Diclofenac is NOT Contraindicated During Breastfeeding
Diclofenac is explicitly compatible with breastfeeding and does not require interruption of nursing or expressing and discarding breast milk. 1
Guideline-Based Safety Profile
Multiple authoritative guidelines confirm diclofenac's safety during lactation:
The Association of Anaesthetists (2020) recommends diclofenac as an analgesic compatible with breastfeeding, listing it among NSAIDs that pose no risk to the nursing infant. 1
The European League Against Rheumatism (EULAR) 2025 recommendations rank diclofenac as the second safest NSAID option after ibuprofen for lactating women, with reassuring safety data. 2, 1
The Association of Anaesthetists specifically states that diclofenac is the second choice NSAID if ibuprofen is contraindicated or ineffective, confirming its established compatibility during breastfeeding. 2
FDA Drug Label Information
The FDA label for diclofenac states that "based on available data, diclofenac may be present in human milk," but does not contraindicate its use during breastfeeding. 3 The label emphasizes that "the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for diclofenac." 3
Pharmacological Evidence Supporting Safety
Diclofenac demonstrates minimal mammary transfer with a milk-to-plasma drug concentration ratio of only 0.093, meaning very little drug reaches breast milk compared to maternal blood levels. 4
The AUC in breast milk was only 0.021 ng/mL.h compared to 0.227 ng/mL.h in plasma, confirming low excretion into breast milk. 4
No need to express and discard breast milk after using diclofenac, and breastfeeding can continue immediately after administration. 1
Clinical Recommendations for Use
Use the lowest effective dose for the shortest duration needed, as recommended by the Association of Anaesthetists for all analgesics during lactation. 1
Multimodal analgesia combining diclofenac with paracetamol is encouraged to minimize the need for opioid medications, which carry significantly higher risks of infant sedation and respiratory depression. 2, 1
Special Considerations
Exercise additional caution in infants under 6 weeks of age (corrected for gestational age) due to immature hepatic and renal function, though this caution applies more significantly to opioids than to NSAIDs like diclofenac. 1
Monitor the infant for any unusual changes in behavior, although adverse effects with diclofenac are extremely rare. 1
Diclofenac allows mothers to maintain their ability to care for the baby without sedation concerns that accompany opioid use. 1
Alternative Safe Options
If diclofenac is not suitable, ibuprofen is considered the first-line NSAID choice with the most extensive safety data, followed by diclofenac as the second choice. 2, 1 Paracetamol (acetaminophen) is also a safe alternative compatible with breastfeeding. 2, 1