What cough medicines are safe for a breastfeeding woman to use?

Safe Cough Medications During Breastfeeding

Dextromethorphan is the antitussive of choice for breastfeeding mothers with cough, as it has demonstrated efficacy in suppressing acute cough and has a favorable safety profile. 1

First-Line Treatment Recommendations

Non-Pharmacologic Approaches

• Start with honey and lemon as the simplest and cheapest initial approach for acute viral cough, as recommended by the American Thoracic Society 1
• Simple voluntary cough suppression through central modulation may be sufficient to reduce cough frequency 1

Preferred Cough Suppressants

• Dextromethorphan is the preferred antitussive medication, with maximum cough reflex suppression occurring at 60 mg 1
• Codeine is considered compatible with breastfeeding by the American Academy of Pediatrics and is acceptable for short-term cough suppression 1, 2
• Menthol by inhalation can suppress the cough reflex acutely, though the effect is short-lived 1

Decongestants and Antihistamines

• Pseudoephedrine and triprolidine are first-line choices for decongestant/antihistamine needs, as they reach breastfed infants in low levels and are considered compatible by the American Academy of Pediatrics 1, 2
• First-generation antihistamines with sedative properties can suppress cough but cause drowsiness, making them suitable specifically for nocturnal cough 1

Expectorants

• Guaifenesin can be used during breastfeeding, though the FDA label advises asking a health professional before use 3

When Antibiotics Are Needed

Preferred Antibiotic Classes

• Penicillins and cephalosporins are the safest antibiotic classes for lactating mothers with bacterial respiratory infections 1, 4
• Amoxicillin/clavulanic acid is compatible with breastfeeding when bacterial infection is present 1, 4
• Azithromycin is classified as "probably safe" during breastfeeding 4
• Ceftriaxone and other cephalosporins are considered "compatible" with breastfeeding 4

Antibiotics to Avoid

• Trimethoprim-sulfamethoxazole should not be given to breastfeeding mothers with infants under 2 months of age due to the risk of kernicterus, according to the CDC 4

Inhaled Medications for Respiratory Symptoms

• Inhaled bronchodilators (salbutamol or terbutaline) are compatible with breastfeeding and should be continued if needed for maternal respiratory stability 1
• Ipratropium bromide is the recommended inhaled anticholinergic for cough suppression in chronic bronchitis, per the American College of Chest Physicians 1

Critical Safety Principles

General Guidelines

• The benefits of treating maternal symptoms generally outweigh the theoretical risks of medication exposure through breast milk 1, 4, 5
• Breastfeeding is strongly recommended even when mothers require medication, as it provides important immune protection to infants 1, 4
• Take medications after breastfeeding and at the lowest effective dose for the shortest duration 2

Important Caveats

• Avoid combination cough and cold products that contain multiple unnecessary ingredients 2
• Many liquid cough products contain alcohol, which should be noted 2
• Watch for adverse events in breastfed infants, such as unusual symptoms, changes in feeding patterns, paradoxical CNS stimulation from antihistamines, or irritability and insomnia from decongestants 1, 4, 2

Medications That May Affect Milk Supply

• Pseudoephedrine and other decongestants may decrease milk supply in some women 2
• Atropine may inhibit lactation, though it is still compatible with breastfeeding 1

Essential Resource

• Consult LactMed (Drugs and Lactation Database) for the most comprehensive and current information on any specific cough medication ingredient 1, 6, 5