding by the American Academy of Pediatrics 2
Codeine or Pholcodine (Use with Caution)
- Codeine is considered compatible with breastfeeding by the AAP and is acceptable for short-term use as a cough suppressant 2
- However, these opiate antitussives have no greater efficacy than dextromethorphan but have a much greater adverse side effect profile and are not recommended as first-line 1
- Maternal opioid use can cause infant sedation, which is an important monitoring consideration 3
Important Considerations and Monitoring
Timing and Dosing Strategy
- Breastfeeding mothers should take medication after breastfeeding, at the lowest effective dose, and for the shortest duration 2
- Timing breastfeeding in relation to dosing helps minimize infant exposure 2
- Prescribing should ideally occur before the infant's longest sleep interval 3
Infant Monitoring
- Mothers taking cough and cold products should watch for adverse events in their breastfed infants 2
- Infants may experience paradoxical central nervous stimulation from antihistamines and irritability and insomnia from decongestants 2
- Watch for unusual symptoms or changes in feeding patterns 4
Product Selection Pitfalls
- Many liquid cough and cold products contain alcohol 2
- Many combination products mix antihistamines with decongestants and may also contain aspirin, acetaminophen, ibuprofen, or caffeine 2
- It is preferable for nursing mothers to only take medications that are necessary and to avoid combination products 2
- Aspirin has been associated with significant negative effects on some nursing infants and should be given with caution 2
General Principles
Safety Framework
- Most commonly used drugs are relatively safe for breastfed babies, with the dose received via milk generally small and much less than known safe doses given directly to infants 5
- The benefits of treating maternal symptoms generally outweigh the theoretical risks of medication exposure through breast milk 4
- Breastfeeding is strongly recommended even when mothers require medication, as it provides important immune protection to infants 4