Is etoricoxib (a non-steroidal anti-inflammatory drug (NSAID)) safe for a healthy lactating woman to use during breastfeeding?

Etoricoxib Should Be Avoided During Breastfeeding

Etoricoxib should not be used during breastfeeding due to insufficient safety data, and safer NSAID alternatives with established safety profiles should be prescribed instead. 1

Guideline-Based Recommendation

The 2025 EULAR recommendations explicitly state that etoricoxib should be avoided in breastfeeding women due to insufficient data rather than evidence of infant harm. 1 This represents the most current, high-quality guideline evidence available and should direct clinical decision-making.

Safer NSAID Alternatives with Established Safety

The Association of Anaesthetists 2020 guideline identifies multiple NSAIDs with proven safety during lactation that should be used instead: 1

First-Line Options:

• Ibuprofen is the preferred choice, extensively studied and considered safe during breastfeeding with the most reassuring safety data available. 1, 2
• Paracetamol (acetaminophen) is also safe, with infant ingestion via breast milk significantly less than pediatric therapeutic doses. 1

Second-Line Options:

• Diclofenac has small amounts detected in breast milk but extensive use during lactation confirms safety. 1, 2
• Naproxen is widely used after caesarean section despite its longer half-life, with normal breastfeeding continuation. 1, 2

COX-2 Inhibitor Alternative:

• Celecoxib (a COX-2 inhibitor like etoricoxib) has very low relative infant dose via milk and is explicitly compatible with breastfeeding. 1, 2 This represents the safest alternative if COX-2 selectivity is specifically desired.

Short-Term Intensive Analgesia:

• Ketorolac and parecoxib show low levels in breast milk without demonstrable neonatal adverse effects and are compatible with breastfeeding. 1, 2

Clinical Decision Algorithm

1. For routine pain/inflammation: Prescribe ibuprofen as first-line (lowest effective dose, shortest duration). 1, 2

2. If ibuprofen inadequate: Switch to diclofenac or naproxen as second-line options. 1, 2

3. If COX-2 selectivity needed: Use celecoxib instead of etoricoxib—it has established breastfeeding safety. 1, 2

4. For multimodal analgesia: Combine NSAIDs with paracetamol to reduce total NSAID exposure. 1

5. Avoid opioids when possible: NSAIDs are preferred over opioids due to risks of infant sedation and respiratory depression. 1

Common Pitfalls to Avoid

• Do not unnecessarily discontinue breastfeeding: The benefits of continued breastfeeding outweigh theoretical minimal drug exposure risks with safe NSAIDs. 1

• Do not recommend "pump and dump": This is not evidence-based for NSAID use and should not be advised. 1

• Do not default to opioids: They carry significantly higher risks of infant adverse effects compared to NSAIDs. 1

• Do not use aspirin in analgesic doses: Only low-dose aspirin (≤100 mg/day) for antiplatelet action is acceptable if strongly indicated. 1

Special Monitoring Considerations

For infants under 6 weeks of age, extra caution is warranted due to immature hepatic and renal function, though the recommended safe NSAIDs remain appropriate even in this population. 1 Observe infants for unusual behavioral changes, though adverse effects with NSAIDs are extremely rare compared to opioids. 1