Is cough syrup safe for breastfeeding mothers and will it affect milk supply?

Cough Syrup Safety During Breastfeeding

Most cough syrups are safe for breastfeeding mothers and will not negatively affect milk supply; in fact, some ingredients may actually increase milk production. 1

Recommended Cough Medications While Breastfeeding

First-Line Treatments

• Honey and lemon are the simplest and safest initial approach for acute viral cough, with no concerns for breastfeeding 1
• Dextromethorphan is the antitussive of choice with a favorable safety profile and proven efficacy in suppressing acute cough 1
  • Maximum cough suppression occurs at 60 mg 1
  • Has been extensively studied and never implicated as harmful during breastfeeding 2
• Codeine is considered compatible with breastfeeding by the American Academy of Pediatrics and is acceptable for short-term use as a cough suppressant 3

Antihistamines and Decongestants

• Triprolidine and pseudoephedrine should be first-line choices among antihistamine-decongestant combinations, as both are considered compatible with breastfeeding by the American Academy of Pediatrics 3
• Low levels of these drugs reach breastfed infants 3
• First-generation antihistamines with sedative properties can suppress cough but may cause drowsiness in both mother and infant 1

Effects on Milk Supply

Medications That May Increase Supply

• Metoclopramide is used as a galactagogue and may increase milk supply 4
• Domperidone is also used as a galactagogue and may increase milk supply; levels in breast milk are low due to first-pass metabolism 4, 5

Medications That May Decrease Supply

• Atropine may inhibit lactation, though it is still compatible with breastfeeding 4
• Pseudoephedrine (a common decongestant) has been reported to potentially decrease milk supply in some women, though it remains compatible with breastfeeding 3

Important Safety Considerations

Timing and Dosing

• Take medications immediately after breastfeeding to minimize infant exposure 3
• Use the lowest effective dose for the shortest duration 3
• Time medication administration before the infant's longest sleep interval 6

Product Selection Pitfalls

• Avoid combination products when possible—many contain unnecessary ingredients like alcohol, aspirin, acetaminophen, ibuprofen, or caffeine 3
• Many liquid cough products contain alcohol, which should be minimized 3
• Aspirin has been associated with significant negative effects in some nursing infants and should be given with caution 3
• Single-ingredient products targeting your specific symptom are preferable 3

Monitoring Your Infant

• Watch for paradoxical central nervous system stimulation from antihistamines 3
• Monitor for irritability and insomnia from decongestants 3
• Observe for unusual symptoms or changes in feeding patterns 1, 7
• Infant sedation may occur with maternal opioid use (like codeine) 6

General Principles

The benefits of treating maternal symptoms generally outweigh the theoretical risks of medication exposure through breast milk 1. Most commonly used drugs are relatively safe for breastfed babies, as the dose received via milk is generally small and much less than known safe doses given directly to infants 8.

The amount of medication entering breast milk is typically very small—often in nanogram concentrations—which would not exert pharmacological activity even if absorbed by the infant 9. Breastfeeding should continue even when mothers require medication, as it provides important immune protection to infants 1.

For the most current and comprehensive information on any specific cough syrup ingredient, consult LactMed (Drugs and Lactation Database), which is the authoritative resource recommended by the American Academy of Pediatrics 4, 1, 7, 6.