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NSAIDs and breastfeeding

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • is very limited published information on the use of NSAIDs during breastfeeding; however ibuprofen (1,2) and diclofenac are the preferred choices due to their shorter half-lives and extensive use during breastfeeding in clinical practice (2)
    • noted that all other NSAIDs have longer half-lives and should be used with caution due to the potential risk of accumulation in the infant
    • mefenamic acid should be avoided during breastfeeding because it has been associated with side effects in adults such as haemolytic anaemia
      • is very limited published evidence of use and no information to confirm how much passes into breast milk.
        • low levels would be expected in breast milk given its pharmacokinetic properties
      • in adults, it has been associated with a higher incidence of diarrhoea than other NSAIDs, and haemolytic anaemia
    • if a cyclo-oxygenase-2 (COX-2) inhibitor is required, the preferred choice is celecoxib because negligible amounts transfer into breast milk

With respect to ibuprofen during breastfeeding (1)

  • ibuprofen is one of the painkillers of choice whilst breastfeeding

  • only very small amounts of ibuprofen pass into the breast milk, and these amounts are far below the doses that would normally be given to infants directly

  • the properties of ibuprofen are such that there is no risk of it building up in the infant’s system

  • there have been no side-effects reported in infants exposed to ibuprofen through breast milk

  • ibuprofen is widely available to purchase as an over-the counter medicine and is also found in some cold and flu remedies

  • this guidance also applies to ibuprofen formulated as the lysine salt

  • this guidance applies to infants born full term and healthy. If an infant is unwell, or premature, or the mother is taking multiple medicines, then an individual risk assessment will need to be made
  • infant monitoring
    • as a precaution, monitor infants for vomiting and diarrhoea (2)

With respect to the use of diclofenac during breastfeeding (2):

  • oral, rectal, and parenteral diclofenac preparations can be used during breastfeeding

  • is limited published evidence, there is extensive experience of use in breastfeeding

  • evidence shows negligible amounts pass into breast milk

  • no side effects have been reported in breastfed infants and the properties of diclofenac are such that there is minimal risk of it accumulating in the infant’s system

  • topical and ophthalmic diclofenac preparations can also be used during breastfeeding
    • negligible milk levels would be anticipated as systemic absorption from topical and ophthalmic formulations is low

  • infant monitoring
    • as a precaution, monitor infants for vomiting and diarrhoea

Reference:


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