Pain Meds While Breastfeeding

Updated on September 30, 2011
S.B. asks from Chicago, IL
7 answers

I just came from seeing a new primary care doctor for a physical. It's been awhile since I've been to the regular doctor, and I haven't seen my OB/GYN since my 6 week checkup after the birth of my son, because she no longer accepts my insurance, and I haven't taken the time to find a new one. Anyway, my knees have really been giving me a lot of trouble lately, as well as some pain in my lower back. The doctor doesn't think it's related to arthritis, and showed me some exercises I could do to strengthen the muscles around my knee. She also recommended taking ibuprofen regularly. I would have no problem doing this, except that I am concerned with heartburn caused by the ibuprofen. Also, I am still nursing my son, albeit very little (He drinks from a cup all day, but I let him nurse in the night and/or morning if he wants, or to soothe him if necessary), so I want to make sure whatever I take is not going to interfere with nursing. She wanted to prescribe Celebrex due to the heartburn issue, but held off because I am breastfeeding and the effects have not been researched well enough. I'd like to try the ibuprofen and see what happens in terms of the heartburn. I know ibuprofen is okay to take occasionally while nursing, I'm just not clear on if it's safe to be on a long term, daily regimen. My new doctor said to ask my OB/GYN for the proper dosage, but right now I don't have one. Anyone have any insight? By the way, my son is 23 months old.

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P.G.

answers from Dallas on

When in doubt, contact a lactation consultant. They usually know more about what medications are safe during nursing than doctors do. :)

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S.C.

answers from Des Moines on

The National Institutes of Health's Lact Med Databse is the BEST source of breastfeeding/medication information. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

It works best if you put in the generic name (ibuprofen instead of Advil) and it can be written in medicalese, but it's always my go to!
Here's what it says about ibuprofen:

Ibuprofen
CASRN: 15687-27-1
For other data, click on the Table of Contents

Drug Levels and Effects:

Summary of Use during Lactation:
Because of its extremely low levels in breastmilk, short half-life and use in infants in doses much higher than those excreted in breastmilk, ibuprofen is a preferred choice as an analgesic or antiinflammatory agent in nursing mothers.

Drug Levels:
Maternal Levels. Two early studies attempted measurement of ibuprofen in milk. In one, the patient's dose was 400 mg twice daily, while in the second study of 12 patients, the dose was 400 mg every 6 hours. Ibuprofen was undetectable in breastmilk in both studies (<0.5 and 1 mg/L, respectively).[1][2]

A later study using a more sensitive assay found ibuprofen in the breastmilk of one woman who took 6 doses of 400 mg orally over a 42.5 hours. A milk ibuprofen level of 13 mcg/L was detected 30 minutes after the first dose. The highest level measured was 180 mcg/L about 4 hours after the third dose, 20.5 hours after the first dose. The authors estimated that the infant would receive about 17 mcg/kg daily (100 mcg daily) with the maternal dose of approximately 1.2 grams daily. This dose represents 0.0008% of the maternal weight-adjusted dosage[3] and 0.06% of the commonly accepted infant dose of 30 mg/kg daily (10 mg/kg every 8 hours).

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants:
At least 23 cases are reported in the literature in which infants (ages not stated) were breastfed during maternal ibuprofen use with no adverse effects reported.[1][3][4]

Possible Effects on Lactation:
Relevant published information was not found as of the revision date.

Alternate Drugs to Consider:
Acetaminophen, Flurbiprofen, Indomethacin, Naproxen, Piroxicam

References:
1. Weibert RT, Townsend RJ, Kaiser DG et al. Lack of ibuprofen secretion into human milk. Clin Pharm. 1982;1:457-8. PMID: ###-###-####
2. Townsend RJ, Benedetti TJ, Erickson SH et al. Excretion of ibuprofen into breast milk. Am J Obstet Gynecol. 1984;149:184-6. PMID: ###-###-####
3. Walter K, Dilger C. Ibuprofen in human milk. Br J Clin Pharmacol. 1997;44:211-2. PMID: ###-###-####
4. Ito S, Blajchman A, Stephenson M. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: ###-###-####

Substance Identification:

Substance Name: Ibuprofen

CAS Registry Number: 15687-27-1

Drug Class:
Analgesic Agents
Nonsteroidal Antiinflammatory Agents

Administrative Information:

LactMed Record Number:
142

Last Revision Date:
20101207
Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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A.V.

answers from Washington DC on

I took a little bit of tylenol when my DD was first born for all the aches and pains I had. Since your son is 23 months old, I would take as little as I needed to until he was weaned but not refrain altogether.

Your local lactation center can tell you more and I think Kellymom.com has links to meds and effects on nursing/nurslings.

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M.L.

answers from Houston on

I would call your obgyn anyways. They can answer a question like that over the phone.

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D.B.

answers from Charlotte on

.

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P.O.

answers from Tampa on

Medications and Mother's Milk by Dr T. Hale 2008 Edition

Ibuprofen = L1 the safest to take
Celebrex = L2 still safe

I took both of these while I was nursing... no issues
I think you should start with Motrin and if the 800mg does 3-4 times a day doesn't help, then ask for the Celebrex.

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E.A.

answers from Atlanta on

S.'s answer was great. I'd also recommend calling your son's pediatrician and seeing what they say.

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