What OTC cold medicines are safe when breastfeeding?
May 3, 2024
Breastmilk is produced in a lactating mother’s mammary glands—highly specialized tissue that filters the blood taking out fats, carbohydrates, proteins, micronutrients, and bioactive substances to make milk. In addition, any medication a lactating mother takes by mouth will be filtered out of her bloodstream and transferred to her milk. This does not mean, however, these medications are unsafe. The quantities of drug that pass into breastmilk are often so small that there is no effect on the baby. Thus, many over-the-counter (OTC) medications are safe for lactating mothers, including the large majority of those used to treat the common cold. Some medications should be used with caution, however, as they have undesirable effects on milk production. Below are some common over-the-counter oral medications and what is known about their presence in breast milk. For more information or specific questions about other medications, please visit the Drugs and Lactation Database (LactMed®) at https://www.ncbi.nlm.nih.gov/books/NBK501922/ .
Acetaminophen (Tylenol): Acetaminophen is perhaps the most widely studied drug in lactating mothers and largely considered a good choice for fever and pain control. Multiple small studies show at most 2-3% of the drug is transferred to the infant with no adverse effect.
Pseudoephedrine (Sudafed): This medication is safe when transferred to infants in breast milk with no lasting effects, but mothers may notice their infant is more irritable than usual due to the stimulant effects. A single dose can decrease milk production, however, and repeated use continues to decrease milk supply over time. This medication should be used with caution in mothers establishing their milk supply or with low milk supply.
Ibuprofen: This medication is a preferred choice for pain and fever in lactating mothers. It is nearly undetectable in breast milk, with total doses for the infant between 0.2-0.3% of the mother’s dose.
Diphenhydramine (Benadryl): When taken in small doses and occasionally, this medication does not affect the infant. However, taking larger doses and/or using this medication for a long time is anecdotally found to cause colic symptoms and increased drowsiness in infants. It, like, pseudoephedrine, also has detrimental effects on milk supply. These effects have not been seen in other antihistamine medications such as Loratadine (Claritin), Fexofenadine (Allegra) and cetirizine (Zyrtec).
Dextromethorphan (Robitussin): The amount of this medication transferred to breastmilk is very low, even lower than ibuprofen—averaging 0.04% and 0.07%. It is safe to take while breastfeeding, though nursing mothers should use caution if their formulation contains alcohol.
Guaifenesin (Mucinex): This medication has not been studied in mother-infant dyads but is thought not to pose any significant risk due to the general low excretion of medications into breast milk. It is unknown whether it effects milk production.
References
- Shah R, Sabir S, Alhawaj AF. Physiology, Breast Milk. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539790/
- Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Acetaminophen. [Updated 2024 Feb 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501194/
- Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Pseudoephedrine. [Updated 2020 Apr 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501085/
- Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Ibuprofen. [Updated 2023 Nov 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500986/
- Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Diphenhydramine. [Updated 2021 Sep 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501878/
- Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Dextromethorphan. [Updated 2023 Dec 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501456/
- Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Guaifenesin. [Updated 2018 Oct 31]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501455/
Question of the week prepared by Elizabeth Ebbens, MD, 2nd Year Fellow, Pediatric Emergency Medicine
I am interested in any topics you would like answered in the Question of the Week. Please email me at donna.seger@vumc.org
Donna Seger MD Professor Emerita
Dept of Medicine
VUMC