What Pain Medication Is Safe While Breastfeeding?

Physical pain is something that can occur in the body anytime, to anyone, for any number of reasons. Breastfeeding mothers are no exception.

In fact, new tasks a mother undertakes when caring for her baby may increase her chance of experiencing pain. This may be due to poor posture while feeding, staying in the one position for a long time, or fatigue or general stresses that can make muscles tighten up.

A breastfeeding mother who has pain may wonder if it is safe for her to take any pain medication (analgesics) while breastfeeding.

What Pain Medication Is Safe While Breastfeeding?

According to Mr Rodney Whyte, Senior Pharmacist at Monash Medicines Information (in Victoria, Australia), says “There are a variety of analgesics that breastfeeding mothers can safely use while breastfeeding.”

What pain relief is chosen largely depends on the type of pain the mother has. For example, short term pain (e.g. a headache, a simple cold or a toothache) would likely require short term painkiller use. Whereas if the mother has chronic pain (e.g. ongoing pain such as due to a car accident many years ago), this may require continued use.

Mr Whyte says: “There are a number of analgesics that must be used with great caution, and there are some that should be avoided under certain circumstances. Many factors determine their suitability or otherwise.”

For example, some of the factors that need to be taken into account when choosing an appropriate pain medication include:

• The baby’s age. “Normally, if a baby is over 3 months of age, any issues are less significant”, says Mr Whyte.
• If the baby has any medical concerns (e.g. prematurity)
• If the mother has any medical concerns (e.g. kidney or blood pressure problems, asthma etc.)

Mr Whyte advises, “It’s important to tailor the right analgesic depending on the type of pain and the circumstances.”

Pain Medication and Breastfeeding

Here is some information about 5 commonly-prescribed pain medications for breastfeeding mothers:

#1: Paracetamol and breastfeeding

According to LACTMED, paracetamol ‘is a good choice for analgesia, and fever reduction in nursing mothers. Amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare.’

#2: Ibuprofen and breastfeeding

According to LACTMED, ‘Because of its extremely low levels in breastmilk, short half-life and safe use in infants in doses much higher than those excreted in breastmilk, ibuprofen is a preferred choice as an analgesic or anti-inflammatory agent in nursing mothers.’

Mr Whyte says: “Both paracetamol and ibuprofen are considered safe and effective for aches, pain and fever for breastfeeding women and may be used in (normal) recommended doses (unless otherwise advised).”

#3: Diclofenac and breastfeeding

Diclofenac is a drug known as Voltaren. In the US, it’s also known as Cataflam and Zipsor. According to LACTMED, ‘Data on excretion of diclofenac into milk are poor. Most reviewers consider diclofenac to be acceptable during breastfeeding. Other agents having more published information may be preferred, especially while nursing a newborn or preterm infant.’

#4: Codeine and breastfeeding

According to LACTMED, ‘The American Academy of Pediatrics recommends that other agents are preferred over codeine during breastfeeding. Both the European Medicines Agency and the UK’s Medicines and Healthcare Products Regulatory Agency recommend that codeine not be used in nursing mothers.”

It is important to remember that chronic use of a medication is very different to a single use. As Mr Whyte says: “It would be very rare for there to be a problem with a single dose such as for a migraine headache or toothache. However, if used regularly, there can be problems in a certain patient population. If more than one dose in needed, expert advice should be sought.”

#5: Asprin and breastfeeding

According to LACTMED, aspirin is not typically a preferred option for pain relief for a breastfeeding mother, especially long term high-doses. This is because of the potential (likely low) risk of Reye’s syndrome which is a rare but serious condition that causes swelling in the liver and brain. Reye’s syndrome most commonly affects children and teenagers recovering from a viral infection. The other concern with the use of aspirin is bleeding.

The Verdict…

Mr Whyte’s advice for breastfeeding mothers is that it’s best to “stick with paracetamol and ibuprofen to full therapeutic doses (unless otherwise advised)”. For other pain relief or medication, expert advice should be sought.