Can a breast-feeding patient take Robitussin DM (dextromethorphan and guaifenesin) and time it to minimize the amount of medication that enters the breast milk?

Robitussin DM During Breastfeeding

Dextromethorphan (the active cough suppressant in Robitussin DM) is safe during breastfeeding and does not require timing strategies, pumping beforehand, or discarding breast milk. 1

Safety Profile of Robitussin DM Components

Dextromethorphan (Antitussive)

• Dextromethorphan is the antitussive of choice for breastfeeding mothers with a favorable safety profile and is recommended as first-line treatment for acute cough 1
• The medication enters breast milk in minimal amounts that pose no significant risk to nursing infants 2, 3
• Maximum cough suppression occurs at 60 mg doses and can be prolonged, allowing effective symptom control 1

Guaifenesin (Expectorant)

• Guaifenesin, the other component of Robitussin DM, also has minimal transfer into breast milk 4
• No adverse effects have been documented in breastfed infants exposed to guaifenesin 4

Timing Strategies Are Not Necessary

The evidence does not support pump-and-dump or timing strategies for medications like dextromethorphan that are compatible with breastfeeding. 5

• The consensus from inflammatory bowel disease guidelines (which examined timing strategies for various medications) found little evidence to support suggestions to discard breast milk or avoid breastfeeding within 4 hours of medication ingestion for drugs with low breast milk transfer 6
• General principles indicate that when medications are compatible with breastfeeding, the benefits of continuous breastfeeding outweigh theoretical risks of minimal medication exposure 2, 4

Practical Recommendations

Optimal Dosing Approach

• If the patient wishes to minimize any theoretical exposure, take the medication immediately after breastfeeding rather than before, as this allows maximum time for drug clearance before the next feeding 2, 4
• Use the lowest effective dose for the shortest duration needed to control symptoms 4

What to Monitor

• Watch for any unusual symptoms in the infant such as excessive drowsiness, irritability, or changes in feeding patterns 4
• These adverse effects are extremely rare with dextromethorphan but mothers should remain observant 4

Common Pitfalls to Avoid

• Do not advise expressing and discarding breast milk - this practice is illogical and risks breast engorgement, blocked ducts, and potential mastitis 7
• Do not interrupt breastfeeding - maintaining regular breastfeeding provides important immune protection to the infant and prevents maternal breast complications 7, 2
• Avoid combination cough products containing aspirin, as aspirin has been associated with negative effects in nursing infants 4
• Check alcohol content in liquid formulations, though alcohol itself is considered compatible with breastfeeding in small amounts 4

Additional Resources

For the most current and comprehensive safety information on any specific medication during breastfeeding, consult LactMed (Drugs and Lactation Database), a free, authoritative government resource available online 2, 5