What over‑the‑counter cough medications are safe for a breastfeeding mother to use?

Safe Cough Medications for Breastfeeding Mothers

For breastfeeding mothers with acute cough, dextromethorphan is the preferred over-the-counter antitussive, while simple home remedies like honey and lemon represent the safest first-line approach, and pseudoephedrine with triprolidine are the recommended choices when decongestant/antihistamine combinations are needed. 1

First-Line Approach: Non-Pharmacologic Options

Start with home remedies before considering medications:

• Honey and lemon mixtures are recommended as the simplest, cheapest, and safest initial treatment for acute viral cough 2, 1
• Simple voluntary cough suppression through central modulation may be sufficient to reduce cough frequency 2, 1
• These approaches avoid any medication exposure to the infant while providing symptomatic relief 1

Safe Over-the-Counter Medications

Preferred Antitussive: Dextromethorphan

Dextromethorphan is the antitussive of choice for breastfeeding mothers:

• It has been shown to suppress acute cough in meta-analysis with a favorable safety profile 2, 1
• Low levels reach the breastfed infant, making it compatible with breastfeeding 3
• Maximum cough suppression occurs at 60 mg and can be prolonged 2, 1
• Important caveat: Check combination products carefully, as higher doses may include other ingredients like paracetamol that could affect total medication exposure 2

Decongestant/Antihistamine Combinations

When nasal congestion accompanies cough:

• Pseudoephedrine and triprolidine are the first-line choices as they are considered compatible with breastfeeding by the American Academy of Pediatrics 1, 3
• Low levels of each drug reach the breastfed infant 3
• First-generation sedating antihistamines may be suitable specifically for nocturnal cough but cause drowsiness 2, 1

Alternative Options

Menthol inhalation:

• Suppresses the cough reflex acutely but effect is short-lived 2, 1
• Safe option for immediate but temporary relief 1

Codeine for short-term use:

• Considered compatible with breastfeeding by the American Academy of Pediatrics for short-term cough suppression 1, 3
• Acceptable for chronic bronchitis when short-term symptomatic relief is needed 2
• Should be used at the lowest effective dose for the shortest duration 3

Critical Safety Principles

Timing and dosing strategies to minimize infant exposure:

• Take medications immediately after breastfeeding to allow maximum time before the next feeding 3
• Use the lowest effective dose for the shortest duration necessary 3, 4
• The benefits of treating maternal symptoms generally outweigh theoretical risks of medication exposure through breast milk 1
• Breastfeeding should continue even when mothers require medication, as it provides important immune protection to infants 1

Important Caveats and Pitfalls

Avoid combination products:

• Many liquid cough and cold products contain alcohol, which should be avoided 3
• Combination products often mix antihistamines with decongestants and may contain aspirin, acetaminophen, ibuprofen, or caffeine 3
• It is preferable to take only necessary single-ingredient medications rather than combination products 3
• Aspirin has been associated with significant negative effects in some nursing infants and should be given with caution 3

Monitor for adverse effects in the infant:

• Watch for paradoxical central nervous system stimulation from antihistamines (nervousness, insomnia, hyperactivity) 2, 3
• Monitor for irritability and insomnia from decongestants 3
• Observe for gastrointestinal symptoms, which occurred in 12% of infants whose mothers took honey-based preparations 5

Medications NOT recommended:

• Codeine and pholcodine have no greater efficacy than dextromethorphan but carry a much greater adverse side effect profile 2
• Over-the-counter combination cold medications (except older antihistamine-decongestant combinations) lack evidence of effectiveness 2

When to Consult Additional Resources

For specific product questions:

• Consult LactMed (Drugs and Lactation Database) for the most current and comprehensive information on any specific cough syrup ingredient 1
• This is the most reliable resource for medication safety during breastfeeding 1

When antibiotics are needed:

• Penicillins and cephalosporins are the safest antibiotic classes for bacterial respiratory infections during lactation 1, 6
• Amoxicillin/clavulanic acid is compatible with breastfeeding when bacterial infection is present 1