What painkillers are safe to take when I’m breastfeeding?

If you're breastfeeding your baby and need pain relief – for a headache, say – is it OK to have over-the-counter pills which contain either ibuprofen or paracetamol? Or could they harm your baby? We explain the official guidelines and get expert advice from family GP Dr Philippa Kaye

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In a nutshell: Paracetamol is generally considered safe to take as a painkiller when you are breastfeeding1, as is ibuprofen2 – although you may want to check with your doctor first if your baby was born prematurely or has a specific medical condition. It’s not recommended to take aspirin or codeine when you are breastfeeding1,2  – and you should always check with your doctor first if you’re thinking of taking any other pain-relieving medication.

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If you take paracetamol or ibuprofen, the drug will pass into your breastmilk but in such tiny quantities, say experts, that neither are likely to harm your baby.1,2 That said, if you’re taking either painkiller, it is wise to take it for the shortest time possible and to stick carefully to the recommended dose on the packet. As our expert family GP Dr Philippa Kaye says:

With both paracetamol and ibuprofen, you do need to make sure you don’t take more than the stated dose in any 24-hour period
Dr Philippa Kaye, family GP

Can I take paracetamol if I’m breastfeeding?

Yes1. In fact, says Gail Johnson, Midwife Educator for the Royal College of Midwives, it’s considered the ‘main’ painkiller for breastfeeding mothers.

Do be careful, though, to check the packet to make sure it’s ‘straight’ paracetamol, not paracetamol combined with codeine (often called co-codamol or Solpadeine). Codeine is not suitable to take when you’re breastfeeding.1

You should also get advice from your health visitor, midwife or doctor before taking paracetamol if your breastfeeding baby:

  • was born prematurely
  • had a low birthweight
  • has a medical condition1

It’s worth noting, says Dr Philippa, that some paracetamol tablets also include caffeine (to help deliver the pain relief better3) and it’s good to avoid these ones, if you can. “If you drink coffee or tea, you are already delivering small amounts of caffeine to your baby,” she says. “These small amounts are unlikely to do your baby any harm but, since paracetamol without caffeine will still work, it’s an easy way to avoid extra amounts of caffeine getting into your breastmilk.”

And do remember, adds Dr Philippa, that your maximum dose for paracetamol is 2 500mg tablets, 4 times in 24 hours.

Can I take ibuprofen if I’m breastfeeding?

Yes2 – although the same caution applies here as it would if you weren’t breastfeeding, meaning you should check with your GP first if you have:

  • a stomach ulcer
  • asthma that gets worse if you take ibuprofen
  • liver or kidney problems
  • heart disease
  • Crohn’s disease
  • a health condition that puts you at increased risk of bleeding
  • chickenpox or shingles2

And, as with paracetamol, you should get advice from your health visitor, midwife or doctor before taking ibuprofen if your breastfeeding baby:

  • was born prematurely
  • had a low birthweight
  • has a medical condition4

Confusingly, although the NHS’ Specialist Pharmacy Service calls ibuprofen “one of the analgesics [painkillers] of choice in breastfeeding mothers”4, the instructions on some ibuprofen packets and/or on some of the leaflets inside,  advise you to avoid taking it while breastfeeding or to seek medical advice before you do.

Added to that, currently even the NHS advice online is a bit confused: with 1 page saying ibuprofen is safe to take while breastfeeding and another saying you should check with your doctor first.

Dr Philippa says she can’t see a reason why you shouldn’t take ibuprofen when you’re breastfeeding – unless you have  asthma or a stomach ulcer. “The amount in breastmilk is too small to be harmful but some manufacturers do say to avoid it,” says Philippa. “Perhaps they’re being super-cautious; my recommendation is that it is safe to take unless you have a known medical reason no to.”

Your maximum dose for ibuprofen is 2 200mg tablets 3 times a day, with 6 hours in between doses.

Can I take aspirin if I’m breastfeeding?

No. “It is recommended that you avoid aspirin during breastfeeding,” says Dr Philippa. This is because small amounts of aspirin may pass into your breastmilk. “And,” says Dr Philippa, “aspirin should be avoided by children until the age of 16, due to the risk of a condition called Reye’s syndrome.”

What about other painkillers?

Dr Philippa strongly recommends that, if you’re thinking of taking any medication other than paracetamol or ibuprofen while breastfeeding, you absolutely should ask your doctor about it first.

References:

1. Can I take paracetamol while I am breastfeeding? NHS Online
2. Can I take ibuprofen while I am breastfeeding? NHS Online
3. Caffeine as an analgesis adjuvant for acute pain in adults. Derry CJ et al. Cochrane, 11 December 2014
4. Can breastfeeding mothers take ibuprofen? Prepared by UK Medicines Information, 24 July 2015

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About our expert GP Philippa Kaye

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.

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