Breastfeeding mothers with cold or flu symptoms often face a dilemma regarding medication. Careful consideration is needed to ensure both maternal well-being and infant safety. Informed choices about medication use during lactation minimize potential risks to the baby and help maintain milk supply.
How Medications Affect Breast Milk
Medications transfer into breast milk primarily through passive diffusion, moving from the mother’s blood to breast milk. Several factors influence this transfer. Molecular weight plays a role; larger molecules, such as insulin and heparin, do not readily transfer.
Lipid solubility, or a drug’s ability to dissolve in fats, is another factor. Highly lipid-soluble drugs tend to concentrate more in breast milk, as milk contains more lipids than plasma. Conversely, drugs with high maternal protein binding are less likely to transfer into milk, as the bound fraction remains in the mother’s plasma. Infant age and health status also influence exposure impact, with premature babies, newborns, and those with kidney issues at higher risk due to less developed drug metabolism.
Cold and Flu Medications to Use with Caution
Some cold and flu medication ingredients warrant caution or avoidance for breastfeeding mothers due to potential effects on the infant or milk supply. Oral decongestants like pseudoephedrine and phenylephrine are generally not recommended. These can significantly reduce milk supply, with a single dose of pseudoephedrine potentially decreasing production by about 24% over 24 hours. Low levels of pseudoephedrine are excreted into breast milk, with anecdotal reports of infant irritability.
Some antihistamines, particularly sedating ones like diphenhydramine, should be used with care. Though small amounts pass into breast milk, larger or prolonged doses may cause infant drowsiness or decrease milk supply, especially if lactation is not well established. While ibuprofen is generally safe at standard doses, prolonged use or higher doses of NSAIDs, particularly naproxen, may be less preferred. Aspirin is generally avoided while breastfeeding due to its possible link to Reye’s syndrome in children, particularly if the child has a viral infection or fever.
Opioid pain relievers, such as codeine, pose a significant risk and are generally not recommended for breastfeeding mothers. Codeine is metabolized into morphine, and some mothers are “ultra-rapid metabolizers,” leading to dangerously high levels of morphine in breast milk. This can cause severe infant drowsiness, difficulty breastfeeding, and serious breathing problems, including rare but fatal central nervous system depression. Given these risks, many professional organizations advise against codeine use during breastfeeding.
Safe Relief Strategies for Breastfeeding Mothers
Several generally safe options exist for breastfeeding mothers to alleviate cold and flu symptoms. For pain and fever, acetaminophen is a good choice, with very small amounts transferring into breast milk and rare infant adverse effects. Ibuprofen, another NSAID, is also widely recommended as a first-choice anti-inflammatory; only tiny amounts enter breast milk, and it is unlikely to cause infant side effects at normal adult doses.
For coughs, dextromethorphan is generally safe, with very low amounts found in breast milk. Guaifenesin, an expectorant, is also considered safe; normal maternal doses are unlikely to harm the infant, particularly those over two months of age. For nasal congestion, saline nasal sprays or drops are safe, effective alternatives to oral decongestants, with very little absorbed or passed into breast milk.
Beyond medications, non-pharmacological remedies can provide significant relief:
Staying well-hydrated by drinking plenty of fluids like water, herbal teas, or warm broths helps thin mucus and soothe sore throats.
Rest is important for immune system recovery.
Steam inhalation, from a bowl of hot water or a steamy shower, can help clear nasal congestion and moisturize dry sinuses.
Throat lozenges, pastilles, and salt water gargles are also generally safe and effective for soothing sore throats.
Consulting Your Healthcare Provider
Seeking personalized medical advice from a healthcare provider, such as a doctor, lactation consultant, or pharmacist, is important for breastfeeding mothers considering cold and flu medications. These professionals can assess individual health conditions, the infant’s age and health status, and potential drug interactions, providing tailored guidance.
Always inform your doctor that you are breastfeeding before any medication is prescribed. This ensures the chosen treatment is appropriate for your specific situation and minimizes risks to your baby.