Cold Remedies and Breastfeeding

11.18.2010

Many breastfeeding mothers often question the safety of cough and cold remedies while breastfeeding.  Although there are many products out on the market, the active ingredients in most cough and cold formulations are the same and include the following:

Acetaminophen: Acetaminophen is compatible with breastfeeding as only small amounts are secreted into breastmilk.  Do not exceed 4grams/day.  Common Trade Name: Tylenol.

Ibuprofen:  Ibuprofen is the preferred analgesic in breastfeeding mothers as only small amounts get into milk (0.6% of maternal dose). Common Trade Names: Advil, Nuprin, and Motrin.

Guaifenecin:  This is an expectorant used to loosen respiratory tract secretions.  It does not suppress cough.  The poor efficacy of expectorants in general would suggest that they do not provide enough justification for use in breastfeeding mothers.  However, untoward effects to the infants have not been described. Common Trade Names: Robitussin, Mucinex

Dextromethorphan: This is an antitussive/cough preparation that appears to work by elevating the cough threshold in the brain.  It is the safest of the antitussives and unlikely to transfer into milk.  Watch for drowsiness.  Common Trade Names: DM, Benylin, Delsym, Robitussin DM.

Pseudoephedrine: Pseudoehpedrine is an adrenergic compound used as a nasal decongestant (It is not an antihistamine). It is excreted into breastmilk in low levels, however, caution should be used with this product as it can reduce milk production in mothers in late stage lactation (mothers breastfeeding infants >8 months). It may have increased toxicity when used with Monoamine Oxidase Inhibitors (MAOI's).  Common Trade Name: Sudafed.

Diphenhydramine:  Diphenhydramine is an antihistamine that is often used in cough, cold, and sinus formulations.  Small levels are thought to be secreted into milk.  Although the levels are low in breastmilk, this medication can cause sedation and therefore is not ideal in breastfeeding mothers.  Non-sedating antihistamines are generally preferred.  These include Cetirizine (Zyrtec), Loratidine (Claritin), and Fexofenadine (Allegra).  It has been said that Diphenhydramine can affect milk production, we do not support this belief.  Other sedating antihistamines that should be used with caution are Chlorpheneramine and Brompheneramine.

Phenylephrine: Phenylephrine is a decongestant that is commonly added to cold mixtures and nasal sprays for use in colds, flu, and congestion.  Levels in milk have not been reported, however, it is poorly orally absorbed.  Similar to pseudoephedrine, there are concerns that this drug can decrease milk production especially in late lactating mothers.  Common Trade Names: Neofrin, Vicks Sinex Nasal.

For more information on the use of Cough and Cold Medications in Pregnant or Breastfeeding Mothers, call The InfantRisk Center at (806)352-2519 and one of our counselors will be able to tell you which medication is right for you.