The information below is compiled from LactMed, PubMed, and Infant Risk Center. Infant Risk Center was established by Dr. Thomas Hale, a world renowned clinical pharmacologist, leading expert in the use of medications during lactation, and author of Hale’s Medications and Mothers Milk, an essential reference manual for clinicians. The Infant Risk Center offers the most current, complete, and evidence-based information on the transmission of maternal drugs into human milk.
Breastfeeding While Sick
Can I breastfeed if I'm sick?
In most circumstances, it is highly recommended to continue breastfeeding as normal when you are sick.
Common illnesses such as cold, flu, diarrhea, fever, mastitis, and even COVID-19 cannot be passed to your baby through your breast milk. Actually, your breast milk protects your baby, since your body produces antibodies to environmental pathogens and passes them on through your breast milk.
This way, your baby can begin to build immunity to airborne germs in your environment.
What medications are safe?
*Important note: Not all drugs have been studied comprehensively in lactating people. This information is based on the most recent available research and is meant to serve as a guide for breastfeeding mothers. Always consult your healthcare provider before beginning any new medication.
There are many symptom relief products that are generally considered safe and approved for use in breastfeeding mothers. The two main things to consider when choosing what to take are 1) the effects on baby if the drug enters into your milk, and 2) the effects on your milk supply. Below, we will list some common ailments and the medications used to treat them, and the level of safety for use while breastfeeding.
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Pain/Fever:
- Ibuprofen (Advil/Motrin)
- secreted at extremely low levels in breast milk, generally considered safe
- max dose: 3200mg/day
- preferred alternative to Naproxen (Aleve)
- Acetaminophen (Tylenol)
- generally considered safe to use
- max dose: 4000mg/day
- use with caution if family history of asthma, as use in the first year of life has been linked to asthma development later on
- avoid Tylenol PM as it may cause drowsiness in baby
- Aspirin
- DO NOT USE without consulting your primary care provider first
Cough/Congestion/Allergy Symptoms:
- Nasal Sprays & Steroids (Afrin, Flonase, Nasacort)
- preferred to systemic decongestants
- virtually undetectable in the blood and breast milk, likely safest option
- Afrin should not be used for >3 days due to risk of rebound congestion
- Antihistamines
- antihistamines for allergies are generally considered safe to use, as minimal amounts are secreted in breast milk and do not cause adverse effects on babies
- Claritin, Zyrtec, Allegra are preferred over Benadryl or Chlor-phen
- Saline & Steam
- Saline rinses and steam treatments are appropriate for breastfeeding mothers, but not young infants
- Dextromethorphan (Robitussin DM or Delsym DM)
- preferred over Guaifenesin (Mucinex) since more effective for cough
- *monitor baby for drowsiness*
AVOID: Pseudoephedrine (Sudafed, Biofed,
Cenafed, Dimetapp Decongestant,
Claritin-D, Mucinex-D)
While generally considered safe for babies, there is evidence that decongestants can reduce milk production, especially in mothers who are breastfeeding older infants or those who already have lower milk production.
Flu:
- Oseltamivir (Tamiflu)
- generally considered safe for breastfeeding and preferred to zanamivir (Relenza) and Oscillococcinum. Baloxavir (Xofluza) is also likely safe
- Oscillococcinum
- homeopathic, there are no data in breastfeeding, but may be acceptable if well matched to the symptoms. Tamiflu is well studied and preferred.
OTC Medication
Dr Hale’s Lactation Risk Categories
Acetaminophen (Tylenol)
Dextromethorphan (Robitussin)
Ibuprofen (Advil, Motrin)
Loratidine (Claritin)
L1: SAFEST
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant.
Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.
Cetrizine (Zyrtec)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Guaifenesin (Mucinex)
Oseltamivir (Tamiflu)
L2: SAFER
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.
Aspirin
Pseudophedrine (Sudafed)
L3: MODERATELY SAFE
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.
L4: POSSIBLY HAZARDOUS
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective)
L5: CONTRAINDICATED
Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.
References:
https://www.infantrisk.com/content/over-counter-treatments-cough-and-cold
LactMed (Drugs & Lactation Database) https://www.ncbi.nlm.nih.gov/books/NBK501922/
Safety of Antihistamines During Pregnancy and Lactation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868610/
***The information provided on our website is intended solely for general educational and informational purposes only. It is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician for any questions you may have regarding your or your child’s medical condition. Never disregard professional medical advice or delay in seeking it because of something you have received in this information.***
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